Which Inter-Organisational Characteristics Supported More Effective Implementation of a New Zealand Falls and Fractures Prevention Programme? Applying and Adapting the Context and Capabilities for Integrated Care Framework.

Introduction: Why do integrated care programmes succeed in some settings but not others, even when national leadership and funding are aligned? This persistent question shaped our examination of the New Zealand Falls and Fracture Prevention Programme (FFPP), a complex, cross-sector initiative targeting older adults. We applied and extended the Context and Capabilities for Integrating Care (CCIC) framework to explore how organisational and inter-organisational factors contributed to variation in implementation and outcomes. Method: We conducted a qualitative comparative case study of four large districts with differences in FFPP implementation including 28 semi-structured interviews. Thematic analysis was primarily deductive, using the CCIC framework, but remained open to emergent, context-specific themes. Results: We identified 43 organisational and implementation factors, of which five had a particularly important effect on FFPP implementation and outcomes: a well-structured governance team, collaborative leadership, engagement with primary care and private organisations, positive prior collaboration experience, and applying a population-based approach. We modified the CCIC framework to more fully reflect our observations by adding prior collaboration experience and a life-cycle approach (from pre-engagement to establishment). Conclusion: The CCIC framework captured most key organisational dynamics but was enhanced by incorporating temporal and historical dimensions of collaboration.