Governing partnerships with technology companies as part of the COVID-19 response in Canada: A qualitative case study

Cross-sector partnerships are vital for maintaining resilient health systems; however, few studies have sought to empirically assess the barriers and enablers of effective and responsible partnerships during public health emergencies. Through a qualitative, multiple case study, we analyzed 210 documents and conducted 26 interviews with stakeholders in three real-world partnerships between Canadian health organizations and private technology startups during the COVID-19 pandemic. The three partnerships involved: 1) deploying a virtual care platform to care for COVID-19 patients at one hospital, 2) deploying a secure messaging platform for physicians at another hospital, and 3) using data science to support a public health organization. Our results demonstrate that a public health emergency created time and resource pressures throughout a partnership. Given these constraints, early and sustained alignment on the core problem was critical for success. Moreover, governance processes designed for normal operations, such as procurement, were triaged and streamlined. Social learning, or the process of learning from observing others, offset some time and resource pressures. Social learning took many forms ranging from informal conversations between individuals at peer organisations (e.g., hospital chief information officers) to standing meetings at the local university’s city-wide COVID-19 response table. We also found that startups’ flexibility and understanding of the local context enabled them to play a highly valuable role in emergency response. However, pandemic fueled “hypergrowth” created risks for startups, such as introducing opportunities for deviation away from their core value proposition. Finally, we found each partnership navigated intense workloads, burnout, and personnel turnover through the pandemic. Strong partnerships required healthy, motivated teams. Visibility into and engagement in partnership governance, belief in partnership impact, and strong emotional intelligence in managers promoted team well-being. Taken together, these findings can help to bridge the theory-to-practice gap and guide effective cross-sector partnerships during public health emergencies.Author summary: Digital technologies have played a unprecedented role in emergency response during the COVID-19 pandemic. Partnerships between private sector technology companies and health institutions, such as hospitals and public health organizations, are often necessary to develop and deploy digital technologies. Here, we sought to understand the barriers and enablers to forming effective and responsible cross-sector partnerships during a public health emergency—with a focus on the role of startups. The firms we studied triaged and streamlined various governance processes (e.g., stakeholder assessment, contracting, procurement) in response to COVID-19’s time and resource pressures. Informants articulated the paramount importance of achieving early and sustained alignment on the core problem to be solved and how governance structures (e.g., connections between team members at different levels of seniority) facilitated this alignment. Flexibility and deep knowledge of the local operating context provided startups with an immense competitive advantage. Key areas for improving partnerships include: knowledge translation to promote the uptake of governance frameworks among decision-makers, accelerating public sector procurement processes that are too long and complex to be financially viable for startups, and developing pragmatic, public engagement strategies to build trust and promote social acceptability.