In your community, do block groups, farmer’s markets, city planners, community clinics, emergency services, and departments of health work elbow-to-elbow, or do they act in organizational silos? Improving population health was an important aspect of the Affordable Care Act, which led to the emergence of new community-based strategies that were launched in part from the public health campaign. In fact, efforts in several communities, including improvements to the built environment will be the focus of an upcoming PBS series hosted by Dr. Richard Jackson (http://dhc.mediapolicycenter.org/).
Community preventive services are growing in number (1, 2). Evaluating the progress of these efforts that often tackle such complex and challenging public health epidemics such as obesity can require years to see improvements in personal health outcomes. Increasingly recognized for their potential to improve human health and reduce health disparities, these approaches have not always delivered on expectations because the anticipated changes to systems, environments, or behaviors do not occur as planned. New evaluation models, focused on change in structures and processes at the community or system level rather than on “state changes” in individuals, are emerging. Partnerships among organizations working at various socio-ecologic levels have been identified as key elements in achieving comprehensive systems change and achieving population health goals. Shortell at al. (3) have categorized six factors affecting the success of these community interventions with respect to organizational partnerships. What do we really know about how to mobilize and sustain successful community interventions through partnerships?
We were interested in how Shortell’s model materializes in real community efforts, populated by overworked, red-eyed volunteers. What specifically about partnerships is important in mobilizing and sustaining positive change? Studying coalitions, direct service providers, a national professional association, and national advocacy organizations we explored how partnerships were used to address complex health issues at local, regional, and national levels. We developed case studies focusing on these efforts, forming our view of success factors for strong, sustained organizational partnerships.
What do we know about sustaining partnerships?
- A successful partnership is like a successful marriage, depending on both chemistry and common values. Whether or not these factors are in place will determine the partnership’s ability to sustain itself over time and align interests when seeking change in policy or processes. Coalition staff members may vet requests for membership to make sure the organizations’ missions are aligned and potential endeavors are within the scope and mission of the overall effort. When this “marriage” dissolves, smart coalitions develop and grow based on lessons learned from exit interviews.
- Community partnerships require care, nurturing, and good communication. Staffing appropriately, encouraging a positive culture, and wise use of technology can strengthen partnerships. Staffing appropriately can support goals and maintain effectiveness; in fact, one organization would like to assign project managers to oversee relationships with the most important partners. Also, regardless of partner size or perceived importance, communication is key to strengthening partnerships. “It used to be that community health centers were really competitive with one another and one day we woke up and went ‘Duh. Why are we reinventing the wheel?’ It used to be that if another organization asked for some examples of grants we write, the reaction was ‘that’s top secret stuff, can’t share anything.’ But a new administrator said, ‘Sure, help out whenever you can.’ And the more people you help, the more people that help you. The community health center world really changed when we started doing that.” Finally, data and technology can be optimized for efficient communication, as illustrated by a birthing center with its partners working together to select a common product from the same vendor to facilitate appropriate exchange of patient information when needed. Some coalitions even co-locate partner organizations under one roof.
- Conflict management is key. For example, when health and environmental policies are regulated by different levels of government, agency interests do not always align. Conflict can be minimized if coalition members learn about the methods and language used by different sectors and undertake collaborative activities where partners can work on less contentious areas first. One emergency preparedness coalition anticipated areas of conflict as coalition members compete in the marketplace but are required to share information and cooperate. Staff ensured that coalition work time was productive for partners.
- Sometimes less is more. Work can sometimes be easier with fewer individuals. Domain leaders within a large coalition can feel overwhelmed by an unending list of potential and actual partners and the need to manage size and diversity. After recognizing that this issue challenged a small staff, one organization proposed limiting partner recruitment to the executive level and established guidelines to use in maintaining partnerships. Another coalition aiming at emergency preparedness designed different categories of participation, whereby it maintained focus on healthcare with core members, yet encouraged a broader group of organizations to connect through a partnership designation.
Our case studies encountered numerous examples of strategies used with, or characteristics of successful partnerships as identified by Shortell et al. In our issue brief we categorized 26 of these into six categories of the types of strategies used. The risks and rewards of community partnerships are great. Some have changed their community for the better for several decades, some don’t get out of the gate, while others don’t survive the long haul. You can’t have healthy communities without partnerships. What can hopeful coalition leaders do to select, nourish, and support its partners in helping their organization maximize its chances for survival?
References
- Garcia A., Boufford J., & Finkelstein R. (2010). A compendium of proven community-based prevention programs. Retrieved from New York Academy of Medicine website: http://www.nyam.org/news/docs/Compendium-of-Proven-Community-Based-Prevention-Programs.pdf
- The guide to community preventive services.(n.d.). http://www.thecommunityguide.org/index.html
- Shortell, S. M., Zukoski, A. P., Alexander, J. A., Bazzoli, G. J., Conrad, D. A., Hasnain-Wynia, R., … Margolin, F. S. (2002). Evaluating partnerships for community health improvement: Tracking the footprints. Journal of Health Politics, Policy and Law, 27(1), 49–92.
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