Too often, collective-impact initiatives focused on community health set unrealistic timelines for reaching their goals. Most efforts involve population or systems change and take five to 10 years to achieve results. It takes time to build relationships, create a common agenda, foster trust and ensure the right people are at the table to begin implementation.
Likewise, healthcare organizations far too commonly dominate community-building activities rather than collaborate with local groups. However, as healthcare organizations and health plans have experimented more often with value-based care and managed care, they have become more open to collaboration.
Nevertheless, the social issues in the United States that created and perpetuated the vast disparities between demographic groups are complex, with deep roots in racism and discrimination, as well as in fear of people who differ from those traditionally chosen as political and organizational leaders. To believe that a few months or years of collaboration will erase entrenched, systemic policy practices is both dangerous and naïve.
Many pilot projects and demonstrations across the country are collaborating across sectors to do good in their communities. However, the challenges continue, including securing long-term funding, scaling the practice beyond a few hundred participants or a small geographic reach, and agreeing on and measuring success.
Decision-makers planning community collaboration projects should review the many ways to address collective impact that are gaining ground—along with the many ways that failed from the start because of flawed design elements. Here are some questions to ask (and answer) before beginning the collaboration:
- Who is at the table? If everyone with leadership responsibilities and decision-making authority looks similar, has similar backgrounds and occupies the same socioeconomic bracket, the program or initiative likely is doomed to fail. Why? Because the people with pertinent lived experience, those who will most benefit from the program or initiative, are absent from the development and design process. Social service and healthcare programs are often developed from an academic and hypothetical perspective without input from those who will use the program.
- Whose money is funding the initiative? If you find that a program or initiative has only one primary funding source, two factors to consider are how little time you will have to prove success and how many strings will be attached to that funding. Those strings can skew the design or implementation of the program. The collective-impact models that have proven most successful have blended public and private funds and have kept driving success because the program or initiative was not beholden to any one funder.
- What structures and processes have been developed? Defined roles and responsibilities matter. Implementation challenges will come regardless, but without a structured action plan, these challenges will be more complex to overcome. Also, be sure the plan processes are followed once created. Some organizations ignore the structure because they fear losing autonomy. Also, stakeholders must define at the outset what success will look like for all partners. It may look different for different partners with different business models.
- Who is benefiting from the program or initiative? If you find that companies, consultants, universities or regulators benefit more from the program than the public for whom it was designed, this is an issue. One way to gauge who benefits the most is to follow the funding. How is the funding distributed across the program, and how much is going toward direct interaction and intervention with patients and community members for the most significant impact? Many healthcare leaders struggle to answer these questions, as we want to believe that all our efforts manifest themselves in better health for our patients, but we know that is not always the case. Also, watch for conflicts of interest that may affect the answers to these questions—maybe even in your own organization!
- Who are your champions? Committed leaders need to be champions for health equity, but they also need to find and cultivate other champions within their organization and in the community.
Leadership is critical to the overall success of any model that affects people. Thankfully, across the country, there are hundreds of examples of community organizations banding together, leading with an understanding of the need for systems change, and working to improve health outcomes in their communities.
For example, the Camden Coalition of Healthcare Providers in New Jersey began this work in early 2000 with a series of breakfast meetings with healthcare providers. Its organizers envisioned a coalition of nonprofit organizations dedicated to improving healthcare delivery and health outcomes for New Jerseyans. It has since grown into a national institute with multiple resources and complex care models that span the community’s resources.
Though these collaborations may develop organically, many are spurred by a single event, such as an emergency like the COVID- 19 pandemic. To be ready to collaborate at these opportunities, healthcare leaders need to educate themselves on the tenets of building fruitful partnerships and making a collective impact—both key factors in substantially improving community health.
Editor’s Note: This content has been excerpted from the book Socially Determined: The Healthcare Executive’s Role in Health Equity. It has been edited for length.