Effective Collaboration Utilizing Partnerships:

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Effective Collaboration Utilizing Partnerships

• Lessons from the Turning
• Point Initiative
• Bobbie Berkowitz, PhD, RN, FAAN
• Professor and Department Chair
• University of Washington

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Do Collaborative Partnerships Make a
Difference?An Oklahoma Story or Two
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Challenges to Public Health Infrastructure

• Limitations in public health information
  technology
• Need performance measures for the public health
  system
• Need to develop strategic public health leaders
• Limited integration across healthcare and public
  health Health status ratings of the US
• The US ranks 25th in the health status compared
  to other countries trailing most European
  countries
• Despite healthcare spending and advances, the US
  moved from 13th in 1960 to 25th in 2000
• Need for stable and predictable public health
  funding

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National Perspectives on Public Health

• Institute of Medicine 2002 Recommendations
• State public health law reform
• Support public health worker competency
• Prioritize leadership training with government
  public health agencies and academic institutions
• Broad-based national dialogue to explore
  perspectives on workforce credentialing
• Regularly assess the state of the nations public
  health system and its capacity

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Turning Point A Framework for Change

• Improve and transform public health
  infrastructure through collaborative models
• Build relationships and create an environment for
  public health improvement
• Improve public health accountability
• Improve population health outcomes
• Impact health policy
• Increase public health technology effectiveness
• Build the public health research base
• Enhance the public health workforce and leadership

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Turning Point States
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A Little Background on Collaboration
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Collaboration

• A method used by members of communities when
  developing coalitions, by organizations when
  doing strategic planning, and by researchers who
  desire the partnership of those being studied.

Berkowitz, B. 2000 Journal of Public Health
Management and Practice
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Key Factors Creating Success

• Clear Vision/Mission
• Action Planning
• Leadership
• Resources for Mobilizing
• Documentation and Feedback on Intermediate
  Outcomes
• Technical Assistance
• Making Outcome Matter (incentives)

Fawcett, S et al. 1999 Public Health Reports
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Expectations

• Realistic
• Info exchange
• Common goal
• Promote collaboration
• Legitimize issue
• Realistic with Reservations
• Program planning
• Influence policy
• Influence resource allocation

• Unrealistic
• Program implementation
• Influence organizational or systems change in a
  community
• Influence health outcomes

Kreuter et al. 2000. Health Promotion Practice
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Example of National Level Collaboration
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Turning Point National Excellence Collaboratives

• Initiated in 2000
• Infrastructure themes common to many states
• Five National Excellence Collaboratives
• States, National partners, invited experts, and
  others

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National Excellence Collaboratives

• Performance Management
• Information Technology
• Leadership Development
• Public Health Statute Modernization
• Social Marketing to Improve Population Health
  Outcomes

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New Tools Products

• A suite of products designed to increase
  effectiveness, improve the quality of practice,
  and advance national priorities.
• CDCynergy-SOC
• Model public health law
• Performance management model
• Collaborative leadership curriculum
• Information technology gateway

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A Little Background on Partnerships

• Mostly community level and health promotion
• Major reviews
• Kreuter, Lezin, Young (2000)
• Roussos Fawcett (2000)
• Foster-Fishman et al (2001)
• Israel, Schulz, et al (1998)
• Lasker Weiss (2003), Lasker (1998)

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State Level Partnerships

• What themes and key elements are associated with
  state-level partnerships?
• How do these compare with partnerships in the
  literature?

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Structure Process

• Hard work, long time
• Formal structure decision-making
• Interpersonal relationships material support
• Choosing projects wisely
• Local context and variability

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Working in across Existing Systems

• Categorical funding silos
• Relationships between state and local agencies
• Proximity to power political transitions

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Leveraging Change

• Importance of high-level support
• Collaborative leadership

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Sustaining Collaborative Partnerships

• What are the strategies in use by Turning
  Point partnerships to sustain their innovations
  for change?

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Sustainability

• Sustaining programs systems
• Transitions from grants to more permanent
  funding
• Finding replacement or successor grants
• Sustaining principles and values
• Incorporation into continuing programs policies

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Integration within Government

• Institutionalizing specific initiatives
• Linking with other programs
• Diffusion and incorporation

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Outside Government Alternative Structures

• Setting up new structures (e.g. 501c3 agencies),
  or linking with pre-existing ones
• Collaboration, not competition, with state
  agencies

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How Does Sustainability Happen?

• Intentional relationships
• Communication visibility
• Context-driven decisions

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The Impact of Collaborative Partnerships Some
Examples
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Turning Point Partnerships Impact Public Health

• Working to eliminate health disparities
• Colorado creates a Minority Health Surveillance
  System, an Office of Minority Health, and
  increases grants received by community-based
  organizations with health disparities programs
• Oklahoma coordinates a legislative taskforce to
  eliminate health disparities
• Minnesota supports development of an Unequal
  Treatment report, participates in the creation
  of the Minnesotas Health Disparities Initiative,
  and brings health care system executives together
  to help resolve health disparities.

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More Impacts

• Promoting a collaborative model and resources for
  community-based programs
• Louisiana enhances the capacity of local public
  health programs by providing technical
  assistance, modest funding, facilitation, and
  training.
• North Carolinas Healthy Carolinians links
  community assessment, the 2010 Health Objectives,
  and community level health improvement efforts
  for 90 of the state.

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More Impacts

• Building infrastructure in public health
• Nebraska covers the state with local health
  departments
• South Carolina serves as a catalyst for community
  engagement planning using MAPP and institutes a
  performance management system based on Silos to
  Systems performance management tool and creates
  benchmarks for improved public health performance
• Oklahoma creates community-based Turning Point
  coalitions

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More Impacts

• Promoting innovative use of resources
• New Hampshire establishes the Public Health
  Network to leverage people, training, knowledge,
  and resources to ensure a public health system
  accessible to 60 of the states population
• Oklahoma finds ways to use categorical state and
  local funds (WIC, tobacco, immunization) to
  support needed infrastructure improvements

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More Impacts

• Louisiana creates the National Network of Public
  Health Institutes bringing non-governmental
  public health entities together to respond to the
  challenges facing public health
• Virginia pioneers engaging the business community
  in health issues through business roundtables and
  meetings with chambers of commerce, designs
  workplace-based health intervention programs
  together with business community, and creates an
  online health data atlas to promote informed
  decision making.

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More Impacts

• Developing a stronger public health workforce
• New York leverages resources to acquire funds for
  workforce development and training, develops a
  nationally broadcast, monthly satellite training
  series Third Thursday Breakfast Broadcast
  (T2B2), and develops an online nursing curriculum
• Minnesota establishes the Emerging Leaders
  Network to develop future public health leaders
  and provide support training, and networking
  opportunities.
• Illinois receives legislative approval for the
  State Health Improvement Plan Act

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Lessons to Carry Forward
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Partnerships are Essential

• Expansion of partnership model to state level
  systems change has been critical to success
• Challenge in creating new systems and new
  relationships
• Selecting goals that are big enough to matter but
  not so big the partnership loses interest
• Require high level support

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Strategies for Sustainability

• Within government institutionalization of system
  changes
• Outside government new or pre-existing
  structures
• Changes spun off and sustained by other
  organizations and systems

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Alternate Structures for Public Health

• Public Health Institutes
• Sustainability/ institutionalization
• Flexibility for policy development
• Flexibility for advocacy
• Flexibility for administrative purposes
• Neutral ground convener/ independent

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Public Health Preparedness

• Turning Point set the stage
• Preparedness planning shared a common
  infrastructure with Turning Point work
• Preparedness planning has challenged public
  health infrastructure development

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Questions?Comments?
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Challenges and Hopes

• Institutionalization of collaborative partnership
  approach
• Permanent broad-based citizen involvement in
  public health
• Dual-use, steady predictable funding sources
• Linking system change with public health
  preparedness
• Informing policy makers about public health
  improvement

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• http//www.turningpointprogram.org/