Pervasive Problems Call for Engaged Partners with Bold Goals
This blog originally appeared in Northern California Grantmakers' Together for Good on August 16, 2018.
About a year ago, we set out to make our work harder: Blue Shield of California Foundation decided to change our strategic focus to look more broadly at how we can have a deeper and longer-term impact on many factors that influence health. We decided to move beyond narrowly focused solutions that rely on existing healthcare institutions to meet the immediate health needs of those at risk to instead seek breakthrough ideas that address the complex issues central to the health of all Californians. Thinking about the multi-dimensional issues that impact health—including domestic violence, an issue that remains a central pillar of our work—we realized we needed to widen our universe of partners to include organizations with diverse perspectives across many sectors. Moreover, we needed to think about partnerships in a different way; to think more in terms of enabling broad, deep cross-sector collaborations that can address the range of issues that impact health, such as inadequate housing, immigration, poverty, education, gender issues, culture, and pervasive gun violence.
This transition in our strategic approach prompted us to reflect on our history. It made us think about the difference between partnership and true collaboration. While we are still defining collaboration in this new context, we know that when we get it right, collaboration will allow us to embrace new viewpoints into the complex problems we want to solve, attract more partners, create new frameworks to guide action, and achieve bolder goals. Through nearly two decades of developing strategic relationships, we have learned a few things about collaboration that will inform our future efforts. Meaningful collaboration requires a balance of power, free-flow of information, and agreement on big goals with broad and well-defined measures.
Balance of Power
Sharing power in a partnership, making it a true collaboration, can be challenging, but it is worth the effort to make sure relationships are open and balanced. If one participant dominates, the more powerful player can drive a project down a narrow path rather than opening it up to new possibilities. Open, multi-dimensional relationships tend to be messier because true collaboration is more demanding and harder to achieve than a simple compromise, where parties just make concessions. Real collaboration is also much messier than dictatorship, where one player calls all the shots, and the others are obligated to follow along. Despite the messiness, collaboration ultimately leads to better thinking that crosses boundaries and identifies new solutions that move towards solutions for ambitious shared goals. When one partner wields too much power, forcing others to make all the concessions, opportunities for fresh, new solutions are lost, as are the energy and enthusiasm that it takes to tackle complex and entrenched problems.
Open collaboration proved its value when we supported 19 partnerships between domestic violence service and advocacy organizations and health care facilities. These pairs of organizations were often serving the same families in the same communities, but their work rarely intersected. Initially, the organizations began working together and communicating through a training program designed to help healthcare professionals make referrals to their partnering domestic violence organizations. In the process, both groups began to understand more about the unmet complex needs of domestic violence survivors. Healthcare professionals learned how to recognize potential abuse victims, and how to sensitively and effectively open a conversation with them about domestic violence. Importantly, they also learned they had a place to send patients for help once abuse was disclosed. Meanwhile, domestic violence advocates, often staff members at shelters, learned how to help their clients overcome obstacles to receiving primary health care.
While we established a broad framework for these novel relationships, when the pairs worked openly together to serve their mutual constituents, they found new ideas and innovative solutions unique to their communities. One partnership took the unusual step of establishing a domestic violence shelter on the hospital grounds. Another health center adopted a strict “seen alone” policy after learning how violent partners often interfere with appointments. Yet another partnership created a system for “warm handoffs,” in which staff literally walked patients or clients down the street for appointments with their partner organization, rather than simply handing them a phone number and expecting them to make a phone call and book the next appointment on their own.
Open, communication made these partnerships work in ways that went far beyond the original concept. If we had wielded the power of the purse as a grant maker and been prescriptive with our vision for these health care and domestic violence advocacy partnerships, we would have missed the new ideas and benefits that flowed from these new collaborations.
Free Flow of Data
Information and data must flow freely to make collaboration work. In philanthropy, we tend to sit on data rather than making it available. Sadly, our data nest eggs rarely hatch. Common fears can get in the way of sharing data: fear that sharing will give competitors an advantage, that incompetence will be uncovered, or that sharing will violate privacy laws. These fears explain why sharing data requires a high level of trust, strong agreement on goals, and carefully established systems for data-sharing. Having access to the right data provides insights needed to identify cross-cutting issues and opportunities for intervention. Our peers at organizations like Stanford Social Innovation Review, Grantmakers for Effective Organizations, and the Foundation Center, have created tools to support information-sharing across funder organizations. The Grantcraft Harnessing Collaborative Technologies tool has assembled many data-sharing and standardization tools that are readily available.
Sharing data allows us to identify patterns that will lead to collaborative solutions. South Stockton, a large, diverse, and low-income community in San Joaquin County, started a coalition of 30 health and community organizations, including local healthcare organizations, public health departments, probation officers, and child protective services. This group initially coalesced around the goal of maintaining and strengthening the health care safety net for underserved populations. It raised funds to hire a consultant who drew from each organization’s data to create a Community Health Needs Assessment. The assessment evaluated existing data and new surveys to compare South Stockton to other communities on measures like life expectancy, education levels, truancy rates, violence and injury rates, access to housing, access to healthcare, and others. The needs assessment, drawn from this shared data, identified trauma prevention and recovery as a key community health issue. This observation, and the ability to collaborate that grew from the initial effort, attracted new partners and seed funding from my foundation and other new funders. With this support, Healing South Stockton was formed, becoming a model for addressing stress and trauma in underserved communities. It began with collection and analysis of data.
Measures of Success
As we think more broadly about our goals, we also must think differently about measuring success. In past partnerships, we have focused on making small improvements in focused areas, and small, limited improvements were what we got. While widely touted SMART goals (Specific, Measurable, Achievable, Relevant, Timely) may have a place in management, they can also be restrictive. Addressing big problems requires engagement with partners across multiple sectors while identifying new ways to define problems and track progress across domains. A few years ago, we co-funded a study to develop Vital Signs: Core Metrics for Health and Health Care Progress. This committee of health leaders developed a set of 15 core domains with subsets of related priority measures that, taken together, provide a broad gauge of individual and community health. Adopting a core set of measures from across multiple domains can help us measure progress against big problems. These measures help us identify areas where we can have a tangible impact while also providing new insights on our progress. Rather than focusing on one measure, we are able to choose multiple core measures across domains that will better indicate progress. Having a comprehensive set of measures means that everyone can learn from the investment and accomplish more.
With growing tension around social issues such as gun violence and the wellbeing of immigrant families within a divided and volatile political climate, working in collaboration is now more important than ever. Balanced and symbiotic collaborations that freely share data and aspire to collectively tackle entrenched problems are the key to opening doors to a better future, because no one taking on these complex, interwoven issues alone will make meaningful and sustainable progress. We must come together, work together, and stand together.