Turning Point

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 USThe US ranks 25th in the health status compared to

other countries; trailing most European countriesDespite 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 RecommendationsState public health law reformSupport public health worker competencyPrioritize leadership training with government public

health agencies and academic institutionsBroad-based national dialogue to explore perspectives

on workforce credentialingRegularly assess the state of the nation’s 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 exchangeCommon goalPromote collaborationLegitimize issue

Realistic with ReservationsProgram planning Influence policy Influence resource

allocation

UnrealisticProgram

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 2000Infrastructure themes common to many

statesFive National Excellence CollaborativesStates, National partners, invited experts,

and others

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National Excellence Collaboratives

Performance ManagementInformation TechnologyLeadership DevelopmentPublic Health Statute ModernizationSocial Marketing to Improve Population

Health Outcomes

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New Tools & ProductsA suite of products designed to increase

effectiveness, improve the quality of practice, and advance national priorities.CDCynergy-SOCModel public health lawPerformance management modelCollaborative 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 & systemsTransitions 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 relationshipsCommunication & visibilityContext-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 disparitiesColorado 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 Minnesota’s 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 programsLouisiana enhances the capacity of local public health

programs by providing technical assistance, modest funding, facilitation, and training.

North Carolina’s 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 ImpactsPromoting 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 state’s 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 InstitutesSustainability/ institutionalizationFlexibility for policy developmentFlexibility for advocacyFlexibility for administrative purposesNeutral 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/