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Exploring Equity in Multisector Community Health Partnerships: Proceedings of a Workshop (2018)

Chapter: 5 Building and Sustaining Equitable Community Partnerships

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Suggested Citation:"5 Building and Sustaining Equitable Community Partnerships." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Equity in Multisector Community Health Partnerships: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24786.
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5

Building and Sustaining Equitable Community Partnerships

To further explore ideas on how to build strong and effective community partnerships, the workshop participants were asked to work at their tables to answer one question from the planning committee per table (see Appendix B for the entire list). After 30 minutes, individual workshop participants shared the discussion highlights they viewed as being relevant, which are described below. These comments should not be construed as reflecting consensus or endorsement by the individuals at a table, the members of the roundtable, workshop participants, or the National Academies of Sciences, Engineering, and Medicine.

The first group discussed the question, What are the principles and practices of engagement and power sharing? Individual workshop participants in the first group shared various ideas, including respect, human connection, and trust; welcoming diverse participants; designing inclusive logistics; acknowledging the history of racism and other -isms; acknowledging the power imbalance; having a good reason to partner; establishing balanced group dynamics; replenishing the commons to create a safe space; and building capacity for all partners.

The second group discussed the question, How do you build the relationships and bridges that enable you to work with people who have different viewpoints and personal and institutional positions of power, particularly at moments of community pain and polarization? Individual workshop participants in this group shared various ideas, including asking about aims and pain points; extending an olive branch; leveraging personal relationships, including those of spouses and children; finding a

Suggested Citation:"5 Building and Sustaining Equitable Community Partnerships." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Equity in Multisector Community Health Partnerships: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24786.
×

broker or go-between, someone less polarized than the individual in question; identifying and using points of affinity outside of any contentious viewpoints; showing interest in the individual as a person and finding out what his or her favorite things are that are not part of the topic of disagreement; meeting people in non-tense situations; meeting for coffee, for example, before anything is on the agenda; taking baby steps and celebrating small wins; compromising; finding a few powerful leaders to support the cause at hand; and finding a solid reason to convene a meeting.

The third group discussed the question, What are the other barriers and challenges to building and sustaining community partnerships? Individual workshop participants in this group shared various ideas, including distractors; the shifting priorities of funders that move them in different directions; an unfair allocation of resources, such as when an academic group writes a grant but distributes little of it to the community; the lack of funded backbone or core factors that keep programs moving; the lack of a skill base needed to procure needed resources; a lack of team members with the technical expertise to bring programs to fruition; leadership turnover; a lack of business community engagement; “truthiness in a post-truth world” negatively affecting community perceptions; and a lack of evidence to support common sense solutions.

The fourth group discussed the question, What is your proudest accomplishment? What has been most meaningful to you in doing this work? Individual workshop participants in this group shared various ideas, including changing a hospital’s governance approach to include population and community engagement; getting city officials to put the Live Algoma logo on all city department letterheads, which changed the program from being an initiative to a movement; getting city officials to recognize the importance of the community’s voice; the San Francisco Board of Supervisors passing a resolution on what it stands for; getting local officials to be willing to innovate, think differently about problem solving, and learn from outsiders; creating the menu of measures within Measure What Matters; getting state departments to think more creatively about how they can promote equity; and getting state departments outside of the health area to be health allies.

The fifth group discussed the question, Have you made mistakes? Individual workshop participants in this group shared various ideas and noted that although its members were from very different organizations, such as small and large local nonprofits and national foundations, similar mistakes were common. For example, several participants noted that taking a strong advocacy position and meeting only with people who share that position, but not taking the time to meet with opponents, demonstrates a lack of respect for others and misses possible opportunities

Suggested Citation:"5 Building and Sustaining Equitable Community Partnerships." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Equity in Multisector Community Health Partnerships: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24786.
×

to come together. Other mistakes individual participants noted included failing to be transparent about who is included in a conversation and why, leaving some members of a coalition feeling disrespected and left out of the process; failing to be transparent about what does not work; not having simultaneous strategies for community work and for engaging elected officials; failing to establish checks and balances to prevent the misuse of resources, particularly when increasing staff responsibilities and authority; celebrating a policy win without having a plan for implementing that new policy or policy change; not doing the best job finding the right balance between providing too much structure and stifling creativity, particularly when talking about ideas generated by the young members of a community, and not having enough structure to make meaningful progress on addressing a problem; not trusting the process and coming into a meeting with a savior mentality; getting so involved in organizational branding that the program loses trust and the partners lose agency; failing to recognize the time and work needed to build connections and relationships and having a false sense that connections and relationships will just happen organically; and ignoring the historic trauma that communities face.

The sixth group discussed the question, If you could go back to the beginning and start from scratch, is there anything that you would do differently? Individual workshop participants in this group shared various ideas, including building in a process that reviews what works and does not work with the community’s involvement; learning from failure and from success; being transparent in every way with community members; and taking a healing approach to community engagement.

The seventh group discussed the question, How can partnerships better use data to inform learning, strategy, decision making, and future actions? Several participants in this group suggested finding frameworks for data use and evaluation that are credible in academic and health sector circles, meaningful for communities, and appropriate for this kind of work, which differs from the type of work that experts in the health sector and academia are trained to conduct. The current data and evaluation industry that the health sector defaults to does not work in the service of community partnerships in that it places too much value on counting and does not approach evaluation in a deeply participatory manner. There is, however, a data and evaluation industry that works to use methods appropriate to these community partnerships. Many participants in the group also suggested that evaluations may be more democratic if they are participatory in the same way that priority setting and problem solving are in the best partnerships and that actions based on evaluations may be more democratic if the evaluations are participatory.

Many workshop participants in the seventh group also suggested exercising caution in using initiative-wide or national menus of metrics,

Suggested Citation:"5 Building and Sustaining Equitable Community Partnerships." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Equity in Multisector Community Health Partnerships: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24786.
×

which are necessary for aggregating successful examples, to the exclusion of community-generated metrics and community-developed approaches to measurement that may better match community concerns. Individual participants suggested that funders incentivize the use of both types of metrics and aggregate both types of metrics as a means of identifying new tools that programs can use. One way of measuring change in partnerships is to ask how people perceive the partnership to be working. Several participants in this group also suggested that social media can provide insights into what community members think about a program and about changes in policies and in the local environment, as well as insights into the impacts of programs on social norms, the balance of power, the development of relationships, and the sustainability of relationships and partnerships beyond what gets measured for grant assessment.

The eighth group discussed the question, How can community health partnerships use communications and social media to advance health improvement agendas? Individual workshop participants in this group shared various ideas, including that the first step in communication is listening and trying to define who the audience is and what the issue is, followed by defining a shared vision to ensure that all communications are relevant to the intended audience and have a common language. Several participants noted that it is important to ensure that the vehicles used for communication are both trusted sources and important sources of information in the community. For example, the Federal Register is a trusted source of information, but few people read it. Actions as well as language can be used to communicate with the community, that is, making sure the program’s presence and accomplishments are visible in the community. Social media, particularly Twitter and texting, can be used as a means of establishing peer-to-peer communication in addition to program-to-community communication. Tweets and retweets can generate useful data to gauge message impact. Text messaging can be used as a means of rapid and immediate communication of urgent methods and even to create flash mob events or meetings.

Suggested Citation:"5 Building and Sustaining Equitable Community Partnerships." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Equity in Multisector Community Health Partnerships: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24786.
×
Page 65
Suggested Citation:"5 Building and Sustaining Equitable Community Partnerships." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Equity in Multisector Community Health Partnerships: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24786.
×
Page 66
Suggested Citation:"5 Building and Sustaining Equitable Community Partnerships." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Equity in Multisector Community Health Partnerships: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24786.
×
Page 67
Suggested Citation:"5 Building and Sustaining Equitable Community Partnerships." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Equity in Multisector Community Health Partnerships: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24786.
×
Page 68
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Building on previous National Academies of Sciences, Engineering, and Medicine workshops that explored how safe and healthy communities are a necessary component of health equity and efforts to improve population health, the Roundtable on Population Health Improvement wanted to explore how a variety of community-based organizations came together to achieve population health. To do so, the roundtable hosted a workshop in Oakland, California, on December 8, 2016, to explore multisector health partnerships that engage residents, reduce health disparities, and improve health and well-being. This publication summarizes the presentations and discussions from the workshop.

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