College of Public Health
University of Kentucky
In Conjunction with
Commonwealth Center for Governance Studies, Inc.
MODELS OF COLLABORATION INVOLVING
HOSPITALS, PUBLIC HEALTH DEPARTMENTS, AND OTHERS
Improving Community Health through Successful Partnerships
Health care expenditures in the USA have risen significantly in recent decades and presently consume nearly 18 percent of the GNP, a much larger share than other industrialized nations. However, studies by the Commonwealth Fund and other organizations show substantial segments of the population still have difficulty in gaining access to health care services and, across the country, the cost and quality of these services varies greatly.
It is widely recognized that greater attention and more resources must be devoted to promotion of healthy life styles, prevention of illnesses and injuries, and early detection and treatment of health problems. Seventy-five percent of USA health care expenditures are related to treating chronic disease, while less than three percent is devoted to prevention and health promotion programs.
It is increasingly clear that a stronger focus on prevention and population health will require better communications and more effective collaboration among hospitals (and their parent systems), public health departments, and other key parties within and outside the health field. Illustrations include:
- Provisions of the Patient Protection and Affordable Care Act (ACA) led to Internal Revenue Service (IRS) requirements for nonprofit hospitals to conduct a community health needs assessment with input from interested parties at least every three years, develop an implementation strategy to address priority needs identified through that process, and make the results available to the public. With the Public Health Accreditation Board (PHAB) standards calling for local health departments to conduct or participate in collaborative processes for assessing, prioritizing, and addressing community health needs, there clearly is great opportunity for mutually-beneficial cooperation in this area among hospitals, public health departments, and other parties who share commitment to improving community health.
- Recent reports by the Trust for America’s Health (A Healthier America 2013: Strategies to Move from Sick Care to Health Care in the Next Four Years, 2013) and the U.S. Department of Health and Human Services (Healthy People and Communities, 2012) emphasize the importance of building strong partnerships among public health agencies, health care providers, and other parties as a core strategy to improve the health of our Nation’s families and communities.
- The need for better communications and more collaboration also is implicit in the American Hospital Association’s recent report, Ensuring a Healthier Tomorrow, 2012. Other American Hospital Association publications (e.g., Managing Population Health: The Role of the Hospital, April, 2012 and Hospital Readiness for Population-Based Accountable Care, May, 2012) advocate a strong focus on population health. The Association’s President, Richard Umbdenstock, has stated “It is important to identify critical interfaces between ‘public health’ and ‘acute medical care’ and open a new, mutually-beneficial chapter in dialog and collaboration between the hospital and public health communities” (University of Kentucky Keeneland Conference, April 18, 2012).
BASIC PURPOSE AND PHASES OF THE PROPOSED STUDY
Previous studies have examined the nature and extent of collaboration between hospitals and public health departments. There is evidence of some increase in recent years (e.g., G. Mays and D. Scutchfield, “Improving Public Health System Performance through Multi-Organizational Partnerships,” Preventing Chronic Disease, 2010). However, there is broad consensus that decades of limited communications, lack of mutual understanding, and incongruent goals have inhibited collaboration between hospitals and public health departments in many communities across the country. The need to accelerate positive change and the potential benefits of enhancing collaboration between hospitals and public health departments have provided the impetus for this study. The overall purpose of this study is:
To identify, compare, and contrast exceptional models of collaboration involving community hospitals, public health departments, and other stakeholders who share commitment to improving community health and determine the key lessons learned from their experience.
The objectives of this study are:
- Identify models of collaboration in improving community health that are operational and considered to be highly successful;
- Examine these models in relation to specified questions and criteria; and
- Produce insights that will assist policy makers and leaders of public and private organizations in building strong, successful partnerships designed to improve community health.
The design of this study involves six principal phases:
Phase 1. Identify Core Characteristics of Successful Collaborative Partnerships. In essence, collaboration involves informal alliances or more formal partnerships established by two or more organizations or groups who agree to work together to achieve a common purpose.
Prior research studies and operational experience in a broad range of settings have produced a substantial foundation of information regarding the reasons why partnerships are established, the factors that influence their performance, and the core characteristics of durable, successful partnerships (e.g., S. Shortell, et al, “Evaluating Partnerships for Community Health Improvement,” Journal of Health Politics, Policy and Law, 2002; R. Axelsson and S. Axelsson, “Integration and Collaboration in Public Health – A Conceptual Framework,” International Journal of Health Planning and Management, 2006; J. Kania and M. Kramer, “Collective Impact,” Stanford Social Innovation Review, 2011; S. Vangen and C. Huxham, “The Tangled Web: Unraveling the Principle of Common Goals in Collaborations,” Journal of Public Administration Research and Theory, 2011; and “Public-Private Partnerships Pave Way for Sustainable Future, NCAD Directorship, 2013).
Based on this foundational work in several sectors, the research team has developed a framework that embodies the most widely accepted characteristics of successful partnerships along with specific indicators of each characteristic. The core characteristics include:
- Vision, Mission, and Values – The partnership’s vision, mission, and values are clearly stated, reflect a strong focus on improving community health, and are firmly supported by the partners
- Partners – The partners demonstrate a culture of collaboration with other parties, understand the challenges in forming and operating partnerships, and enjoy mutual respect and trust
- Goals and Objectives – The goals and objectives of the partnership are clearly stated, widely communicated, and fully supported by the partners and the partnership staff
- Organizational Structure – A durable structure is in place to carry out the mission and goals of the collaborative arrangement. This can take the form of a legal entity, affiliation agreement, memorandum of understanding, or other less formal arrangements such as community coalitions
- Leadership – The partners jointly have designated highly-qualified and dedicated persons to manage the partnership and its programs
- Partnership operations – The partnership institutes programs and operates them effectively
- Program Success and Sustainability – The collaborative partnership has been operational for at least two (2) years, has demonstrated operational success, and is having positive impact on the health of the population served
- Performance Evaluation and Improvement – The partnership monitors and measures its performance periodically against agreed upon goals, objectives, and metrics
This framework will facilitate the process of inviting nominations by depicting the caliber of partnerships we want to identify. Subsequently, the core characteristics and key indicators will be employed in the process of screening the nominations and determining those we want to consider visiting. A document that includes the eight core characteristics, the related indicators, and a list of some key resources of information used in compiling them is available at http://www.uky.edu/publichealth/CoreCharacteristicsSuccessfulPartners.php.
Phase 2. Communicate and Cooperate with Others Who Share Our Team’s Interests. Our research team is familiar with current efforts by other parties to examine relationships among public health entities and health care delivery organizations; e.g., the Democracy Collaborative at the University of Maryland; Duke University; George Washington University; the Hilltop Institute; the Network for Public Health Law; and others. As one of our basic vehicles for communication and coordination, a project advisory committee will be appointed to advise the research team in developing the study methodology and tools; providing counsel in all phases of the study; and facilitating interaction with related initiatives around the country. The advisory committee will be diverse and multi-disciplinary in composition.
Phase 3. Identify Exceptional Collaborative Partnerships. Identify examples of collaborative arrangements involving hospitals, public health departments, and other organizations that are operational, meet the characteristics of successful partnerships, and are doing exceptional work in defining and addressing their community’s health needs.
Nominations will be invited on a national basis in concert with AcademyHealth, the American Hospital Association, the American Medical Association, the Association of State and Territorial Health Officials, the Association for Community Health Improvement, the Catholic Health Association, the National Association of County & City Health Officials, state and metropolitan hospital associations, and the Public Health Practice-Based Research Networks. These organizations have been consulted in the process of developing this proposal, agreed to participate in identifying and nominating excellent models of collaboration, and expressed interest and support for this study.
Nominations will be screened by an expert panel that includes some members of the project advisory committee with the goal of identifying collaborative models that most fully meet established characteristics and criteria. In addition, a complete inventory of all nominations with baseline information including location, participating organizations, and basic mission will be constructed and made available to interested parties.
Phase 4. Make On-site Visits to a Substantial Sub-set (Up to Ten) of These Collaborative Partnerships. Through in-depth interviews with organizational leaders and examining key documents, the team will examine each partnership in relation to a pre-defined set of questions including:
- When and why was the partnership created?
- Which organizations and other stakeholders are involved in the partnership and what roles do they serve?
- What is the partnership’s organizational structure, and how is it governed and managed?
- What mechanisms are in place to assess and improve the partnership’s governance and management structure and processes?
- What programs and services does the partnership provide at this time, and what are the plans, if any, for modification and/or expansion?
- How is the performance of the partnership’s programs and services being measured and evaluated? Does the current protocol include assessment of the impact the partnership’s efforts are having on community health status and, if so, what criteria and evaluative methods are being used?
- How does the partnership’s leadership team view their collaboration’s principal successes and disappointments to-date? If they were starting over in building a partnership model, what, if anything, would they do differently?
Phase 5. Data Analysis and Preparation of Reports. Based on the analysis of data compiled from documents and site visits, the research team will prepare reports that describe and compare the models and distill the key lessons learned from their collective experiences. The aim is to assist hospital and public health leaders in other settings who are interested in building successful collaborative arrangements focused on improving community health. The reports will include both public policy recommendations and organization-level recommendations intended to facilitate successful governance and operation of collaborative partnerships that will improve the health of communities.
Phase 6. Distribute Findings, Conclusions, and Recommendations. In concert with the parties who provided grant support and other organizations engaged in this study, develop plans that will ensure broad dissemination to the practice, policy, and research communities of the study’s findings, conclusions, and recommendations.
TIMETABLE AND GRANT SUPPORT
The process of designing this study and securing grant support was initiated in the spring of 2013. The study will be formally launched in August, 2013, and is targeted for completion in September-October 2014. Lawrence Prybil, PhD, will serve as Principal Investigator in collaboration with Dr. F. Douglas Scutchfield, Rex Killian, JD, Dr. Glen Mays, and Dr. Samuel Levey as Co-Principal Investigators. Funding support is being provided by a coalition of three organizations. They are:
- Grant Thornton, LLP
- Hospira, Inc.
- Robert Wood Johnson Foundation
Lawrence Prybil, PhD, LFACHE
Norton Professor in Healthcare Leadership
College of Public Health, University of Kentucky