In a recent FSG webinar discussion on collective impact in health Christy Reeves, director of the Blue Cross and Blue Shield of Louisiana Foundation, Dr. Victoria Rogers, director of Let's Go! in Maine, and Karen Ordinans, executive director of the Children's Health Alliance of Wisconsin joined FSG’s John Kania to explore how collective impact initiatives are creating impact to increase health and well-being in their communities.
This is the last post in a 3-part blog series in which all four continue the discussion, answering questions submitted by webinar participants on how broad cross-sector coordination can be effective in addressing the continuing complexity of the health space. In this post, Christy, Karen, and Tory provide additional details on their experiences and initiatives, and FSG discusses the backbone role.
Q: How do you keep the lines clear between the backbone as a driver vs. a supporter?
FSG: The backbone staff is both the enabler and supporter. It can advocate on behalf of the group, bring data and evidence to bear about what works well, and build the group’s capacity… but it is not a driver of the agenda. This is part of what can make the backbone role both so critical and yet so challenging. The backbone must “lead” from behind. It is a neutral convener, builds key relationships across members of the initiative, and focuses people’s attention to create a sense of urgency. Backbones must balance the tension between coordinating and maintaining accountability, while staying behind the scenes to establish collective ownership.
Tory: This can be a little tricky. At Let's Go! we try to drive our partners to evidence-based or promising interventions that we know will lead to behavior change. At the same time we encourage and support innovation. I think the balance of offering innovation within a framework allows for accurate measurement. One of the keys to this balance is the positive relationship between Let's Go! (the backbone organization) and partners out in the community doing the hard work. We communicate often through multiple formats. This allows for that push- pull. Another element to this is that the Children's Hospital and Let's Go! are seen as credible drivers of this program – this gives us the “street cred” to push our partners to the evidence-based strategies that we hope will have the biggest impact.
Karen Ordinans: As the backbone organization, we make our role and functions clear to the group of partners. This is spelled out in meetings verbally, or put in writing. For example, we will describe if we are the facilitator of meetings, the collector/disseminator of information, drafter of the report etc. The Alliance is clear in articulating any interests in a specific activity, such as a piece of related legislation. However, everything we’ve supported has been in the interests of the group. Leave nothing to assumptions! For example we are the sole coordinator of meetings, correspondence and action steps. Everyone can count on information being disseminated through us. As the backbone, we also make our position on the matter known. We are a supporter within the Milwaukee Clean Air Coalition effort because of our work in asthma. We work within the group to help build consensus that meets our asthma interests and at the same time meets the goals of the overall groups’ broader agenda.
Q: Several presenters spoke about including a broad spectrum of partners. How do you approach more removed partners to get them interested in participating? Do you try to get these more removed partners involved from the beginning, or bring them on and broaden the coalition as you go?
Karen Ordinans: There is no right or wrong answer to this in terms of timing or how to approach someone. Suggested steps: brainstorm who the unlikely partners are; identify who has even the slightest relationship with those identified; determine what the partner’s connection might be; identify what you think the partner could add to the issue; and approach the potential partner with a clear statement of the problem, what the group is looking to achieve, and why they may want to join in the cause. Be sure to listen for their concerns or how they view the issue from their lens.
Tory: Great question – for Let's Go! the community message of 5210 has resonated well with most demographics and has been well received in most communities. That said, however, we have encountered resistance in trying to work in a few areas. And when this has happened we have tried to have respectful conversations with the individuals about what the barriers are – sometimes they are perceived barriers – they think they can't partner without losing their autonomy. Once we are able to allay their fears then the partnerships can form and you can start working together. We have used peer to peer mentoring when encountering resistance. We have asked local teachers to talk to other teachers and doctors to talk to other doctors, and this has been really successful. Lastly, it is critical for us to tie the mission of Let's Go! to the mission of our partners – an example of this is working with schools. Schools have a mission to educate children and the evidence shows that the healthy eating movement is positively associated with learning and higher education scores. So when I go to talk to a school, I always talk to them about academic achievement and what we know will increase grades. And I let them know the Let's Go! can help them achieve their goals.
Q: Do you have any examples you would be willing to share of what did not work and what you learned from that?
Christy Reeves: We have learned many lessons thus far and I will address two general topics: 1) dynamics of the different coalitions and 2) evaluation.
To date, we have seen how the success of the project is very dependent on who the grantees had at the table at project conception, and how well those initial collaborations are working. Perhaps some grantees were short-sighted as to who needed to be engaged to ensure a project's success and now they are behind schedule because they have to go back and re-work some relationships and bring on additional partners. Other groups are struggling with the concept of having one project lead and working collaboratively within their group with a shared vision and toward common goals.
In addition we have found that evaluation design will vary based on the composition of projects and partnerships, size, capacity, and desires of partnerships. Flexibility is key. Expect and embrace change along the project lifetime. The evaluation itself will change over time due to the developing nature of the collaborative. Set good expectations about the fluidness of the process
Not acknowledging all the work that is already happening on the ground.
We learned to slow down a bit and spend some time talking to those who are currently engaged in this work
Moving too fast and getting ahead of people.
Healthy eating and physical activity may seem like simple concepts but they are steeped in cultural and sometimes political land mines. It has taken us years to get to where we are in the area of childhood obesity – we need to unwind this maze of unhealthy eating habits and sedentary lifestyle slowly and give folks a chance to catch up to the changing culture.
You can't please everybody.
We have learned that there will always be some folks who don't approve of what you are doing. That is okay.
Sometimes we can make things too complicated.
Whether it's a registration form to sign up to work with Let's Go! or an evaluation form to fill out at the end of the year – often times we complicate things and this can be a big turn off. We are working to simplify everything we do and we are pulling in our community partners to help us figure out ways to make their work easier.
About Karen Ordinans – Karen serves is executive director of Children’s Health Alliance of Wisconsin, a statewide advocacy organization affiliated with Children’s Hospital of Wisconsin. Karen leads efforts to build partnerships with public and private health systems, organizations and individuals to improve the health of Wisconsin children. The Alliance focuses on seven key initiatives: asthma, early literacy, emergency medical services for children, grief and bereavement, injury prevention and death review, lead poisoning and oral health.
About Christy Reeves – Christy is the Executive Director of the Blue Cross and Blue Shield of Louisiana Foundation, the company’s charitable subsidiary. Christy also leads the Foundation’s strategic grant-making and its two signature programs, the Angel Award and Smart Bodies. Christy spearheaded the Foundation’s Challenge for a Healthier Louisiana Grant Program. This almost $30 million project takes a multi-pronged approach toward tackling childhood obesity, nutrition education, healthy food access and neighborhood fitness in Louisiana. Christy has received critical praise and numerous awards and honors for re-defining her company’s role and reputation in the state.
About Tory Rogers – Tory is the Director of The Kids CO-OP at The Barbara Bush Children’s Hospital at Maine Medical Center where she oversees the development, coordination, and promotion of community-oriented, pediatric healthcare initiatives. She is also Director of the Let’s Go! Program, which uses a multi-sector approach to reach youth and families where they live, learn, work and play to reinforce the importance of healthy eating and physical activity.