Collective Impact at work: A preliminary assessment of a

Midwestern university-community health promotion

partnership.

Wilson Majee, PhD, MPH

University of Missouri, USA

Introduction - the issues.

o In 2011, in the United States alone, 46.2 million Americans (15%)

lived in poverty, up from 31.6 million (11.3%) in 2000 (DeNavas-Walt, Proctor, & Lee, 2012).

o Between 2009 and 2011,

• the poverty rate increased for:

• Blacks (from 25.8% to 27.6%),

• Hispanics (from 25.3% to 26.5%),

• Children under age 18 (from 20.7% to 21.9%) and for people aged 18 to 64 (from 12.9% to 13.7%)

o That 1 in 5 children in the richest nation in the world should live in poverty is a moral failing.

Introduction - the issues.

o The poor, and those with less education, mostly people of color, continue to be disproportionately affected by disease and unemployment.

o Only 12% of the U.S. population is African American, yet they account for 46% of people living with HIV disease in the U.S.

o Adult obesity rates for Blacks topped 30% in 42 states and the District of Columbia, 30% for Latinos in 23 states, compared to 30% for Whites in only four states.

Introduction – potential strategy.

o Need for better approaches to improve the health and

well-being of communities

o Collaborative

o Inclusive

o Sustainable

o University Community Partnerships

Introduction – University Plan

Reach out to a community to improve the health where people work, live and go to school

Engage UMHS in innovative community partnerships

Utilize MU &UMHS’s unique resources

Multidisciplinary faculty and professional staff

Tiger Institute for Health Innovation

Missouri Telehealth Network

Extension

Assess and leverage community resources

Introduction – the community

Memphis is a rural community of about 21, 500 people (United States Census Bureau 2013)

For the period 2008-2012, the median household income for Memphis was $32,354 while those

for the county and state were $38,543 and $47,333 respectively.

High percentage of low-paying manufacturing jobs: 18.5% for the county, compared to 8.2%

for the state.

Poor education attainment levels: only 15.9% persons aged 25+ had a college degree or

higher in the county, compared to 25.8% for the state and 28.5% for the nation.

County and State population living below the poverty level was 17.2% and 15% respectively

(United States Census Bureau 2013).

City hosts the state fairgrounds, a community college, a regional hospital, a chamber of

commerce, several corporations (Tyson Foods, Walmart etc.), and two national highways, YET has

had difficulties attracting external funding for social services.

The Partnership …key stakeholders

Research questions

o The study’s goal was to examine:

o a) conditions and factors that influence the effectiveness of

university-community partnerships,

o b) how the factors interact with each other to challenge

unhealthy living conditions, and

o c) ways to best tap the potential of university-community

partnerships.

Collective Impact Framework

o Commitment of a group of important actors from different sectors to a

common agenda for solving a specific social problem” (Edmondson et al.

2012 p. 11).

o Rather than viewing collaborations as loose affiliations of programs and

services addressing similar issues, yet operating in silos, Collective Impact

advocates for a “more rigorous and focused approach of coordinating

these disparate efforts” (Hanleybrown et al. 2012).

o Instead of working in isolation, community members embrace a collective

approach to, define, measure, and improve their health and well-being.

Collective Impact Framework

The Five Conditions of Collective Impact

Common Agenda: All participants have a shared vision for change including a common understanding of the problem and a joint approach to solving it through agreed upon actions.

Shared Measurement: Collecting data and measuring results consistently across all participants ensures efforts remain aligned and participants hold each other accountable.

Mutually Reinforcing Activities: Participant activities must be differentiated while still being coordinated through a mutually reinforcing plan of action.

Continuous Communication: Consistent and open communication is needed across the many players to build trust, assure mutual objectives, and create common motivation.

Backbone Support: Creating and managing collective impact requires a separate organization(s) with staff and a specific set of skills to serve as the backbone for the entire initiative and coordinate participating organizations and agencies.

Stanford Innovation Center (Hanleybrown et al. 2012)

Data Collection

o Interviews and focus groups - purposive sampling

o One focus group with 10 breastfeeding mothers

o In-depth Interviews: 35

o 8 with community partnership members

o 7 with MU HC partnership members

o 8 with breastfeeding mothers (follow-up)

o 7 with health care providers (nurses, and pediatricians)

o 5 with employers (focusing on workplace lactation friendliness)

Data Analysis

o Interviews were transcribed by a consultant

o 3 researchers were involved

o Coding began by labeling concepts within field notes, and interview transcripts.

o Themes were based on the five key conditions of the collective impact framework:

o participatory agenda formulation

o shared outcome measurement

o participation in mutually reinforcing activities

o continuous communication, and

o backbone support.

Findings – Conditions and Factors

Readiness as community capacity - most community partners felt that the local leadership

development program prepped them for collective initiatives:

It (the leadership development program) provides an opportunity to learn a lot more about the

businesses, about the community, the history of Memphis – the entrenched beliefs and patterns

that even though Memphis has evolved, some have persisted. Going to Tyson’s, which is a large

employer and a critical asset to the community and learning about and seeing the processing of

food, really allowed me to understand better the challenges that go on for people who work in

those industries and people who manage those industries. And I think it’s critical to understand

that when you’re talking about wanting to change a mindset to talk about wellness, to talk

about improving health, you have to keep that manufacturing business perspective in mind. So I

think the leadership class really does a good job of introducing people to all the different

components of Memphis, which gives you a picture of how this community works (Adams,

August 25, 2013).

Because I have always had kind of an insider role because I had that prior

relationship with the Memphis team, they would sometimes tell me of their

concerns and fears, saying I could relay that back to the University team….so

trust kept developing more and more and that allowed (for) a more honest

conversation (Johnson, September 18, 2013).

Readiness as community capacity - several 8 of the 15 partnership members felt that the

pre-existing relationship facilitated the development of trust:

Findings – Conditions and Factors

Community Participation and Engagement – all 15 research participants expressed the

importance of committed participation and shared responsibility:

Findings – Conditions and Factors

We’ve taken it very seriously and we have met, and we have monthly meetings.

I view my role as the leader of a health system and it’s, we’re not just a hospital

anymore. I really have no credentials to either be an expert in weight loss

management or behavioral modification. I am a leader and I think it’s

important and my contribution is to say “Hey, do we need resources?” I show

my public support by, when we have our annual health summit; I and other

leaders are the face of that (Bailey, November 14, 2013).

Sharing of skills and resources

Findings – Conditions and Factors

There are experts at the University that have the knowledge and the skillset to help the BRHWPT

really map out a long range plan for success and make an impactful difference in our community in

terms of health and wellness. It’s that kind of brain capital that is really helpful to have (Hooper,

October 20, 2013)

“It’s the resources of the University, the expertise of the University, and the nimbleness of a

community that I think makes a good partnership” (Westwood, October 30, 2013).

“While we know how to do evaluation, research, how to get resources….on the Memphis side, a lot of

those folks do know how to roll out programs, how to get funding, how to be creative and how to

organize around an issue. For example, (they) already got people that are listened to and sought

after in their community… so we have their ear and they listen to us” (Nelson, October 4, 2013).

Findings – the outcome

Community Empowerment

What’s happening now in Memphis is there is an expanded conversation about what health

means and the impact of making that a priority in your community, both from a social

perspective and economic perspective, as well as, health and education perspectives.

People are talking about breastfeeding. Nobody was talking about breastfeeding two

years ago, three years ago. People talk about Healthy U all the time. People are very

engaged in that. People are talking about tobacco. People are talking about teenage

pregnancy and risky behaviors in young people. You know, when I came to this community

there wasn’t any conversation going on about any of that (Smith, August 19, 2013).

Findings – the outcome

What we don’t know sometimes is how to approach it (health issue), and a great

example is Clean Air Memphis. The need for the smoking ordinance was quite

obvious but we didn’t know how to approach it. We didn’t know how to work

with elected officials. We didn’t have the statistics, the data. University partners

were critical. You know, they came down and helped us do the air quality

monitoring and with the strategies. All those outside folks were there to help, to

cheerlead, but it still had to be us. It had to be the local people who spoke

(Adams, August 25, 2013).

Community Empowerment

Findings – the hurdles

Paralysis by analysis

I think there’s always a challenge between the world of academia and the world of a

community….very large institutions don’t move fast. It takes a while for them to, to move things

through all their channels. In a community, particularly a small community, if we want to change

something you get a much smaller group of people together and you start making a change

(Westwood, October 30, 2013).

Inadequate resources

I do not have enough time to go there (Memphis) as much as I should…I would really love to see

sort of a mirror image of how we organize ourselves here at the university planted in our

community so they have a community investigator, a community project director, and so on…we

maybe would connect better that way (Nelson, October 4, 2013).

Conclusion – Back to Collective Impact Conditions Partnership status University Role

Common Agenda: common

understanding of problem and joint

approach to solving it.

Partnership members met and developed a shared vision

for the partnership.

Provides ongoing expertise with visioning and

strategic planning. Organizes and coordinates

regular partnership meetings.

Shared Measurement: consistent

data collection and results

measurement across participants.

Community-partners work with university experts to

collect data and assess impact of each of the five issue-

focused planning teams.

Assists the partnership with “trend analysis” and

development of instruments to collect data around

specific health issues, e.g. breastfeeding, air-

quality indexes.

Mutually Reinforcing Activities:

Differentiated but coordinated

participant activities.

Partnership has five issue task forces (breastfeeding,

clean air, healthy living, adolescent health, and medical

home) in which participants play different but

coordinated roles.

University professionals assigned to each of the 5

coalitions in the community to ensure that members

stay motivated and coordinate their activities with

the other coalitions.

Continuous Communication:

Consistent and open

communication.

Partnership members hold regular quarterly meetings

while issue-focused planning teams meet bi-weekly.

Ensures that communication is continuous through

having representatives in the coalitions, who

support coalition efforts and make progress

reports to the partnership on a regular basis.

Backbone Support: Separate

organization(s) with staff and a

specific set of skills.

Partnership has no separate organization. It utilizes the

diverse yet specific skill sets among partners.

Provides a pool of professionals with diverse

training to consult with the coalitions. Also provides

funding for partnership activities.

Collective Impact Framework