Turning Point: Collaborating for a New Century in Public
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Transcript Turning Point: Collaborating for a New Century in Public
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 US
The US ranks 25th in the health status compared to
other countries; trailing most European countries
Despite 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 Recommendations
State public health law reform
Support public health worker competency
Prioritize leadership training with government public
health agencies and academic institutions
Broad-based national dialogue to explore perspectives
on workforce credentialing
Regularly 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 exchange
Common goal
Promote collaboration
Legitimize issue
Unrealistic
Program
implementation
Influence
organizational or
systems change in a
community
Influence health
outcomes
Realistic with Reservations
Program planning
Influence policy
Influence resource
allocation
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 2000
Infrastructure themes common to many
states
Five National Excellence Collaboratives
States, National partners, invited experts,
and others
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National Excellence
Collaboratives
Performance Management
Information Technology
Leadership Development
Public Health Statute Modernization
Social Marketing to Improve Population
Health Outcomes
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New Tools & Products
A suite of products designed to increase
effectiveness, improve the quality of
practice, and advance national priorities.
CDCynergy-SOC
Model public health law
Performance management model
Collaborative 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 & systems
Transitions 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 relationships
Communication & visibility
Context-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 disparities
Colorado 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 programs
Louisiana 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 Impacts
Promoting 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 Institutes
Sustainability/ institutionalization
Flexibility for policy development
Flexibility for advocacy
Flexibility for administrative purposes
Neutral 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/
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