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Managing competition and turf in coalitions: Ask Dr. Coalition November 15, 2011

Posted by tomwolff in : Coalition Building, Collaborative Solutions, Uncategorized , add a comment

Dear Dr. Coalition,

In my local coalition all the organizational members talk about working for the good of the community. But in reality they are driven by their own self interest. They spend much of their coalition time protecting their territory. Turf wars seem to dominate.

So we really don’t identify what the community needs and coordinate our resources for the good of the community

Any ideas?

Frustrated by turf wars in Illinois

Dear Frustrated,

A clear and explicit goal of coalitions is often to promote coordination, cooperation and collaboration. – to do together that which we cannot do apart. But it comes as no surprise that turf, territoriality and competition among coalition members is a major barrier to coalition success. The capacity of one organization to feel competitive with another often amazes me.

This competition can be just among health and human service agencies as the compete for clients and contracts , but it also can be between private sector and public sector, between local government and state government, or between local government and the community. A new request to provide a service might be issued by the state and two or three different agencies – all members of the same coalition- might begin to compete for that contract, seemingly undermining the coalition’s goal of cooperation.

One would hope that having declared themselves wanting to be part of a coalition, these turf battles would decline – but instead they often escalate.

So what can we do?

A good clear first step is to create a common vision (see The Power of Collaborative Solutions for an easy visioning exercise). This will set up your common goal for all to see.

Then identify (brainstorm) the steps that are needed to reach the vision. This will set out some doable steps that you can take together.

Use priority dots to pick your starting point. Next you are off and running in a direction to meet the community’s needs and hopefully reduce the turf issues.

Here is the bottom line: I know it may sound like heresy to say this, but we need to get competition out of the helping system; it seems to cause much more harm than good. Competition and helping do not necessarily go well together. We need to replace competition with cooperation and collaboration.

Dr Coalition

Dear Reader: What would you suggest to Frustrated in Illinois?

And what coalition dilemmas are you struggling with?

Please comment below:

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Help I am trapped in a Coalition and can’t get out: Meet Dr.Coalition September 26, 2011

Posted by tomwolff in : Coalition Building, Collaborative Solutions , add a comment

So let’s ask Dr Coalition about what traps us in coalitions where there is a failure to act and what we can do to turn that around.

Dear Dr. Coalition,

 I am in a coalition that talks, talks, talks but never acts. This failure to act makes me feel trapped. The members of our coalition can talk about issues endlessly. If anyone suggests taking action they urge them to first do a careful needs assessment, even though we have shelves of these assessments already. It is almost as if they don’t know how to take action or are afraid of taking any action. What can we do?

Sincerely,

Exasperated in Ohio

 

Dear Exasperated,

I’ve seen it all as well– coalitions are creative in finding ways to put off being catalysts for community change and moving to action to change programs, policies and practices in their communities. I have seen coalitions:

So how do we get stuck coalitions to move to action?  Here are some ideas:

First, identify that the lack of action is a problem that many members are experiencing (just ask them!). The literature on successful coalitions says that one of the key variables in successful coalitions is that “outcomes matter”. So tap into that sentiment among your members – that they joined the coalition and continue to commit time to it in order to create community change.

Then together identify some “low hanging fruit” – easy win situations where they can start to act together – they need to see that the core premise of coalitions will work for them – namely “That they can do together that which that they cannot do apart”. They won’t believe that until they act together and get something done.

One helpful tool is “The Continuum of Collaboration Worksheet”. This allows a coalition to assess whether they are mainly doing “networking” which does not involve taking action or whether they have moved on to other more powerful forms of coalition action – namely “coordination” “cooperation” or “collaboration”. This tool, based on Arthur Himmelman’s definitions, is available in The Power of Collaborative Solutions p. 52 ( http://www.tomwolff.com/healthy-communities-tools-and-resources.html) and also on my website (http://www.tomwolff.com/collaborative-solutions-newsletter-summer-05.htm#resources).

 

In future blogs Doctor Coalition will tackle other common coalition issues, such as:

 

Please send Doctor Coalition the coalition dilemmas and issues that you are struggling with.

 

Comment on your ideas on how to address failure to act or pose your own dilemma below.

 

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New Hospital Community Benefit Requirements: Who Will They Benefit? August 22, 2011

Posted by tomwolff in : Uncategorized , 1 comment so far

I was recently invited to present at a Centers for Disease Control and Prevention (CDC) meeting in Atlanta regarding new requirements in the recently passed Affordable Health Care Act and also in new IRS regulations concerning Hospital Community Benefits.

Yes, the IRS is regulating hospital community benefits!

Sounds boring? Think again. This is a real opportunity for communities to partner with local hospitals on key community issues.

What are Community Benefits? Non profit hospitals earn their non-profit status by demonstrating that they have met community health needs that have been determined by a community health needs assessment. This can be a meaningful community collaboration process or it can be window dressing. So, new regulations by HHS and the IRS are trying to ensure that the process has meaning.

A number of years back I was involved in a process of voluntary community benefit guidelines for hospitals and HMOs being piloted by then Massachusetts Attorney General Scott Harshbarger. Through the trials and tribulations of that process we all learned many lessons that can be brought to bear on this present effort. My role, as the founder of  Healthy Communities Massachusetts, in this earlier process was to organize the community side of the equation – local groups that mobilized to hold their community hospitals accountable.

What we discovered was that a few hospitals took the community benefits process seriously and did a great job of partnering with their local communities and developing effective, responsive and relevant community programs. However, most hospitals tried to do the minimum. Their Community Benefits Committees did not represent those most affected by the issues from the grassroots in their community but rather represented the “usual suspects” like local community non-profits, many of whom already held contracts with the hospital.

It was a major effort just to get many of the hospitals to submit their annual reports that described their required community assessments and their community benefit activities in the community. Most fascinating was that when we looked at the reports in many cases we saw almost no correlation between the community assessments and what the hospitals actually did. Their community needs assessment process may have determined that their community need was X and yet they provided Y because Y was more in tune with their mission and plan. Clearly this voluntary process needed more bite to be effective.

So fast forward to 2011, and we see potentially much the same scenario. At this excellent conference, we heard of outstanding examples of hospitals doing a great job of community benefits. I think of the work of Dory Escobar at St Joseph’s Health System in Sonoma County California. Dory is the Director of Healthy Communities and is a community organizer and her work represents those values. Her organizational framework has three areas: Advocacy Initiatives, Healthy Communities Programs and Community Health Programs. (See www.stjosephhealth.org).

We also heard of valuable tools from Julie Willems Van Dijk (U.Wisconsin) like a county system of health rankings. The Rankings are based on a model of population health that emphasizes the many factors that, if improved, can help make communities healthier places to live, learn, work and play. Building on the work of America’s Health Rankings the University of Wisconsin Population Health Institute has used this model to rank the health of Wisconsin counties every year since 2003. Rankings are now available for all counties in the country www.countyhealthranking.org.

Check it out for your county.

When I had my ten minute chance to present -(http://nnphi.org/CMSuploads/Panel%207%20-%20Wolff.pdf ) -

I urged hospitals to engage in true collaboration with those most affected by the issue in the community – with true collaboration described as relationships where we enhance the capacity of each other. I also suggested that community engagement go beyond the needs assessment stage of the process. Rather community partners need to share decision making throughout the community benefit process including setting priorities, implementation, and evaluation. I used the work of the Center for Health Equity and Social Justice at the Boston Public Health Commission as a model of this approach (see http://tomwolff.com/collaborative-solutions-newsletter-summer-10.htm).

So what happens from here on out?

These new regulations are an occasion for all of us to engage with our local hospitals. We must ask what they will be doing to meet these new requirements and tell them how we would like to partner with them in the process of creating their community needs assessment and then continue to work with them on the implementation of their community benefit programs that will meet the identified needs.

My good colleagues at the Community Tool Box (http://ctb.ku.edu) at the University of Kansas have been contracted by the CDC to develop “Recommended Practices for Enhancing Community Health Improvement”. This will be a very comprehensive tool kit based on the wonderful resources of the Community Tool Box for the community needs assessment process.  I will try to keep you informed as to when these resources will go public.

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Time to Transform our Health and Human Service System July 22, 2011

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The time has come for us to rethink and transform the health and human services system in this country. These services cover a vast array of organizations providing a very broad range of services and consume large parts of federal, state and local budgets. The services are often critical for the consumers but the core premises on which the system is based and the system of delivery itself is highly dysfunctional.

The delivery system is characterized by:

1)      A focus on individuals not communities and ignores the environment in which the individual lives

2)      Focuses on the deficits of the individual and the community not their strengths and assets

3)      Services remain targeted at crises and remedial services ignoring how prevention could prevent the problem from occurring in the first place by catching issues upstream

4)      Our systems fail to respond to the diversity of our communities much less address issues of structural oppression, racism etc.

5)      Our helping systems excessively rely on professionals and fail to acknowledge and engage the natural helping systems of families and neighborhoods. Increasingly our helping systems have become detached from the communities they serve.

6)       Our helping system fails to engage those most affected by the issue as equal partners in planning, delivering and evaluating their interventions.

7)      As a system the health and human services in any given community tends to be: competitive rather than collaborative; fragmented so that individuals are treated for distinct problems rather than as whole beings; efforts are duplicated due to lack of information rather than coordinated

8)      Finally the helping system and many of those working in the system have lost their spiritual purpose. They may have chosen their fields with hopes of addressing the common good and now end up counting billable hours.

These system dysfunctions are discussed at greater length in my book The Power of Collaborative Solutions www.tomwolff.com

I have been preaching these dysfunctions and their solutions for decades so it was  a delight to find a fellow traveler and another community psychologist on this campaign in Isaac Prilleltensky , the Dean of  the School of Education at the University of Miami.

Isaac contrasts systems that he describes as SPEC vs DRAIN with SPEC systems standing for systems based on  Strength, Prevention, Empowering and Community. While DRAIN stands for Deficit, Reactive, Arrogant, Individual.

More details on Isaac’s system are available at their web site: http://www.specway.org/wiki/collaboration

Many of us have some stories of individual systems, agencies or interventions that have been able to move from SPEC vs DRAIN (see community stories in my book, or previous issues of my Collaborative Solutions Newsletters  www.tomwolff.com ). These stories need more public airing.

However, the urgent questions now facing all of us are how do we transform our dysfunctional helping system to a strength based system that addresses the system shortcomings noted above and moves in new positive directions.

The present fiscal crisis is leading to dramatic cuts of funding to this helping sector but as noted in my last newsletter (Thriving and Surviving in Hard Times) this is not leading to system transformation but rather retrenchment to a more dysfunctional system. We are cutting prevention and keeping remediation, cutting community wide healthy community programs and keeping services for individuals, etc.

I’d love to hear your thoughts on how to convert our dysfunctional helping systems to ones that are focused on communities, prevention, strengths, our community’s diversity, build on community helping systems, bring those most affected by the issues to the table as equal partners, operate collaboratively, and engage our spirituality as the compass for social change. What are your ideas for transformation of our nation’s health and human service systems.

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More Musings on Community Transformation Grants June 1, 2011

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In my last post I told you about the upcoming Community Transformation Grants. (http://www.cdc.gov/communitytransformation/)

Here are some of my thoughts as I’ve listened and read about what people are saying on this topic:

This is the largest amount of $ we have seen for community prevention in a very long time– over $100 million next year and potentially $900 million over the next five years. So everyone is drooling.

Thanks goes to the Obama Administration for proposing it and to all who lobbied this through despite opposition.

But it is over promised and over committed money. All kinds of federal programs that are facing cut backs are being told that this single pot of $ is going to be their savior. This includes: substance abuse prevention programs, tobacco prevention programs, health disparity programs, food and fitness programs, and all programs funded under the Recovery Act. Clearly there will be winners and losers. So watching and influencing the process at the state level will be crucial.

Now comes the hard part. With only 75 entities to be funded we can be pretty sure that all 50 states will apply and will likely end up being 2/3 of the awardees.

So what is happening in the states? How much input are the state health departments and public health departments getting?  Will they look all across their states at the most successful programs addressing the needs in the RfP or will they choose to mainly include their own department funded programs that are facing budget cuts due to fewer state dollars.

Will the programs that get included address the needs of communities of color and other communities experiencing health inequities?  Will the voice of those most affected by the issues be included in the application? Usually we apply first, state our priorities, and then invite the community in later after we get funding. Will the process be different this time?

If these grants are to live up to their name of “Community Transformation”  and really transform communities (a bold stroke right there) they will need to look like the best community prevention programs that we have seen in recent years.

These exemplars are based on a healthy community model that requires:

serious community engagement and community power,

support of a broad community coalition

understanding health from a Social Determinants of Health perspective

aiming to create systems and policy change

addressing issues of social justice

shifting  from social service to social change models

Some resources that you may find helpful:

Building a Regional Health Equity Model from the Boston Public Health Commission

http://journals.lww.com/familyandcommunityhealth/Fulltext/2011/01001/Building_a_Regional_Health_Equity_Movement__The.6.aspx

A recent Tom Wolff & Associates Collaborative Solutions Newsletter http://tomwolff.com/collaborative-solutions-newsletter-summer-10.htm#center

The Community Tool Box – always a great resource http://ctb.ku.edu

And of course : The Power of Collaborative Solutions  www.tomwolff.com

Please share with all of us what you are seeing in your community? Your state? Add your comments above.

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Community Transformation Grants Are Here at Last May 17, 2011

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New healthy community funding is  now available – check this out.

This announcement just came across my desk:

The U.S. Department of Health and Human Services has announced the availability of over $100 million in funding for up to 75 Community Transformation Grants. Created by the Affordable Care Act, these grants are aimed at helping communities implement projects proven to reduce chronic disease, violence and injury, and improve mental health and equity. It is noteworthy that, this round of funding increases the grant cycle to a five-year period ($900 million), which will allow communities more time to tailor and implement strategies, engage communities and ultimately shift norms around healthy eating and physical activity. It will also engage multiple sectors, encouraging community-based organizations, local and state governments to work together to build sustainable, effective change. This funding cycle emphasizes health equity, with specific outcomes geared towards improving health among those who face the greatest disparities, along with resources dedicated directly towards building capacity.

The language in the CDC announcement http://www.cdc.gov/communitytransformation/ suggests that the purpose of the CTG grants is to create healthier communities by 1) building capacity to implement broad evidence and practice-based policy, environmental, programmatic and infrastructure changes, as appropriate, in large counties and in states, tribes and territories, including in rural and frontier areas and 2) supporting implementation of such interventions in five strategic areas….and demonstrate progress in the following performance measures…1) changes in weight, 2) changes in proper nutrition, 3) changes in physical activity, 4)changes in tobacco use prevalence, 5) changes in emotional well being and overall mental health changes…

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New Newsletter Available: Thriving and Surviving Devastating Funding Cuts May 3, 2011

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A new issue of our Collaborative Solutions Newsletter has just hit the web. This issue is entitled: “Thriving and Surviving Devastating Funding Cuts: Collaboration and Community Building as the Answer – Part One of Survival Tips”

The issue covers:

The present crisis

Time for a new approach: Collaboration, community building and systems change.

Four specific strategies

Focus on sustaining what you have developed

Engage the people in the community and build their support for your efforts

What is new at TW & Associates

Take a look  HERE and let us know what you think

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Great New Resource on Health Equity April 25, 2011

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Health equity is the hot new topic of interest – it is one of the four top goals of HHS’ Healthy People 2020. However many groups approach this critical topic with limited vision. Not so the article entitled “Building a Regional Health Equity Movement: The grantmaking model of a local health department” (click for full article HERE).

This fascinating article describes the work of the Boston Public Health Commission’s Office of Health Equity and Social Justice. They take a broad social determinants approach to reduce racial and ethnic inequities that is based on overtly addressing racism, building local coalitions, community engagement for those most affected by the issues, moving from social services to social change  and focusing on policy change.

Seeing is believing – read the article and let me know what you think by clicking on Add a Comment above. Thanks

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Look at what’s in this month’s APA Monitor April 12, 2011

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I was very pleased to see that the April 2011 issue of the American Psychological Association Monitor (their trade news magazine that goes to all ….. members) featured  an article entitled “Bringing Communities Together”  which looks at my coalition and community building work. Often when you talk to reporters you are not too sure what will emerge. In this case Kirsten Weir did a great job in taking a long rambling interview and consolidating it into a brief engaging story. Take a look and let me know what you think….

http://www.apa.org/monitor/2011/04/communities.aspx

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The Reviews Are Starting to Come In April 4, 2011

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When you have a book published like The Power of Collaborative Solutions it is so hard to know what people actually think of it . So it is fun when the reviews finally start to come in.  I am pleased to be able to share with you some of the new reviews of my book that have been emerging in recent issues of professional journals:

Bill Berkowitz in the January 2011 issue of The National Civic Review

“Tom Wolff’s The Power of Collaborative Solutions does in fact give us something different and new, in two major respects; one in its practical teaching, the other in its specific content. Both are distinctive, making this book well worth the attention of any community or civic affairs leader”

For full review:HERE

Adrienne Paine Andrews in the January 2010 issue of the Global Journal of Community Psychology Practice  www.gjcpp.org

“Tom Wolff provides a passionate and convincing case for using collaborative approaches to address our most intractable community problems. He offers personal reflection, case studies and tools based on his extensive experience to help us move toward more effective, sustainable, and collaborative solutions.”

Full review HERE

Brad Olsen in the April 2011 Issue of The Community Psychologist

“The book is filled with tips, theoretical orientations, and practical tools. One regularly encounters sections of the text and says, “Yes, I’ll have to try that in my next dialogue with X organization. That could be useful.”

Full Review HERE

 

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