Effective Collaboration
Utilizing Partnerships:
Lessons from the Turning
Point Initiative
Bobbie Berkowitz, PhD, RN, FAAN
Professor and Department Chair
University of Washington
Turning Point
Do Collaborative Partnerships
Make a Difference?
An Oklahoma Story or Two
Turning Point
Challenges to Public
Health Infrastructure
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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
Turning Point
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.
Turning Point
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
Turning Point
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.
Turning Point
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
Turning Point
•http://www.turningpointprogram.org/
Turning Point