Mapping the Partnership: Using Concept Mapping for the Development of a Complementary Action Partner

1
Mapping the Partnership Using Concept Mapping
for the Development of a Complementary Action
Partnership Model for Public Health

• Mary Kane, President/CEO
• Kathleen M. Quinlan, Senior Consultant
• Concept Systems, Inc.
• October 29, 2005
• 2005 Joint Canadian Evaluation Society and
  American Evaluation Association meeting Toronto,
  Ontario

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Outline

• Define Problem - limitations of existing models
  and importance to public health
• Method Concept mapping to develop partnership
  model
• Results Complementary Action Partnership Model
  for Public Health
• Assessment and Evaluation in the Partnership
  Model

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Why partner?

• Problems are too big, too complex, too
  intransigent
• Outside constraints or influencers neutralize
  potential impact of an organization.
• Any one organization is limited by mission or
  mandate in efforts to effect broad change.
• Resources are insufficient.

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Why partner for public health?

• All members of a community are affected by the
  poor health status of its least healthy members.
  IOM
• To eliminate the things that burden people
  unfairly, that cause disparities and inequities
  in quality of health, and that perpetuate
  inequity.
• To create a new national health status.

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Partnerships Defined

• Working together from multiple sectors..to
  achieve a common purpose (Himmelman, 1992)
• Establishing an equitably negotiated
  arrangement (Roussos and Fawcett, 2000)
• A dynamic relationship (with) mutually agreed
  objectives (and) division of labor based on
  respective comparative advantages of each partner
  (demonstrating) mutual respect, equal
  participation in decision-making, mutual
  accountability and transparency. (Brinkerhoff,
  2002)
• a process in which the stakeholders invest
  themselvesto collectively bear on the problem
  through mechanisms for joint decision making and
  action. (El Ansari 2004 Orange Free State
  Community Partnership, 1995)

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Looking more closelySome Partnership Elements

• Time, trust, turf
• Network/cooperative/collaboration
• Risks, rewards, responsibilities
• Longevity, habit
• Functions or purposes
• Formality of structures

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Hierarchies of commitment in partnerships
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Limitations of Existing Partnership Models

• Language is imprecise
• Purposes are sometimes vague
• Structures can be exclusionary
• In the business of being in business
• Many good ideas within current models, but need
  to be combined meaningfully

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A Definition for consideration..

• A partnership is the result of a conscious
  decision to
• Commit assets to a common goal
• Negotiate an acceptable level of autonomy
• Broaden emphasis from ones own needs to those of
  an aggregate effort
• Take action on behalf of others
• in order to realize expected rewards.

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Creating a Conceptual Framework

• Reviewed literature on partnerships
• Tapped experience of seasoned partners in chronic
  disease
• Abstracted ideas that responded to the focus
  prompt
• For a partnership to work well .it should..
• Organized ideas conceptually

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A concept map of specific definitionsConceptuall
y similar ideas are in close proximity
Articulate how a specific partnership will
address disparities for the population, life
stage or context that is their responsibility.
(41) Ensure that all partnership leaders, lead
agencies, and fiscal agents are accountable to
the decision-making body of the collaborative
process. (61) Develop a common agreement on what
will constitute success for the partnerships
efforts. (82)
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Conceptually different ideas are further apart
Demonstrate effective leadership skills in
meeting facilitation, negotiation and networking.
(62)
Actively solicit input from affected groups or
communities. (1)
Develop a common agreement on what will
constitute success for the partnerships efforts.
(82)
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The ideas are clustered by similarity
Each cluster contains a group of characteristics
of a successful partnership we will illustrate
with just a few
14
Build Political Support
Actively solicit input from affected groups or
communities. (1) Use planning time to seek
financial support for the operation of the
partnership. (13) Expand the partnership's
support base and funding sources. (14) Use a
swinging door approach to communication with
communitiesopen communication from the
partnership and open reception of knowledge and
feedback from the communities. (24) Rely on CDC
and other federal or national sources for
gathering and making available knowledge and data
on disparities. (30) Keep abreast of social and
political changes that may affect the work of the
partnership. (32) Ensure that funding and support
agencies for each active partner are also
supportive of the activities of the partnership.
(38) Ensure that the partnership is recognized as
a respected entity that can speak to the issue at
hand. (40) Have knowledge of educational,
structural, behavioral and other interventions
that could be considered in specific contexts.
(45) Make decisions based on relevant
surveillance data or environmental scans.
(46) Make sure we measure, report on and
disseminate the information that matters to the
desired outcomes of a partnership effort.
(52) Have a social marketing component that
ensures the partnerships efforts and successes
are recognized. (83) Commit to reaching and
involving community members in a variety of ways
to meet needs of the issue at hand. (84)
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Agree Upon Operating Principles
Talk candidly about the serious issues
surrounding health disparities. (16) Work on
earning and maintaining a high level of trust
among the partners. (18) Support comprehensive
approaches, while still keeping attention focused
on the partnership's goals. (33) Know the issues
and have a common vocabulary to help effective
communication and increase the partnership's
effectiveness. (58) Develop deliberate ways to
broaden capacity and build sustainability for
partners organizations. (81)
16
Plan Purposefully
Be aware of the benefits and drawbacks of the
partnership structure. (2) Demonstrate shared
governance, responsibility and ownership in good
times and bad. (15) Attempt to establish equity
in risk and responsibility levels for partners.
(29) Recognize that a partnership cannot move as
fast as a single entity. (39) Articulate how a
specific partnership will address disparities for
the population, life stage or context that is
their responsibility. (41) Recognize various
kinds of resources, and work deliberately to
balance each members level of risk as a partner.
(48) Work on commonly valuable health goals, not
just common funding initiatives. (49) Be willing
to dissolve the partnership if it is not a
working entity. (50) Spend time planning the
partnership as an entity, whether it is a
long-term relationship or and adhoc
collaboration. (51) Ensure that all partnership
leaders, lead agencies, and fiscal agents are
accountable to the decision-making body of the
collaborative process. (61) Clearly define the
need and plan the work of the partnership toward
that need. (72)
Develop a common agreement on what will
constitute success for the partnerships efforts.
(82) Establish a clearly articulated agreement as
to the vision and purposes of the partnership.
(89)
17
Adopt a Responsive Structure
Know what type of partnership is needed for the
purpose at hand, and focus membership and
responsibilities accordingly. (4) Encourage
members to think like a system of resources and
will to change the impact of disparities on
health. (7) Encourage or require rotating
leadership, to include other organizations than
the traditional leaders. (10) Respect partner
commitment by working efficiently to set work
plans and accomplish tasks. (26) Be allowed to
grow at its own pace so solid bridges can be
built to sustain it. (27) Have a flexible
structure to allow for responsive action.
(31) Use a process that is designed and run by
its diverse participants. (53)
Set goals, expectations and time frames for
achieving them. (59) Agree on the definition of a
working partnership, and use the definition to
keep the partnership on track. (66) Be prepared
to expand or rotate the partnership membership,
depending on the partnership agenda at any time.
(70) Identify and recognize the core group of
partners, and support their added commitment.
(75) Be willing to put itself out of business
when goals have been met to the level possible by
the partnership. (76) Have formal agreements for
data sharing. (87)
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Identify Partner Risks and Rewards
Deliberately articulate the risks and rewards
that members may have, and seek equitable
balance. (5) Recognizes the value of supporting
the research and development efforts of its
partner members. (6) Concentrate on focusing
public attention on disparities as a major public
health issue, even as other threats are emerging.
(8) Have partners willing to share turf in order
to reach common goals. (11) Recognize and address
competing demands of the partner institutions, to
lead to a "win-win" expectation. (12) Be
sensitive to the risks that an initiative might
pose in the eyes of underrepresented or
disparate groups. (21) Work innovatively within
the categorical framework of funding. (22) Have
support of funders, in advance of partnership
action. (28)
Keep focus on the larger issue of elimination of
disparities, and be able to connect each
partnership activity to that focus. (35) Accept
that credit for achievement is not always shared
equitably within a partnership. (43) Understand
the partnerships responsibilities to funders and
recognize funders' roles in the partnership.
(47) Clearly identify what each partners stake
and interest in the project or problem is.
(78) Demonstrate respect for each partners
contribution to the work of the partnership.
(80) Ensure accountability by ongoing assessment
of the partnerships effectiveness. (88)
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Employ Effective Work Strategies
Use a democratic, consensus-building process.
(9) Demand involvement and participation on the
part of all partners, in keeping with their
identified capabilities and resources.
(44) Document activities and outcomes to provide
feedback to partners about what is working.
(55) Have an approach to communicating among and
through the partners that is effective and saves
time and cost. (56) Agree in advance to specific
conflict resolution strategies. (57) Lead to the
adoption of actions, not merely advising on
problems. (67) Use conference meetings as partner
work sessions, to cross-germinate plans and
actions to address the issues. (69) Be aware of
existing power differentials, and make deliberate
commitment to balance within the partnership.
(74) Understand the need for negotiating within
the partnership. (77) Break the work of the
partnership down into achievable segments or
progress units. (90)
20
Engage Diverse Partners
Cross over traditional barriers to build
partnerships. (3) Include individuals who are
able to present innovations and problem-solving
approaches that traditional members may not have
access to. (17)
Include the communities of greatest burden, need
or ability to inform the partnership. (20) Engage
non-health partners who have access to the
communities that shoulder the greatest health
burdens. (36) Include partners who have a strong
background in comorbidity and co-existing
conditions. (42) Include partners who can act as
advocates, and train other partners to advocate.
(54) Encourage and expect national public health
leaders to lead in connecting non traditional
partners with traditional groups. (60) Bring
together the public and private sectors to
deliver integrated, cost-effective services
across the continuum of carefrom health
protection and primary prevention to tertiary
care. (63) Encourage researchers to take part in
the partnership as more than technical support
resources. (64) Create a profile of partner
organizations and representatives to ensure
inclusivity. (65) Involve private sector
stakeholders in the partnership, for information,
buy-in and operational support. (71) Include
individuals who are capable of helping the
partnership manage differences of opinion or
emphasis. (79) Include members who are able to
persuade policy makers at any appropriate level.
(86)
21
Activate Partners as Resources
Identify strategies to incorporate partners with
participation constraints such as limited
funding, staff, etc. (19) Use the knowledge of
the partners to decide on most appropriate
actions to take. (23) Include a leader or member
who is capable of mobilizing the partnership for
action on the issue at hand. (25) Build actions
based on evidence of success in similar contexts.
(34) Develop a panel of resources to support the
work of the partnership, who can be called upon
as partnership advisors. (37) Demonstrate
effective leadership skills in meeting
facilitation, negotiation and networking.
(62) Connect the capabilities of a specific
member to an achievable action that benefits the
partnership. (68) Rely on evidence-based
strategies. (73) Work at the local level with the
knowledge and support of state and/or national
agencies. (85)
22
Characteristics of a Successful Partnership
Engage Diverse Partners
Build Political Support
Activate Partners as Resources
Employ Effective Work Strategies
Agree Upon Operating Principles
Identify Partner Risks and Rewards
Adopt a Responsive Structure
Plan Purposefully
contains all the details and provides a
conceptual framework.
23
Transforming the Map into a Model

• Based on
• Complementarity a goal of equitability in
  partner contribution and benefit
• Action Focus a solid, supported structure for
  action on the issues
• Emergent concepts from
• Literature
• Expert interviews
• Concept mapping
• Framed by focus For a partnership to work well
  to eliminate disparities and inequities in health
  care, service and delivery, it should.
• Major clusters define model

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Graphic transition from map to model start with
operating principles
Engage Diverse Partners
Build Political Support
Activate Partners as Resources
Employ Effective Work Strategies
Agree Upon Operating Principles
Identify Partner Risks and Rewards
Adopt a Responsive Structure
Plan Purposefully
25
Graphic transition from map to model start with
operating principles
Talk candidly about the serious issues
surrounding health disparities. (16) Work on
earning and maintaining a high level of trust
among the partners. (18) Support comprehensive
approaches, while still keeping attention focused
on the partnership's goals. (33) Know the issues
and have a common vocabulary to help effective
communication and increase the partnership's
effectiveness. (58) Develop deliberate ways to
broaden capacity and build sustainability for
partners organizations. (81)
Agree Upon Operating Principles
26
Concentrate on Partnership Development
Engage Diverse Partners
Build Political Support
Activate Partners as Resources
Employ Effective Work Strategies
Agree Upon Operating Principles
Identify Partner Risks and Rewards
Adopt a Responsive Structure
Plan Purposefully
27
Concentrate on Partnership Development
Spend time planning the partnership as an entity,
whether it is a long-term relationship or and
adhoc collaboration. (51) Ensure that all
partnership leaders, lead agencies, and fiscal
agents are accountable to the decision-making
body of the collaborative process. (61) Clearly
define the need and plan the work of the
partnership toward that need. (72) Clearly
identify what each partners stake and interest
in the project or problem is. (78) Recognize and
address competing demands of the partner
institutions, to lead to a "win-win" expectation.
(12) Be sensitive to the risks that an initiative
might pose in the eyes of underrepresented or
disparate groups. (21) Set goals, expectations
and time frames for achieving them. (59) Agree on
the definition of a working partnership, and
use the definition to keep the partnership on
track. (66) Be willing to put itself out of
business when goals have been met to the level
possible by the partnership. (76) ..
Identify Partner Risks and Rewards
Adopt a Responsive Structure
Plan Purposefully
28
Engage Potential Partners
Engage Diverse Partners
Build Political Support
Activate Partners as Resources
Employ Effective Work Strategies
Agree Upon Operating Principles
Identify Partner Risks and Rewards
Adopt a Responsive Structure
Plan Purposefully
29
Engage Potential Partners
Support involvement and participation on the part
of all partners, in keeping with their identified
capabilities and resources. (44) Document
activities and outcomes to provide feedback to
partners about what is working. (55) Have an
approach to communicating among and through the
partners that is effective and saves time and
cost. (56) Agree in advance to specific conflict
resolution strategies. (57) Include the
communities of greatest burden, need or ability
to inform the partnership. (20) Engage non-health
partners who have access to the communities that
shoulder the greatest health burdens.
(36) Include partners who have a strong
background in comorbidity and co-existing
conditions. (42) Include partners who can act as
advocates, and train other partners to advocate.
(54) Identify strategies to incorporate partners
with participation constraints such as limited
funding, staff, etc. (19) Use the knowledge of
the partners to decide on most appropriate
actions to take. (23) Include a leader or member
who is capable of mobilizing the partnership for
action on the issue at hand. (25) Build actions
based on evidence of success in similar contexts.
(34).
Engage Diverse Partners
Activate Partners as Resources
Employ Effective Work Strategies
30
Ongoing Activity Build Political Support
Engage Diverse Partners
Build Political Support
Activate Partners as Resources
Employ Effective Work Strategies
Agree Upon Operating Principles
Identify Partner Risks and Rewards
Adopt a Responsive Structure
Plan Purposefully
31
Ongoing Activity Build Political Support
Actively solicit input from affected groups or
communities. (1) Use planning time to seek
financial support for the operation of the
partnership. (13) Expand the partnership's
support base and funding sources. (14) Use a
swinging door approach to communication with
communitiesopen communication from the
partnership and open reception of knowledge and
feedback from the communities. (24) Rely on CDC
and other federal or national sources for
gathering and making available knowledge and data
on disparities. (30) Keep abreast of social and
political changes that may affect the work of the
partnership. (32) Ensure that funding and support
agencies for each active partner are also
supportive of the activities of the partnership.
(38)
Build Political Support
32
Ongoing Activity Assessment and Measurement
Engage Diverse Partners
Build Political Support
Activate Partners as Resources
Employ Effective Work Strategies
Agree Upon Operating Principles
Identify Partner Risks and Rewards
Adopt a Responsive Structure
Plan Purposefully
33
Ongoing Activity Assessment and Measurement
Make decisions based on relevant surveillance
data or environmental scans. (46)
Expand the partnership's support base and funding
sources. (14)
Engage Diverse Partners
ENGAGE
POLITICAL SUPPORT
Activate Partners as Resources
Employ Effective Work Strategies
OPERATING PRINCIPLES
Identify Partner Risks and Rewards
Adopt a Responsive Structure
Plan Purposefully
Make sure we measure, report on and disseminate
the information that matters to the desired
outcomes of a partnership effort. (52)
DEVELOP
Develop a common agreement on what will
constitute success for the partnerships efforts.
(82)
34
A Complementary Action Partnership Model
BUILD POLITICAL SUPPORT
NEED
Buy-In, Funding
Use, innovation, legislation
Develop Engage Act
Change
Operating Principles
Accountability MEASURE/ASSESS Evidence
35
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From a Model to a Workplan

• Look back inside the concept map
• Use go zones to establish priorities for
• Assessment
• Action
• Evaluation

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After the Model.

• Based on the model and the resulting workplan
• workshops on partnerships in public health
• training materials
• self-assessments

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Thank You and An Invitation

• See you during the conference at the Concept
  Systems, Inc. - Hard Art Cafe
• Visit us online www.conceptsystems.com