1. Turning Point Effective Collaboration Utilizing Partnerships: Lessons from the Turning Point Initiative Bobbie Berkowitz, PhD, RN, FAAN Professor and Department Chair University of Washington

2. Turning Point Do Collaborative Partnerships Make a Difference? An Oklahoma Story or Two

3. Turning Point 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 25 th in the health status compared to other countries; trailing most European countries  Despite healthcare spending and advances, the US moved from 13 th in 1960 to 25 th in 2000  Need for stable and predictable public health funding

4. Turning Point 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

5. Turning Point 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

6. Turning Point Turning Point States

7. Turning Point A Little Background on Collaboration

8. Turning Point 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

9. Turning Point 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

10. Turning Point Expectations  Realistic  Info exchange  Common goal  Promote collaboration  Legitimize issue  Realistic with Reservations  Program planning  Influence policy  Influence resource allocation  Unrealistic  Program implementation  Influence organizational or systems change in a community  Influence health outcomes Kreuter et al. 2000. Health Promotion Practice

11. Turning Point Example of National Level Collaboration

12. 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

13. Turning Point National Excellence Collaboratives  Performance Management  Information Technology  Leadership Development  Public Health Statute Modernization  Social Marketing to Improve Population Health Outcomes

14. Turning Point 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

15. Turning Point 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)

16. Turning Point State Level Partnerships  What themes and key elements are associated with state-level partnerships?  How do these compare with partnerships in the literature?

17. Turning Point Structure & Process  Hard work, long time  Formal structure & decision-making  Interpersonal relationships & material support  Choosing projects wisely  Local context and variability

18. Turning Point Working in & across Existing Systems  Categorical funding – “silos”  Relationships between state and local agencies  Proximity to power & political ‘transitions’

19. Turning Point Leveraging Change  Importance of high-level support  Collaborative leadership

20. Turning Point Sustaining Collaborative Partnerships What are the strategies in use by Turning Point partnerships to sustain their innovations for change?

21. Turning Point 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

22. Turning Point Integration within Government  Institutionalizing specific initiatives  Linking with other programs  Diffusion and incorporation

23. Turning Point Outside Government: Alternative Structures  Setting up new structures (e.g. 501c3 agencies), or linking with pre-existing ones  Collaboration, not competition, with state agencies

24. Turning Point How Does Sustainability Happen?  Intentional relationships  Communication & visibility  Context-driven decisions

25. Turning Point The Impact of Collaborative Partnerships: Some Examples

26. Turning Point 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.

27. 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.

28. Turning Point 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

29. Turning Point 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

30. 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.

31. 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

32. Turning Point Lessons to Carry Forward

33. Turning Point 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

34. Turning Point 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

35. Turning Point 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

36. Turning Point 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

37. Turning Point Questions? Comments?

38. Turning Point 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

39. Turning Point http://www.turningpointprogram.org/