Diagnosis of sustainable collaboration in health promotion – a case study

Background  

Collaborations are important to health promotion in addressing multi-party problems. Interest in collaborative processes in health promotion is rising, but still lacks monitoring instruments. The authors developed the DIagnosis of Sustainable Collaboration (DISC) model to enable comprehensive monitoring of public health collaboratives. The model focuses on opportunities and impediments for collaborative change, based on evidence from interorganizational collaboration, organizational behavior and planned organizational change. To illustrate and assess the DISC-model, the 2003/2004 application of the model to the Dutch whole-school health promotion collaboration is described.     

Communicating Health at Work: Organizational Wellness Programs as Identity Bridges

With the growth in workplace health promotion (WHP) initiatives, organizations are asking employees to enact their personal health identities at work. To understand this prominent yet poorly understood phenomenon, we surveyed 204 employees at a company with a WHP program and found that participation in the wellness program mediated personal health and organizational identities. Results fill a gap in communication literature by demonstrating the effect of individual identity enactment on organizational identification and contribute to recent research stressing the relationship between identity and health behaviors. In addition, findings illuminate the role of situated activity in identity negotiation, suggesting that certain activities in organizations, like wellness programs, serve as identity bridges between personal and work-related identity targets.     

Working with community organizations for nutrition intervention

Effective community nutrition interventions require nutritionand health professionals to collaborate with organizations thatserve as hosts or loci for programs. These organizations includeworkplaces, schools, cafeterias, restaurants and supermarkets.Although nutritionists need to develop collaborative workingrelationships with community organizations, they often lackknowledge about organizational change and experience difficultyinitiating and maintaining relationships. This paper describesconcepts from theories of organizational change and an exampleof how they were used to help formulate guidelines for developingand analyzing successful collaborative relationships. In a consensusdevelopment workshop guidelines were developed in five areas:(1) goals for mutual relationships; (2) initiation: decidingwhether to work with an organization; (3) strategies for workingwith host organizations; (4) identifying sources of resistanceto change; and (5) warning signs and strategic retreat. Applyingthese guidelines should result in more effective collaborativerelationships for community nutrition education.     

Organizational change--key to capacity building and effective health promotion

Contemporary health promotion is now a well-defined discipline with a strong (albeit diverse) theoretical base, proven technologies (based on program planning) for addressing complex social problems, processes to guide practice and a body of evidence of efficacy and increasingly, effectiveness. Health promotion has evolved principally within the health sector where it is frequently considered optional rather than core business. To maximize effectiveness, quality health promotion technologies and practices need to be adopted as core business by the health sector and by organizations in other sectors. It has proven difficult to develop the infrastructure, workforce and resource base needed to ensure the routine introduction of high-quality health promotion into organizations. Recognizing these problems, this paper explores the use of organizational theory and practice in building the capacity of organizations to design, deliver and evaluate health promotion effectively and efficiently. The paper argues that organizational change is an essential but under-recognized function for the sustainability of health promotion practice and a necessary component of capacity-building frameworks. The interdependence of quality health promotion with organizational change is discussed in this paper through three case studies. While each focused on different aspects of health promotion development, the centrality of organizational change in each of them was striking. This paper draws out elements of organizational change to demonstrate that health promotion specialists and practitioners, wherever they are located, should be building organizational change into both their practice and capacity-building frameworks because without it, effectiveness and sustainability are at risk.     

The meaning of justice in safety incident reporting

Safety experts contend that to make incident reporting work, healthcare organizations must establish a "just" culture-that is, an organizational context in which health professionals feel assured that they will receive fair treatment when they report safety incidents. Although healthcare leaders have expressed keen interest in establishing a just culture in their institutions, the patient safety literature offers little guidance as to what the term "just culture" really means or how one goes about creating a just culture. Moreover, the safety literature does not indicate what constitutes a just incident reporting process in the eyes of the health professionals who provide direct patient care. This gap is unfortunate, for knowing what constitutes a just incident reporting process in the eyes of front-line health professionals is essential for designing useful information systems to detect, monitor, and correct safety problems. In this article, we seek to clarify the conceptual meaning of just culture and identify the attributes of incident reporting processes that make such systems just in the eyes of health professionals. To accomplish these aims, we draw upon organizational justice theory and research to develop a conceptual model of perceived justice in incident reporting processes. This model could assist those healthcare leaders interested in creating a just culture by clarifying the multiple meanings, antecedents, and consequences of justice.     

Advancing community health through community health partnerships

Improving a community's health is a key goal of health services organizations. Effectively pursuing that goal requires health services organizations to create partnerships with other organizations to help identify community health needs and to create and carry out programs that bring together community members and needed health services. Drawing on community systems concepts and a recent study of community health partnership efforts in three cities, this article provides a framework for such partnerships. Types of partnerships described include: Community action partnerships, in which the partnership forms to address a specific problem or pursue a specific opportunity. Community organization partnerships, in which a set of organizations in a similar service sector agree to collaborate for mutually agreed upon goals; and Community development partnerships, in which a partnership attempts to increase participation by people and organizations in collaborative activities that advance the community on multiple fronts or that contribute to community assets and services in multiple areas. The article also describes how the pressures to create large integrated delivery systems can affect creation of partnerships to improve community health. Increasingly, healthcare leaders are being held accountable for the health of communities they serve. When creating partnerships for community health and carrying out health-improvement activities, leaders should be aware of and respond to four key dimensions of accountability: political accountability, commercial accountability, clinical/patient accountability, and community accountability.     

Defining and operationalizing capacity for heart health promotion in Nova Scotia, Canada

This paper presents an operational definition of capacity building for heart health promotion, instruments developed to measure heart health capacity, and baseline results of capacity for 20 organizations. Qualitative and quantitative research methods were used to collect data. Three instruments were developed to measure organizational capacity for heart health promotion: a survey of community agencies involved in heart health, a questionnaire of organizational practices supportive of heart health promotion, and an interview guide that focused on factors influencing heart health promotion. These instruments proved effective and informed the development of a comprehensive framework for heart health promotion.     

Community action and reflective practice in health promotion research

While health promotion practitioners are engaging increasingly in research, there has been little examination of the practical dilemmas they may face in negotiating and collaborating with academics and community members in action research projects. This paper analyses how the practice of health promotion can interact with action research, and considers issues that arise for organizationally based health promotion practitioners and professional researchers. The first section charts types of action research along three dimensions (power, goals/values, resources). The second section examines some of the issues and practical dilemmas which arise in negotiating and researching collaborative projects in community health promotion. The discussion includes the differing perspectives of: practitioners (managerial and frontline), community members and academic researchers. The final section outlines a hybrid model of action research, developed in our work with community members, organizationally based health promoters and academy-based researchers. It combines the reflective practice of practice-based action research with the community participation and control of participatory research. The model is called community reflective action research.     

Building capacity for heart health promotion: results of a 5-year experience in Nova Scotia,Canada

PURPOSE: To present the outcomes of a capacity-building initiative for heart health promotion. DESIGN: Follow-up study combining quantitative and qualitative methods. SETTING: The Western Health Region of Nova Scotia, Canada. SUBJECTS: Twenty organizations, including provincial and municipal agencies and community groups engaged in health, education, and recreation activities. INTERVENTION: Two strategies were used for this study: partnership development and organizational development. Partnership development included the creation of multilevel partnerships in diverse sectors. Organizational development included the provision of technical support, action research, community activation, and organizational consultation. MEASURES: Quantitative data included number and type of partnerships, learning opportunities, community activation initiatives, and organizational changes. Qualitative data included information on the effectiveness of partnerships, organizational consultation, and organizational changes. RESULTS: Results included the development of 204 intersectoral partnerships, creation of a health promotion clearinghouse, 47 workshops attended by approximately 1400 participants, diverse research products, implementation of 18 community heart health promotion initiatives, and increased organizational capacity for heart health promotion via varied organizational changes, including policy changes, fund reallocations, and enhanced knowledge and practices. CONCLUSIONS: Partnership and organizational development were effective mechanisms for building capacity in heart health promotion. This intervention may have implications for large-scale, community-based, chronic-disease prevention projects.     

Partnerships for Comprehensive School Health: Collaboration Among Colleges/Universities, State-Level Organizations, and Local School Districts

A qualitative survey on the collaborative experiences of colleges and universities, state-level organizations, and school districts related to comprehensive school health programs in 12 states found four primary collaborative outcomes: training, consultation, research, and networking. Five common dimensions of collaboration also were identified: interpersonal and organizational interactions, level of awareness and understanding of comprehensive school health programs, organizational priorities and reward systems, political forces, and availability and sharing of resources. The potential for such linkages to advance comprehensive school health programs remains largely untapped. Recommendations for developing such collaborations are presented.     

The productive use of threat in primary care: behavioural responses to health promotion.

The importance of a scientific understanding of the behavioural change processes involved in certain health promotion interventions is stressed. A model for guiding the behavioural dimensions in health promotion in primary care is presented. This distinguishes between information-giving and -providing skills to facilitate behavioural change. The social factors which impinge upon processes of behaviour change are highlighted. It is suggested that health promotion clinics in primary care may produce a situation with which the client has to cope. The manner of their coping will be a critical factor in determining outcome. Some key organizational issues are underlined.     

An integrative framework for community partnering to translate theory into effective health promotion strategy

INTRODUCTION: Although there is general agreement about the complex interplay among individual-, family-, organizational-, and community-level factors as they influence health outcomes, there is still a gap between health promotion research and practice. The authors suggest that a disjuncture exists between the multiple theories and models of health promotion and the practitioner's need for a more unified set of guidelines for comprehensive planning of programs. Therefore, we put forward in this paper an idea toward closing the gap between research and practice, a case for developing an overarching framework--with several health promotion models that could integrate existing theories--and applying it to comprehensive health promotion strategy. AN INTEGRATIVE FRAMEWORK: We outline a theoretical foundation for future health promotion research and practice that integrates four models: the social ecology; the Life Course Health Development; the Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation-Policy, Regulatory and Organizational Constructs in Educational and Environmental Development; and the community partnering models. The first three models are well developed and complementary. There is little consensus on the latter model, community partnering. However, we suggest that such a model is a vital part of an overall framework, and we present an approach to reconciling theoretical tensions among researchers and practitioners involved in community health promotion. INTEGRATING THE MODELS: THE NEED FOR SYSTEMS THEORY AND THINKING: Systems theory has been relatively ignored both by the health promotion field and, more generally, by the health services. We make a case for greater use of systems theory in the development of an overall framework, both to improve integration and to incorporate key concepts from the diverse systems literatures of other disciplines. VISION FOR HEALTHY COMMUNITIES: (1) Researchers and practitioners understand the complex interplay among individual-, family-, organizational-, and community-level factors as they influence population health; (2) health promotion researchers and practitioners collaborate effectively with others in the community to create integrated strategies that work as a system to address a wide array of health-related factors; (3) The Healthy People Objectives for the Nation includes balanced indicators to reflect health promotion realities and research-measures effects on all levels; (4) the gap between community health promotion "best practices" guidelines and the way things work in the everyday world of health promotion practice has been substantially closed. CONCLUSIONS AND RECOMMENDATIONS: We suggest critical next steps toward closing the gap between health promotion research and practice: investing in networks that promote, support, and sustain ongoing dialogue and sharing of experience; finding common ground in an approach to community partnering; and gaining consensus on the proposed integrating framework.     

A methodological approach and framework for sustainability assessment in NGO-implemented primary health care programs

An estimated 10.8 million children under 5 continue to die each year in developing countries from causes easily treatable or preventable. Non governmental organizations (NGOs) are frontline implementers of low-cost and effective child health interventions, but their progress toward sustainable child health gains is a challenge to evaluate. This paper presents the Child Survival Sustainability Assessment (CSSA) methodology--a framework and process--to map progress towards sustainable child health from the community level and upward. The CSSA was developed with NGOs through a participatory process of research and dialogue. Commitment to sustainability requires a systematic and systemic consideration of human, social and organizational processes beyond a purely biomedical perspective. The CSSA is organized around three interrelated dimensions of evaluation: (1) health and health services; (2) capacity and viability of local organizations; (3) capacity of the community in its social ecological context. The CSSA uses a participatory, action-planning process, engaging a 'local system' of stakeholders in the contextual definition of objectives and indicators. Improved conditions measured in the three dimensions correspond to progress toward a sustainable health situation for the population. This framework opens new opportunities for evaluation and research design and places sustainability at the center of primary health care programming.     

Community-Based Organizational Capacity Building as a Strategy to Reduce Racial Health Disparities

One of the biggest challenges facing racial health disparities research is identifying how and where to implement effective, sustainable interventions. Community-based organizations (CBOs) and community-academic partnerships are frequently utilized as vehicles to conduct community health promotion interventions without attending to the viability and sustainability of CBOs or capacity inequities among partners. Utilizing organizational empowerment theory, this paper describes an intervention designed to increase the capacity of CBOs and community-academic partnerships to implement strategies to improve community health. The Capacity Building project illustrates how capacity building interventions can help to identify community health needs, promote community empowerment, and reduce health disparities.     

The meta-volition model: Organizational leadership is the key ingredient in getting society moving, literally!

This paper argues that substantive and sustainable population-wide improvements in physical activity can be achieved only through the large scale adoption and implementation of policies and practices that make being active the default choice and remaining inactive difficult. Meta-volition refers to the volition and collective agency of early adopter leaders who implement such changes in their own organizations to drive productivity and health improvements. Leaders, themselves, are motivated by strong incentives to accomplish their organizational missions. The meta-volition model (MVM) specifies a cascade of changes that may be sparked by structural integration of brief activity bouts into organizational routine across sectors and types of organizations. MVM builds upon inter-disciplinary social ecological change models and frameworks such as diffusion of innovations, social learning and social marketing. MVM is dynamic rather than static, integrating biological influences with psychological factors, and socio-cultural influences with organizational processes. The model proposes six levels of dissemination triggered by organizational marketing to early adopter leaders carried out by “sparkplugs,” boisterous leaders in population physical activity promotion: initiating (leader–leader), catalyzing (organizational–individual), viral marketing (individual–organizational), accelerating (organizational–organizational), anchoring (organizational–community) and institutionalizing (community–individual). MVM embodies public–private partnership principles, a collective investment in the high cost of achieving and maintaining active lifestyles.     

Why hospitals offer health promotion: perspectives for collaborating with health promotion practitioners

Most hospitals have expanded their services in recent years to become involved with health promotion programs and activities. A hospital might offer health promotion services to promote health and to raise the health status of its community. However, it might provide health promotion for other reasons, such as to improve the hospital's cost-effectiveness, competitive strategy, organizational legitimacy, or tax exemption. Health promotion practitioners who collaborate with a hospital for health promotion should understand the hospital's reasons for providing health promotion. Furthermore, they should understand that different reasons may lead to different priority populations, resource commitments, organizational structures, work processes, and health outcomes.     

Development of a collaborative model to improve school health promotion in The Netherlands

In recent decades, school health promotion programs have been developing into whole-school health approaches. This has been accompanied by a greater understanding among health promoters of the core-business of schools, namely education, and how health promotion objectives can be integrated into this task. Evidence of the positive impact of school health promotion on health risk behavior of students is increasing. This article focuses on the processes and initial results of developing a collaborative model tailored for whole-school health in the Netherlands, named schoolBeat. The Dutch situation is characterized by fragmentation, a variety of health and welfare groups supporting schools, and a lack of sound integrated youth policies. A literature review, observations, and stakeholder consultation provided a clear picture of the current situation in school health promotion, and factors limiting a comprehensive and needs-based approach to school health. This revealed that a health promotion team within a school is fundamental to an effective approach to tailored school health promotion. A respected member of school staff should chair this team. To strengthen the link with the school care team, the school care coordinator should be a member of both teams. To provide coordinated support to all schools in a region, participating organizations decided to share advisory tasks. These tasks are included in the regular health promotion work of their staff. This means working with one advisor representing all school-health organizations per school, and using a comprehensive overview of possible support and projects promoting health. Empowering schools in needs assessments and comprehensive school health promotion is an important element of the developed approach. This article concludes with an examination of emerging issues in evaluating collaborative school health support during the first 18 months of development, and implementation and future perspectives regarding sustainable collaboration and quality improvement.     

Developing and sustaining community-academic partnerships: lessons from Downstate New York Healthy Start

Partnering with communities is a critical aspect of contemporary health promotion. Linkages between universities and communities are particularly significant, given the prominence of academic institutions in channeling grants. This article describes the collaboration between a school of public health and several community-based organizations on a maternal and infant health grant project. The partnership serves as a model for ways in which a university and community organizations can interrelate and interact. Central lessons include the significance of sharing values and goals, the benefit of drawing on the different strengths of each partner, the gap created by the university's institutional focus on research rather than service and advocacy, and the strains created by power inequities and distribution of funds. A key element of the partnership's success is the emphasis on capacity building and colearning. The project demonstrates the potential of employing community-academic partnerships as a valuable mechanism for implementing community-based health promotion programs.     

A conceptual model of community capacity development for health promotion in the Alberta Heart Health Project

PURPOSE: The objective of this study was to derive a conceptual model of community capacity development for health promotion based on the 5-year demonstration phase of the Alberta Heart Health Project. METHOD: Community actions associated with successful implementation and uptake of initiatives in four diverse target sites were identified by case study evaluation. RESULTS: Thirteen common elements of capacity development were found across the projects and categorized to define three primary dimensions of the process: (a) leadership that provided a driving force for implementation, (b) policy making that ensured diffusion and sustainability, and (c) use of local community resources and infrastructure. A conceptual model was constructed using these 3 dimensions and their interactions. CONCLUSION: Effective implementation of community health initiatives to promote heart health can be conceptualized as the involvement of local leadership, policy advocacy, and enhancement of existing infrastructure. The model highlights building these dimensions of community capacity development for health promotion.