Aug 18 2016 Research to Practice: What role should foundations play in partnerships for community health?

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The relationship between foundations and grantees hasn’t always been collaborative. But there is a growing awareness among funders that working closely with current and potential grantees can help them tackle complex problems and work toward a shared goal within a community. Kathryn Heinze, Jane Banaszak-Holl, and Kathy Babiak, associate professors at the University of Michigan, illustrate and provide insights into this trend in their recent look at health conversion foundations — foundations formed when a non-profit hospital or health system is acquired by a for-profit operator or converted into a for-profit model, generating proceeds. Their article, “Social Entrepreneurship in Communities: Examining the Collaborative Processes of Health Conversion Foundations,” was recently published in Nonprofit Management and Leadership.

Health conversion foundations employ their endowments to continue the missions of the original entities from which they arose, initiating and supporting local programs to improve community wellness. They often create cross-sector coalitions and community groups, that may include representatives from the school system, local hospitals, local businesses, and non-profits. The 5 Healthy Towns Foundation (5HF), formerly the Chelsea Wellness Foundation and one of the foundations studied by the researchers, for example, worked with libraries, senior centers, school districts, farmers’ markets, a hospital, local businesses, and government to design, implement, and deliver health and wellbeing initiatives.

The authors looked at several health conversion foundations across the United States, interviewing foundation executive directors, visiting with foundation representatives and community partners, and analyzing documents that included information ranging from mission statements to financial information. Their findings suggest that three mechanisms employed by health conversion foundations — defining the social problem locally, developing social capital in their communities, and educating potential partners — built the groundwork for effective collaboration between the foundation and potential grantees and community partners.

The authors learned a great deal about the role that foundations can play in enabling cross-sector collaboration within a community as a locally-embedded connector and convener. Their findings may be of interest to organizations or foundations seeking to facilitate the work of cross-sector partners in promoting population health issues, such as maternal health, efficient housing, or food systems.

Takeaways for Practitioners

 Hold events — whether formal meetings or informal gatherings — in inclusive spaces to build trust and knowledge among cross-sector stakeholders. It’s important for a health conversion foundation to hold discussions and work directly with partners in the community, in order to break away from the typical transactional relationship between funder and grantee. In a phone call with The Intersector Project, Heinze shared that moving meetings from a boardroom to a community room with flexible seating made meetings more inclusive and participatory for a wider array of stakeholders. These meetings, ideally recurring, can range in formality from roundtables to meals. A representative from the HealthSpark Foundation told the authors, “We are literally breaking bread with people who we are funding or considering funding.”

• See 5HF’s calendar for examples of meetings held in community spaces, including a middle school, wellness center, and township hall.

• The Before You Start section of The Community Toolbox’s Generating and Choosing Solutions offers discussion and tips on the importance of a meeting space that is both physically and mentally comfortable.

 Use both expertise generated nationally or in other locations, as well as information about the local context to shape an initiative. Foundations can look to larger organizations like Grantmakers in Health to identify the central tenets of the community health approach. This can help them avoid feeling like they are starting from scratch, which Heinze noted that several foundations found themselves doing, and allows them to build upon existing models (e.g. for identifying evidence-based approaches) that are informed by larger entities’ practices. In tandem, they should look to the local individuals and organizations to help define how the model can be adapted to the specific health needs of the community.

• The Generating Solutions section of The Community Toolbox’s Generating and Choosing Solutions provides discussion and instructions on sharing ideas within a coalition.

• See points 2 and 3 of The Community Toolbox’s Assess Community Needs and Resources for guidance on assessing how community members and key stakeholders view the problem the coalition will address.

• For an example of a public health approach where leaders took time to understand community-identified problems, see our case study Combatting Childhood Obesity in Somerville.

 Tailor the amount of decision-making power shared with local coalition partners based on that partner’s level of experience working with diverse groups. It’s a central challenge for foundations to determine how to balance their oversight of process and vision with giving local coalitions decision-making power. Heinze shared that sometimes when coalitions are tasked with carrying out complex practices such as needs assessments for their first tim, foundations may bring in a consultant or send a foundation representative to guide the coalition. Other coalitions that have experience with carrying out foundation-provided processes or high levels of group cohesiveness may not need this level of oversight.

• See Tool 3: Sample Partnering Agreement on p. 45 of “The Partnering Toolbook” for a template to record governance structures for ensuring that decision making, management, and development arrangements among partners are appropriate and operate effectively. This governance structure document can be revisited and adjusted as the collaboration progresses.

 Require cross-sector and interorganizational partnerships in the funding model. By including a call for cross-sector collaboration within grant guidelines, foundations can ensure that the resulting initiatives employ a range of perspectives. Funding collaboratives can also bring together non-profit organizations that would typically be competing for funds or duplicating work in the same community. Heinze shared that a foundation in Pennsylvania offered one grant in particular with the requirement that grantees collaborate with multiple sectors — partnering with businesses, farmers, and schools on a food systems initiative, for example.

• For an example of a grant application that calls for collaboration, see The St. Joseph Community Health Foundation’s 2016 Grant Guidelines.

For Further Reading

From The Intersector Project Toolkit:

• Engage Potential Partners: The identification of and engagement with individuals and organizations that have a stake in the issue at hand to address their suitability for and interest in a cross-sector partnership
• Establish a Governance Structure: The creation of a formal or informal organizational system for project management
• Share Discretion: The deliberate allocation of decision-making authority based on areas of expertise

Additional Resources:

• See the Prevention Institute’s guide Developing Effective Coalitions: An Eight Step Guide for information on determining the appropriateness of a coalition, selecting members, defining key elements, maintaining vitality, and conducting ongoing evaluations.
• See the Community Toolbox’s Creating and Gathering A Group to Guide Your Initiative for further discussion on what a group overseeing an initiative designed to meet a community need would look like, how it would function, who the members would be, and where to find them.