Collaboration to Improve Community Health: Trends and Alternative Models

Many health care organizations have begun to pursue collaborative approaches for addressing community-level health issues. To understand how these community health alliances develop and operate, a descriptive study was conducted within a nationally selected group of 60 local communities and supplemented by detailed case studies in 8 communities. A broad array of organizations were found to participate in community health alliances. Moreover, alliances were found to vary considerably. Strategically, alliances focused on one of three primary objectives: acquiring needed organizational knowledge and skills; addressing common resource needs; and pursuing a shared organizational mission. Functionally, alliances were observed in the areas of service delivery, planning and policy development, surveillance and assessment, and education and outreach. Structurally, alliances were found to operate through one of four interorganizational arrangements: informal collaboration, contractual agreements, shared governance, and shared ownership. Organizational characteristics such as ownership type, organizational proximity, and market share appear to be important in the development of community health alliances. Community and market characteristics-including health resource availability, HMO penetration, and market consolidation-also appear to be influential in alliance development. Longitudinal observations suggest that alliances evolve over time in response to changing community health needs and organizational objectives. Several managerial tasks appear to be important to successful alliance operations, including developing a shared vision of collaboration; devising explicit strategies for addressing participation constraints; ensuring the compatibility of organizational incentives; managing communication and information flows across organizations; and developing appropriate processes for performance monitoring. The observed variation in alliance structures and functions appears healthy rather than problematic, as organizations develop arrangements to fit community needs, organizational capacities, and market conditions. By pooling the resources and skills of multiple organizations within the community, alliances offer promising strategies for achieving population-based health improvement.