George Wolfe
Health Officer, County of Santa Cruz

Harvey Smith
President and CEO, Kapiolani Health Hawaii

• Two successful partnerships:
  
1. PEAK, an economically driven partnership between a health plan and physician group.
   
• physician-directed.
• aligning quality with compensation.
2. H2P2, Hawaii Health Performance Plan
   
   • came about to restructure health planning.
• Both partnerships relied on common purpose rather than formal structure for success; neither was a "legal" partnership.
• Examples of two failures were "legal" partnerships - one resulted in lawsuits; the other was between 2 institutions. Basic issue was that there was no common purpose.
• Both successful partnerships resulted in behavior changes by participants. Partnerships happen because individuals cannot accomplish desired outcome by themselves (e.g. PEAK: Physicians’ wanted to practice prevention and the health plan wanted to reduce inpatient costs; H2P2: Everyone agreed to change behavior).
• To build effective partnerships, need to spend considerable time on perspective; too often, time is focused on implementation. Need to spend time on perspective to understand each other’s point of view.
• Strategy comes easily once perspective is in place.
• Implementation begins with having everyone’s role defined.
• Critical success factors:

• Engage partners who wish to accomplish something that is possible.
• Trust.
• Leadership and management who listen.
• Clear work product identified.
• Measurement of success.

Ron Metler, MD
Kauai District Health Services Administrator, Kauai District Health Office

• A devastating hurricane that hit the island led to partnerships.
• The number one health priority that was identified was tooth decay--incidence of 33% versus 5% nationally.
• Once priority was identified, strategies and funding followed.
• Kept things small by proceeding in stages.
• Be able to measure a defined outcome/target and to evaluate progress towards that outcome/target.
• Established a committee that met monthly for 3 years.
• Accomplishments included a conference aimed to increase public awareness and education that had the entire island in attendance; next year’s conference will focus on fluoridation.
• Need to keep partnerships local and involve community partners.
• Successful in pushing for current law that recommends a dental exam for children entering school and provides financial assistance.
• For partnerships, most important factor is to keep it local, then to listen.
• Other factors include flexibility, guidance versus pushing, having fun.

Nancy Thomann
Turning Point Project, Arizona Department of Health

• Health is a shared responsibility of many entities.
• Turning Point was established to transform and strengthen the capacity of state and local health agencies.
• It is a 2-pronged initiative: 1) Funded by the Robert Wood Johnson Foundation, states can apply to be a site; Arizona is one of 14 states; 2) Funded by the W.K. Kellogg Foundation, local agencies can apply to be sites; Arizona has 4 of 41 local partners.
• Requirements: Transforming and strengthening of public health infrastructure involves 1) taking risks and proposing innovative relationships; 2) engaging a broad range of state and community partners working together; 3) submitting a clear plan that achieves public health system improvements.
• The Arizona Turning Point Project is guided and overseen by a Steering Committee
• There are 4 Subcommittees: Community (largest with 70 members), Policy, Technology, Workforce.
• Examples of local partners: 1) African Faith Partnership-a church partnership in South Phoenix; 2) Conchise County Health and Social Services-a local health department bordering Mexico; 3) Gila River Indian Community-two tribes assuming public health functions; 4) Machan Healthy Communities-school-based partners.
• Partnership development: The AZ Health Alliance was formed in response to the Medicine and Public Health Initiative. The Turning Point Project presented a challenge, but also opportunities to work together on a real need to improve public health systems that was exciting.
• Partners include those in the public health community, faith organizations, libraries, monasteries, social programs. The Project will require partners to submit commitment to participate in plans and partnership.
• Vision for partnerships for public health in the 21st century: 1) partnerships for advocacy; 2) partnerships for technical assistance and training; many partners have knowledge and resources (e.g. libraries for information systems); 3) non-public health partners utilizing Healthy People 2010 objectives; and 4) inclusion of non-public health partners in projects and coalitions.

• To encourage partnerships, need flexibility in categorical funding, information and data as a basis for decision-making, and requirement of partnerships in grants.
• When struggling with outreach and raising awareness of a developing partnership, make it clear that there is a strong interest in expanding membership; everyone is invited.
• The art of partnerships emphasizes the importance of the relationship and trust.
• Common purpose is critical.
• Need to make the final work product "measurable" so that progress towards that goal can be determined.
• Need more partnerships between researchers and practitioners to promote evidence-based practices.

Sacramento Transcripts and Summaries