The Stew BLOG

Overcoming the Most Common Pitfalls Along the Pathway to Transformation

Ruth Wageman, Senior Scholar & Advisor | 04/26/2017

Regular (and observant) readers of the ReThinkers’ Blog have probably noticed a number of blogs recently about ReThink Health’s 2nd biennial Pulse Check report. Watch this space! There are more to come. In the report, we analyzed trends and shared findings from the 237 multi-sector partnerships that responded to our survey. But in keeping the report short and sweet, we couldn’t include everything we learned. The report is a snapshot; thankfully, the blog allows us to dive a little deeper.

Among many questions, the Pulse Check survey asked partnerships about the most common barriers they face and how they are able to build momentum and sustain progress. The two most prevalent obstacles to success, respondents report, are inadequate infrastructure (63 percent said this was a barrier) and difficulties measuring progress toward a better health system (69 percent).

Bridging the Infrastructure Challenge

Over the past decade of working with multi-sector partnerships across the country, we have seen that building collaboration among many groups and organizations is complex. With many leaders joining forces, each with their own priorities but committed to forging a common purpose, there are bound to be challenges.

As a result, partnerships that are in the earlier phases of their work, eager to get to work on shared projects, can find themselves falling short as the infrastructure becomes overstrained. You can see this in the figure below. Fortunately, this challenge can be overcome in a variety of ways, and taking those steps can set partnerships up for greater success down the road.



Some partnerships launch a new organization from scratch to serve that purpose. For example, before the Pueblo Triple Aim Corporation was formally instituted as a nonprofit in 2012, many participating institutions pitched in to support the infrastructure of the partnership. One organization provided data and analytics support, another donated space, and all shared the time of key staff in-kind. Their steering committee eventually decided to create a self-sustaining organization that would be responsible for building and maintaining infrastructure. Seed grant funding allowed them to hire staff, including an executive director, who were guided strategically by a board comprised of all participating organizations.

Other organizations, such as the Health Improvement Partnership of Santa Cruz County, ask their members to contribute resources—including staff—to coordinate their mutual efforts. Many partnerships develop an informal agreement among member organizations to contribute personnel, time, and information systems to the work of the partnership.

Strained infrastructure, then, is a predictable pitfall for early-stage partnerships, and we have seen many overcome it through joint investment, engaging additional stakeholders, or forming a new organization. A second predictable pitfall is figuring out how to sustain enthusiasm and motivation even when progress feels remote.

How Do We Measure Up?

As partnerships progress beyond their exciting beginnings, and complete projects together over time, success often yields real progress. In fact, early cooperative moves—for example, conducting a shared needs assessment—usually feel like a huge improvement over the fragmented efforts that characterized the region before. These types of successes can be inspiring for new partnerships, galvanizing new undertakings and attracting even more partners. But unfortunately, sometimes the very real changes in capacity to work together don’t feel like accomplishments, and tangible outcomes sometimes are visible only over long time horizons, or only to certain outcomes for certain residents and organizations. It can be a real motivation killer when partners are committed and showing up regularly over a long period of time… and still see very little tangible evidence of big results.

Strong partnerships gain a lot of their momentum—particularly early in their development—from the audacity of their visions and the significant effort they put into engaging a broad group of people across the spectrum. But with such ambitious and audacious goals, they are bound to feel like change is beyond the horizon. What can ambitious partnerships do about this conundrum? For one thing, effective partnerships sustain their momentum by identifying and pursuing “easy wins”—ways of achieving tangible success that is measurable and impactful.

In addition, it takes real skill to show the value of what a partnership can do. Great partnerships promote and celebrate movement and find new ways of defining success: for example, the uptake and spread of successful innovations, greater involvement of more members and capacity to do more, together, and tangible joint commitments such as pooled funding and wellness trusts. Respondents to the Pulse Check referred to such wins as:

  • “Getting many people from different sectors talking at the same table”
  • “We’ve created a voluntary all payer database for broad use by others, such as sharing multi-plan reports with physicians on cost and improvement opportunities”
  • “Collectively conducting a Community Health Needs Assessment with 26 hospitals, six health departments, and highly engaged community/ stakeholder participation”
  • “Engaging community members in the leadership of health planning”

Each of these is indeed worthy of celebration! What do you do to measure and celebrate progress to ensure that motivation doesn’t falter? How are you managing your partnership’s infrastructure challenges? Share your experiences in the comments below, or write us at [email protected].