Lynda Krisowaty
Program Manager, Evidence-Based Practice; AMCHP

Sara Miller
Program Associate, Health Systems Transformation; AMCHP

Charlotte Cleveland
Program Analyst, Epidemiology and Evaluation; AMCHP

Meet the 4 L’s

The Practical Playbook, a national initiative sponsored by the de Beaumont Foundation and the Duke University School of Medicine, provides implementation tools, guidance, and resources to help public health and primary care work together to improve population health. At the Practical Playbook National Conference in July, presentations and panels focused on cross-sector collaborations emphasizing the importance of backbone organizations, data and metrics, leadership, and evidence-based interventions.

Presenters worked from the premise that to achieve a healthy nation, consumers and providers of health care must work in partnership to identify and implement local priorities. They discussed a set of strategies to promote cross-sector collaborations and communication known as the 4 L’s: language, listening, like-minded goals, and longitudinal engagement. Below are examples of projects that have implemented components of the 4 L approach.

Language: Ensure language is appropriate and not unintentionally offensive

Mindfulness for Sport Performance Enhancement

The importance of language in public health is tied to support and understanding from communities and health-related organizations. Appropriate language that engages a target audience can spur progress and support. In 2014, Fairfax County Virginia public schools introduced the “Mindfulness for Sport Performance Enhancement” project. Spurred by six suicides within one high school over three years, the pilot program sought to address the need for preventive help for athletes struggling with mental illness.. Community advisors were careful not to associate the word “mindfulness” and “meditation” with religion. For parents, students, and school officials, organizers emphasized that the program could help improve athletic performance through mentoring, modeling, monitoring, and mindfulness. Removing the mental health stigma allowed student athletes the freedom to seek support when needed.

Listening: Use active listening techniques

Collaborating for Health Equity in Chicago: Healthcare and Public Health Partnering with Communities

The West Side Total Health Collaborative is a partnership between health systems and community partners working to address social determinants of health and other inequities on the west side of Chicago. In January 2017, stakeholders from various sectors met to plan the collaboration. The meeting was attended by over 120 local residents, educators, government officials, businesses, community-based organizations, health care providers, and others.

The diverse group of stakeholders recognized the need to affirm and engage residents as the experts best able to identify and define the problems and solutions related to health equity on the West Side. This conversation positioned the Collaborative to be an authentic partner of the community. The Collaborative is an example of how developing solutions requires listening to the community’s needs and recognizing its expertise. As a result of this process, the Collaborative published a “What We Heard” report to summarize the conversation and move it forward

Like-minded Goals: Identify an issue that both sides can agree on

Engaging Multi-Sector Partners Through Collaboration: The Multiplier Tool to Advance Health and Equity

This presentation reviewed the Collaboration Multiplier Tool and worksheet used by the Prevention Institute. The tool helps organizations representing different sectors with potentially different interests and goals come together to align their visions and resources. This asset-based tool emphasizes the importance of leveraging different stakeholders’ perspectives, resources, and goals. It also emphasizes the importance of including those who are most affected by the issue to participate in defining the problem and developing solutions. The tool stresses the importance of asset-based strategies when bringing together diverse stakeholders to develop a unified vision and goal.

Moving Upstream – Health Care’s Response to the Social Determinants of Health

This program is built on one central question: How can we move health care upstream to address social determinants of health? Two major barriers hinder an upstream view of health care: lack of awareness and organizational silos. Organizational siloing is often caused by traditional competition, differing ideas, and limited resources. To address these barriers, it is important to strengthen existing relationships, ask questions, listen and recognize opportunities for collaboration. Parties also need to identify goals or actions that both can agree on, and find common ground that links the efforts of one organization to the efforts and strategy of the other. This common ground becomes the foundation for mutual understanding, and provides both parties with a launching point to break down silos by reducing duplication or strengthening relationships. It can turn a “my strategy” and “their strategy” into an “our strategy” approach.

Longitudinal Engagement: Cultivate and maintain relationships over time

Someone Has to Actually Do This: The Critical Role of a Partnership Bridge Builder

This presentation highlighted the concept of a “health instigator” – a person who works in the community to help organize and coordinate activities with partners and assist with translating their strategies and ideas into actions. The health instigator is supported by a developmental evaluator who provides ongoing training and coaching, as well as an external perspective. Because relationship-building is the crux of a successful collaboration, it may be necessary to dedicate one person (the health instigator) to work with the community to establish these relationships. This toolkit explains the health instigator approach in detail.

By highlighting effective strategies to facilitate communication and foster relationships, the Practical Playbook National Meeting illustrated the critical importance of the 4-L approach to improving population health.