REVIEWED BY IRENE WARD
Howard Greenwald and William Beery
Health Administration Press, Chicago, 2002, 255 pp., $52 (paperback)
In Health for All: Making Community Collaboration Work, authors Howard
Greenwald and William Beery explore the different models that have been used
by major health services organizations in collaborating with communities to
improve community health since the 1800s. As indicated by the title, the authors
believe that collaboration offers solutions to many of society's most challenging
health issues. Their argument is that collaboration among various community
partners brings together different and valued perspectives, expertise, knowledge,
resources, and access that typically do not reside within any one organization.
Because collaborations bring together this wealth of community talent, the authors
say, they will likely be successful, thereby improving community health.
To set a context in which collaboration might work effectively in today's
environment, Greenwald and Beery identify the different types of collaboration
that have been used by community health agencies since the 1800s. Indeed, the
authors have discovered a continuum of collaboration, the eight levels of which
they identify as: manipulation, therapy, information, consultation, placation,
partnership, delegated power, and citizen power.
The authors devote a considerable amount of space to explaining and evaluating
the Mutual Partnerships Coalition (MPC) in Seattle. This collaboration is an
example of the type being developed in many communities today. By analyzing
the MPC in such detail, the authors show both the collaboration's initial
vision and structure and how the implementation of the vision was limited by
the difficulties inherent in working through collaborative relationships and
activities.
The idea for the collaboration was initiated by Group Health Cooperative, which,
founded in 1947, was one of the first HMOs. Group Health has a history in the
community of being responsive to consumer input and concerned about social issues.
Four other community partners were involved in the MPC project: the Seattle
Housing Authority, United in Outreach, the Central Area Motivation Program,
and Senior Services of Seattle/King County. Funding was provided by the W. K.
Kellogg Foundation; MPC was intended as a demonstration project whose goal was
to "identify interventions of potential value in reducing isolation and
rebuilding community." Most of the work was accomplished between 1992 and
1996, which was the length of the grant.
The collaboration was governed by a steering committee composed of members
from each of the organizations involved. Making up the collaboration's
staff were a project director, evaluation consultant, training specialist, project
coordinator, four community specialists, and a project assistant.
The MPC's mission was to work with the isolated elderly, helping them
to recognize their own gifts and capabilities and assisting them to function
again as members of the community. The theory was that the collaboration's
activities would not only improve the health of the elderly people targeted
but also, through the reintroduction of their gifts and capabilities, improve
the overall health of the community.
Although the MPC did accomplish several of the original goals, its overall
outcomes were not particularly good. The collaboration's failure, Greenwald
and Beery write, was due at least in part to problems likely to inhibit the
success of other collaborative efforts: lack of a unified vision and goals,
lack of clarity concerning roles and lines of accountability, poor communication,
different worldviews and experiences among participants, unresolved interpersonal
conflicts, and disagreement over evaluation methodology.
The issues regarding the evaluation process, which proved especially difficult
for the MPC, could, if not corrected, make it difficult for other collaborations
to collect and analyze meaningful data and evaluate programs, the authors say.
They contend that evaluation of these collaborative efforts is intrinsically
difficult. Those who plan them must begin by developing a collaborative relationship
between program implementers and program evaluators, with both parties agreeing
on both the value and need for program evaluation and a methodology for it.
Highlights of this section of the book include summaries of evaluation models,
including one used successfully in a collaborative community-based health initiative
in California.
Greenwald and Beery conclude their book with a chapter summarizing the strengths
and challenges offered by community collaborations and outlining principles
for successful collaborative efforts. The authors also provide a comprehensive
appendix of resources to help implement and evaluate community partnerships.
This publication provides a good basic framework that can help readers evaluate
the pros and cons of collaborative activities in their own communities. Health
for All: Making Community Collaboration Work is instructive in its description
of collaborative efforts already undertaken, and it can help readers interested
in such activities set up their own collaborations in a way likely to be successful.
I recommend the book for those interested in developing or assessing collaborative
activities in their own communities.
Irene Ward
Chief of Operations
Catholic Community Services of Western Washington, Seattle
Copyright © 2004 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.