The Stew BLOG

Developing Mature Partnerships to Meet the Challenges of Our Time

Bobby Milstein, Director, System Strategy | 06/14/2017

Several weeks ago, The Greenville News published a story about a visionary investment of $80 million over the next 20 years to help Greenville, South Carolina, become the healthiest county in the United States. Embracing such an ambitious goal is one sign of a truly dedicated endeavor. Even more special is their chosen strategy, featuring not just one or two narrow priorities, but a combined portfolio covering mental and physical health, access to health care, and healthy eating and exercise, as well as wider drivers of well-being, like education and economic development. Rarer still are long-term commitments from institutional investors who are ready to devote dependable resources into doing business differently.

Katy Smith, executive director of the Piedmont Health Foundation, is quoted in the story: “There are others who want to be the best in the country . . . But few communities are making this kind of investment with this long term goal.”

Leaders in Greenville surely will encounter many surprises in the work ahead. They may even discover that $4 million a year, in this region of about 60,000 people, is just a down payment toward a much larger long-term investment. But they have already taken several decisive steps into a new space as serious stewards of their common health system.

Parts of this same story are unfolding in many other places across the country. Judging from ReThink Health’s recent Pulse Check on Multi-Sector Partnerships, which surveyed 260 partnerships from across the country, most appear to be in earlier stages of development. Indeed, after I had commented on Greenville’s promising move, one reader wrote back to share her own passion for breaking from the status quo. In her case, she posed one simple yet poignant question: “Where do we begin?”

Those groups that are just beginning and others, like Greenville, that have matured to enact a multi-million-dollar, 20-year plan face qualitatively different challenges. They sit at different points on an enormous developmental spiral. And those of us who want them to succeed—including funders, policy makers, and other allies—must design our engagements with a clear sense of where they are in their development. If we approach them with a fixed set of tools and techniques, we will fail each and squander their vast potential to become true stewards in their own regions.

Like human beings, multi-sector partnerships advance through developmental phases, from formation through maturity. Many partnerships are quite nascent: a majority of contributors to the Pulse Check formed after 2010. And just like in human development, beginnings are essential. Nascent partnerships typically form for clear and urgent reasons, in environments with high stakes. They recognize an issue and organize to address it. As they get started, they depend on specific experiences and supports to nurture them through those early years.

Over time, however, the particular competencies that drive momentum and the pitfalls that stall progress tend to change. For example, as the charts below suggest, partnerships in the earlier stages may benefit most from actively engaging stakeholders and experimenting with what you might consider “low-hanging fruit” such as a shared needs assessments, allowing stakeholders who are just getting to know each other to collaborate on a project they already agree is important to them all. But the momentum from these activities decreases as the work progresses. As partnerships mature, they exhaust easy wins and encounter resistance when attempting to transform prevailing mindsets, structures, and policies. Success in these later stages demands a wider view of the system, backed by political acumen and a collective sense of power—or “civic muscle” to exercise influence upward and outward.

Contributors and Barriers to Momentum Shift by Phase



More and more regions now rely on having capable, mature partnerships to fulfill vital roles as stewards of a fragile health system—a trend that will likely grow stronger as the nation faces such troubling trends as skyrocketing healthcare costs, entrenched inequities, eroding well-being, and lost productivity. Moreover, the variety across our large, diverse country means these groups cannot follow a single blueprint. Instead, the champions of health system change need a flexible developmental framework to anticipate and adjust to changes over time.

At ReThink Health, we provide the Pathway for Transforming Regional Health as practical way for partnerships to assess and celebrate past milestones, while also pointing to their next frontiers for development. The Pathway also provides a common structure for internal leaders and outside allies to negotiate priorities and accumulate the evidence needed to improve over time. It can therefore help us learn faster and uncover the pivotal points to help partnerships mature along their own developmental trajectories.

The Pulse Check asked all respondents to name catalytic initiatives that have supported their growth and development. The data suggest that participation in such initiatives, such as 100 Million Healthier Lives and BUILD, is high for early-stage groups but is even higher among those in the later developmental phases. These capacity-building initiatives and others like them, including ReThink Health’s own Ventures project, are therefore in unique positions—and have special responsibilities—to design our work with development in mind. In this way, we can provide partnerships with what they actually need, generating enough power and momentum to restructure how the health economy works in a particular region, while avoiding pernicious pitfalls that threaten to reinforce the status quo. As the ecology of support around these multi-sector groups grows, it’s essential that we all pay attention to the changing needs, challenges, and achievements of partnerships as they develop.

When it comes to human development, parents and teachers have begun to emphasize things like flexibility, creativity, resilience, and empathy—previously considered “soft skills,” but that now are regarded as critical to successful adulthood in a rapidly changing world. So it is too with organizational development. Partnerships and their allies must continually cultivate a different set of skills to meet and master the challenges of our time.