Stories

COMMUNITY HEALTH GOVERNANCE
David D. Chrislip

In 2002, I participated as a resource consultant in the Center for the Advancement of Collaborative Strategies in Health's (New York Academy of Medicine) Community Health Governance (CHG) initiative. The initiative included nine Turning Point partnerships from across the country in a joint learning work group focused on collaborative approaches to agenda setting and problem solving on community health concerns.

My role was to view the CHG experience through my own lens. As I quickly observed, the emerging CHG model had much in common with my past work reported in Collaborative Leadership. Although organized in different ways, the two concepts share several common elements. Both models assert that effective community problem-solving emerges from a broadly inclusive group of people engaging in constructive ways. Each model recognizes the importance of a special kind of process-oriented leadership that energizes and facilitates these engagements. While there are similarities in the way outcomes and results are described, the two models place emphasis on different aspects. The CHG model introduces the notion of synergy as a first order outcome recognizing the breakthrough potential that can be achieved by a diverse group with the knowledge, skills and capacities to work together effectively. The Collaborative Leadership model illuminates the transforming power of collaboration leading to changes in the way communities "do business" on public issues. Incorporating both the synergistic and the transforming aspects of collaboration in future theory and research could enhance both models. The real insight for me came from recognizing the convergence of findings in the two independently developed models based on data from different though complementary arenas.

When I first reviewed the materials describing the work at each site, I was immediately struck by the wide variation among the sites in terms of governance structure, leadership approach, role definition, who participates, how they participate, depth of understanding about what collaboration means, and what capacities they have. Personal experience with each of the sites at the meetings confirmed these differences while illuminating the varying quality of accomplishments across the sites.

I was also intrigued by how the CHG model was developed and the extent of its usefulness in enhancing each site's understanding of the underlying concepts. When presented with varying approaches to CHG, many of the participants could readily discern those that were consistent or contradictory with the model. The model obviously had some strength in building conceptual understanding though it wasn't clear to me at the time to what extent this understanding translated into practice. Each of the sites has developed its own structure and model for leadership and governance. These differences in approach have led to widely varying performance and some tentative conclusions about leadership and collaboration in the community health governance arena.