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Correspondence: Address correspondence to Elise J. Bolda, PhD, Community Partnerships for Older Adults, Muskie School of Public Service, University of Southern Maine, P.O. Box 9300, 509 Forest Avenue, Suite 290, Portland, ME 04104-9300. E-mail: eliseb{at}usm.maine.edu
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Key Words: Community partnerships • Partnership governance • Partnership management • Partnership sustainability • Long-term care systems
In 2004, the Robert Wood Johnson Foundation awarded 8 community partnerships with 4-year implementation grants of $750,000 each to support implementation of community strategic plans that had been prepared in an earlier planning cycle. The eight communities were: Atlanta, GA; Boston, MA; Broome County, NY; El Paso, TX; Harris County, TX; Maui, HI; Milwaukee County, WI; and San Francisco, CA. Each community brought to the national program a unique sociodemographic and historical context, and each community had developed its own goals and objectives through a local planning process. Nevertheless, all grantees had a common goal of sustaining their efforts beyond the grant period.
The National Program Office at the Muskie School of Public Service, University of Southern Maine, provides program direction. The Duke University Long-Term Care Resources Program oversees technical assistance to grantees and facilitates cross-site dissemination through teaching and learning, in which grantees are encouraged to take progressively increasing responsibility for sharing expertise and learning among themselves and with other communities. The program uses various approaches in order to foster teaching and learning. These include frequent teleconferences; annual in-person meetings of all grantees; an interactive Web site through which grantees can engage in virtual discussion and post resources for one another; an electronic resource center (www.cpfoa.org), where experience is codified for the benefit of others; and ad hoc grantee gatherings at meetings of national associations, such as The Gerontological Society of America, the National Association of Area Agencies on Aging, and the American Society on Aging/National Council on the Aging.
Conceptual Framework
Early on, CPFOA introduced grantee partnerships to a conceptual framework of community health partnerships developed by Mitchell and Shortell (2000). After an exhaustive literature review, Mitchell and Shortell concluded that (a) despite the growing popularity of community health partnerships, they often fail to achieve measurable results or sustain themselves; and (b) problems related to governance and management frequently contribute to their failure.
Mitchell and Shortell (2000, p. 243) described governance of community partnerships "as being primarily concerned with positioning the partnership relative to the external environment within which it operates." Governance includes establishing a partnership's strategic priorities, determining membership composition, obtaining necessary resources, and providing accountability to the community. Mitchell and Shortell described management as being concerned primarily with execution or implementation of the direction established by the governance body of a partnership. Management functions include managing communication, conflict, external links, and change over time.
A significant challenge for community partnerships is understanding that the "right" governance and management structures are not universal. They are highly contextual and must fit the history, social dynamics, politics, and resources of a given community. In a community that enjoys a long tradition of successful collaboration in the context of informal governance structures, a more formal structure may fail because it does not honor tradition. However, if that community partnership were trying to address a more difficult and controversial problem than it ever had in the past, it may need to adopt a more formal structure that is easily understood in the community and enhances accountability.
If a partnership adopts effective governance and management structures appropriate to its local context, it is more likely to attain centrality, which Mitchell and Shortell (2000, p. 253) defined as the extent to which a partnership "becomes institutionalized and pivotal to the life of the community." Centrality, in turn, is a likely predictor of sustainability. As applied to CPFOA grantees, the expectation is that as a partnership becomes central to its community on aging issues, its visibility and influence rise and more stakeholders want to be associated with the partnership, further adding to its influence and expanding the sense of collective efficacy in the community. Furthermore, it is expected that local funders and decision makers will pay increasing attention to the partnership as a vehicle for effective collaboration as the partnership's centrality increases.
This article describes how four CPFOA grantees, like community health partnerships before them, have struggled with issues of governance and management and have responded by adopting governance and management structures unique to their local needs. We should note that this is not a comprehensive case study, but rather a brief analysis of early experiences of selected CPFOA grantees. At this early phase of the grant cycle, each partnership can point to early indicators of centrality, suggesting that sustainability is an attainable goal.
Overview of Four Grantees
CPFOA implementation grantees shared certain mandatory characteristics in order to be selected by the Robert Wood Johnson Foundation. They each represented broad community partnerships that included older adults, social service and health providers, government agencies, advocacy organizations, and other local stakeholders in long-term care and supportive services. They had each demonstrated success working in partnership prior to becoming grantees, and their communities each had in place adequate community-based services infrastructure that served as a foundation for greater partnership efforts. Each grantee had to select a fiscal agent to accept and manage grant funds for the partnership, and each partnership had to designate a core leadership group.
Beyond these requirements, CPFOA was designed to encourage unique local partnerships that responded to the needs of their communities. The result was a group of grantees with a variety of approaches to governance and management. We have drawn examples from four diverse grantee communities in order to illustrate the range. Representatives from the four partnerships (Boston, Harris County, Milwaukee County, and El Paso) presented their early experiences in a Presidential Symposium at the 57th Annual Scientific Meeting of The Gerontological Society of America, November 21, 2004, in Washington, DC. We have based this article on that panel discussion ("A Framework for Learning With and About Community Partnerships") and on additional information gathered by the CPFOA National Program Office through site visits, technical assistance teleconferences, reports and materials submitted by partnerships, grantee extranet postings, and individual conversations with partnership leaders.
A Diverse Group of Communities
Table 1 provides an overview of the four community partnerships and illustrates the unique characteristics of each.
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Governing a Community Partnership
One of the functions of governance is to establish the size and composition of the partnership, which includes determining the type of organizations and individuals desired for membership, defining the obligations and benefits of membership, and potentially creating membership tiers in order to accommodate different levels of interest and contribution. CPFOA experience to date suggests that addressing size and composition issues clearly and openly can help partnerships avoid or overcome conflict and equity concerns. In Harris County's Care for Elders partnership (in Houston), early tensions surfaced about the widely varying levels of cash and in-kind commitments made across members. The partnership's primary governance document—its operating guidelines—addressed the issue directly by specifying levels of membership corresponding to contributions made and whether an organization had a founding role in the partnership. Level of membership in turn determines member's formal position in a multileveled governance structure that includes the fiscal agent's board of directors, the partnership governing council, and multiple workgroups. The Care for Elders partnership also recognized that an original composition restriction (i.e., that members have nonprofit status) excluded many of the government, media, and housing-sector partners it had desired. Therefore, the partnership altered the composition rules in order to encourage broader participation. Care for Elders also wanted to increase participation among individual older adults and caregivers. It created a separate consumer advisory council and empowered it to appoint four of its members to the overall governing council. The operating guidelines (as opposed to a formal charter and bylaws) articulated each of these structures in part because Care for Elders does not have its own legal corporate status and the partnership's fiscal agent is a member of the partnership in its own right. Having operating guidelines satisfied the need for clear definition of the partnership's composition and scope without requiring the fiscal agent to alter dramatically the fiscal agent's own governance documents.
El Paso's SALSA partnership also addressed composition of membership early in its evolution. With a long history of informal collaboration among key partners, SALSA did not experience the membership tensions that were evident in Harris County's Care for Elders partnership. However, SALSA did recognize that it would need to broaden its membership composition in order to reach the large numbers of Hispanics/Latinos in their partnership area. The issue was not one of cultural identity. The fiscal agent and several partners were social service agencies led and staffed largely by Hispanics/Latinos. However, social service agencies are viewed by some as closely associated with the government and therefore potentially dangerous to people with questionable legal status. In order to address this outreach barrier, SALSA has specifically targeted for membership the faith community and other segments of El Paso's informal network that have better access to consumers not otherwise connected to more formal social service agencies.
Another important governance function is accountability, defined as the processes adopted by a partnership that justify its existence and actions to the community. In long-term care and supportive services, accountability is usually established by laws governing the creation of nonprofit corporations. However, because CPFOA partnerships are not incorporated as freestanding entities, accountability has been divisive, particularly with regard to the role and accountability of each partnership's fiscal agent. Boston originally conceived its Partnership for Older Adults as a coalition of several existing and overlapping groups, with the city's Commission on Affairs of the Elderly acting as fiscal agent. Boston is not a city, however, where organizations and citizens take readily to dominant government structures (the Boston Tea Party comes to mind). Furthermore, as the city's designated Area Agency on Aging, the Commission plays an important role in establishing aging policy for the city and allocating Older Americans Act funds to social service organizations. After a fractious debate about whether the Commission, in its dominant position based at City Hall, could be held accountable by partnership members, a decision was made to have a city-affiliated yet freestanding Senior Center with 501(c)(3) nonprofit status act as the fiscal agent. This maintained the tie to the city and respected the Commission's role as a founding member while putting the fiscal agent more at par with the other social service agencies that comprise the majority of members of the Boston Partnership for Older Adults (BPOA).
Harris County's Care for Elders partnership had a similar challenge when some members became suspicious of the intentions of the fiscal agent, a 100-year-old social service agency with a history and goals of its own. At the same time, the fiscal agent's board of directors had become concerned about whether acting as fiscal agent required it to sublimate its individual agency prerogatives to those of the partnership in a way that other members had not been required to do. To whom was the board accountable—to its traditional constituency, or to the much broader community reflected in the partnership? A creative solution was crafted in which the partnership created its own governing council. The chair of the governing council has a seat on the fiscal agent's board, tying the two together for accountability, yet enabling the fiscal agent to comfortably delegate partnership governance functions to the council.
Community Partnership Management
A governance document provides a solid foundation for a partnership, but it is only words on paper until managers execute its provisions. Tending to day-to-day details of partnership implementation can be particularly challenging because activities are often spread across multiple member organizations that are contributing in-kind services. Individual member agencies generally view partnership tasks as discretionary activities that come after their "real" work (such as delivering meals, investigating abuse complaints, or answering a telephone information line). Communication also is more challenging, because it must span multiple organizations and individuals.
The Boston Partnership for Older Adults learned that conflict could best be prevented or managed by providing neutral staff resources to workgroups, rather than relying on in-kind staffing from member agencies. In order to make clear the intent to provide neutral staff accessible by all members, the staff moved from their original location in City Hall to office space not associated with any individual member organization.
Milwaukee County's Connecting Caring Communities partnership uses a similar mechanism in order to ensure that work will be done in an unbiased manner, although it contracts for professional facilitators rather than dedicating staff to support its multiple project steering committees. The contracted facilitators are responsible for ensuring good communication among steering committee members, preparing agendas, keeping meetings on task, documenting meetings, and conducting research and other tasks outside of meetings.
As a partnership gains credibility in the community and association with it becomes positive to funders, policy makers, and others, it becomes important to manage external communication about the partnership. For example, BPOA bylaws specify that approval of the executive director and the Public Relations Committee are required before anyone represents the Partnership at a public event.
Another management function is providing the appropriate structures and coordination mechanisms that enable a partnership to achieve its goals. Again, this has proved to be an important issue for CPFOA grantees. How can a partnership's work be broken into manageable parts (especially if it is the work of a large partnership with diverse interests), yet not become fragmented and compartmentalized? BPOA answered this question by creating 13 issue-focused workgroups, each of which has a chair who also sits on the Partnership's board of directors. This ensures high-level strategic coordination across workgroup activities. At the operational level, the chairs also sit on a program and planning council that meets with BPOA staff to discuss day-to-day integration and coordination of work.
Milwaukee County's Connecting Caring Communities, with its tradition of decentralized partnership activity, has taken a different approach. Like BPOA, Connecting Caring Communities has multiple workgroups overseeing different parts of the partnership's work plan. But unlike BPOA, Connecting Caring Communities did not see a need to create an additional forum to address operational coordination. Strategic coordination is addressed within the partnership's core leadership group, which meets every other month, and operational coordination is left to the workgroups' discretion.
Toward Sustainability: Early Evidence of Centrality
As was discussed earlier, centrality refers to the state of a partnership becoming a pivotal institutional force in the life of a community. Each of the partnerships continues to evolve, but each can also point to early indicators of centrality within their communities.
In El Paso, SALSA has been recognized by the media as a source for public affairs programming and news related to older adults. The partnership manages a weekly column, Viva 3rd Age, in the local newspaper. The column is an excellent communication vehicle for reaching a mass audience, and it gives SALSA widespread exposure in the community. Viva 3rd Age also acts to sustain interest among members and to attract new members to SALSA, which is viewed as having expertise. SALSA also hosts a weekly show on the local public radio station. As an indication that state agencies view SALSA as an important local resource, the adult protective agency contacted the partnership to help respond to a serious breakdown of the adult protective services system. SALSA was able to respond by drawing on its members to quickly establish a Neighbors Helping Neighbors initiative in El Paso.
BPOA established itself as a source of credible quantitative data on older people in Boston with publication of 100,000 Voices on Growing Older in Boston (Boston Partnership for Older Adults, 2003). This report is a compendium of information synthesized from existing data collected by partners and buttressed by the results of a survey conducted by Mathematica Policy Research, Inc. (Black & Brown, 2004), as part of the Robert Wood Johnson Foundation's national evaluation of CPFOA. BPOA has had substantial media attention as a result of the report and has since been sought after by local mass media as a source of objective information when issues related to older adults are in the news. The report also resulted in contact from two local foundations. One sought out BPOA after receiving several funding requests that cited 100,000 Voices as evidence of the community's needs. That foundation had considered pulling out of grantmaking for older adults but recommitted itself to the population after BPOA met with the foundation's trustees and demonstrated the need. Another local foundation decided it would use BPOA's strategic plan as a guidepost for elder grantmaking. The report also prompted a contact from a local health maintenance organization seeking advice on a request for proposals it was issuing for initiatives that would prevent or delay institutionalization. The health maintenance organization asked BPOA to help narrow the focus of the request for proposals based on the findings reported in 100,000 Voices.
Milwaukee County's Connecting Caring Communities also reports having been buttressed in its efforts by local foundations, which have begun insisting that organizations seeking funding tie their requests into the partnership's strategic plan. Like BPOA, Connecting Caring Communities received positive attention after publishing Now at 60 What I See (Milwaukee County, 2003), a report on aging in Milwaukee County that, like in Boston, took advantage of the survey data from the national evaluation of CPFOA.
Harris County's Care for Elders issued a similar report, Meeting the Long-Term Care Challenge: A Strategic Plan for Addressing the Needs of Older Adults and Family Caregivers in Harris County (Care for Elders, 2004). The report has become a frequently cited source on the status of aging in Harris County and is now routinely referred to as "the Blue Book." The report created opportunities for dialogue with the Houston City Council and local foundations, some of which now want to access the data in order to inform their grantmaking. Care for Elders has gained sufficient influence in the community to convince five separate information and referral sources in the Houston area to contribute to a single electronic database of resources for older adults.
Lessons Learned
Looking across the experiences of CPFOA grantees in this early phase of their work, we see some important lessons emerging.
Local Context Matters
Partnerships are experiencing similar difficulties and sharing ideas, but their solutions are unique to their individual environments. Care for Elders and BPOA both saw a need to clarify governance and the role of the fiscal agent, for example, but one community chose to adopt operating guidelines in order to codify procedures for membership, decision making, resource allocation, leadership roles, and partnership relationship to the host agency, whereas the other chose to adopt a new fiscal agent and a formal partnership governance structure that includes a board, officers, and bylaws.
If Attention is not Paid Early on to Governance and Management, Progress will Stall
This was perhaps surprising to both the partnerships and the National Program Office, because a criterion for funding was that partnerships have prior experience working together as well as some demonstrated outcomes. In retrospect, with new resources from the Robert Wood Johnson Foundation, many of the partnerships took on goals of unprecedented complexity and some controversy, and they found that their existing governance and management structures were no longer adequate. Although the ensuing development work was initially frustrating to many involved, it was a necessary investment in partnership building.
Communities Value and Use Information from One Another and Adapt it to Local Context
For example, once one partnership used national evaluation data in order to produce a local report, several other partnerships followed suit. Communities shared methods and drafts during this process.
Data are not Simply an Important Partnership Planning Tool
When presented effectively (as in the community strategic plans and reports produced by partnerships), data are key tools for achieving centrality and giving partnerships visibility, credibility, and entrée with policy makers, the media, researchers, and funders.
Emerging Centrality can be Traced Directly to Some Early Planning Activities
Several communities report that local foundations now look to the community strategic plans for long-term care and supportive-services systems improvements that were created by partnerships in order to inform their grantmaking. A planning process with broad participation by older adults, service providers, government agencies, community leaders, and other stakeholders gives partnerships credibility in the community.
Resource Issues can be Divisive to Partnerships but can also Help Clarify Accountability Mechanisms
For many CPFOA grantees, the Robert Wood Johnson Foundation grant represents the largest infusion of external resources ever controlled by the partnership. In some communities, the response to substantial new resources was mistrust—particularly of fiscal agents, but also of other partnership members. Partnerships appear to have successfully channeled the mistrust into clarification of governance and management structures.
Power Imbalances Exist in all Partnerships and Should be Acknowledged and Addressed
Being the fiscal agent for a partnership is one example of one member having greater potential influence than another, and the size and role of individual partners in the community affect the influence a member has in the partnership. Grantees have used relatively simple approaches in order to ensure that power imbalances do not get in the way of partnership activities. For example, providing dedicated partnership staff gives members some comfort that activities will not be dominated by in-kind staff from larger partners.
Conclusions
Although these four community partnerships can point to emerging importance and influence in their communities, it is too early to predict sustainability. It remains to be seen whether any of these partnerships will be able to maintain current levels of activity and increase their centrality after the Robert Wood Johnson Foundation grant funding ends. But the experiences of these communities to date underscore that governance and management need to be grappled with explicitly and early if a partnership is to become a sustainable force in the life of its community.
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1 Muskie School of Public Service, University of Southern Maine, Portland.
2 Center for the Study of Aging and Human Development, Duke University, Durham, NC.
3 Department of Public Health and Public Policy, Brown University, Providence, RI.
4 The Robert Wood Johnson Foundation, Princeton, NJ.
Decision Editor: Nancy Morrow-Howell, PhD
Received for publication August 1, 2005. Accepted for publication November 4, 2005.
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