Work Together:
Key Activities

Where we live should not determine our health, the health of our children, or how long we live, and yet, it often does. As you work to improve health in your community, be sure to focus efforts and priorities on those who are experiencing conditions that limit their opportunity to be healthy. This doesn’t mean offering everyone the same resources. Instead, it’s about creating conditions that will ensure all can realize the same health outcomes.

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In 2020, County Health Rankings State Health Reports provided a starting point to raise awareness about persistent gaps in opportunity by place and race. Building on our efforts to call attention to the many factors that influence health, these reports highlight data on social and economic disparities across groups within the same community based on place, race, and ethnicity, in addition to providing evidence-informed strategies and examples of communities taking action to address equity.

These reports illustrate:

1. What health equity is and why it matters.
2. Differences in health outcomes within states by place and racial/ethnic groups.
3. Differences in health factors within states by place and racial/ethnic groups.
4. What communities can do to create opportunity and health for all.

Using the What Works for Health strategies listed in your Report as a starting point, work with your state and local leaders to choose policies and programs that have been effective for improving health in other places and that are a good fit for your community's context.

• If there are examples of effective and sustainable ways your community is addressing health gaps, publicize those stories so that others in your state are inspired to take similar action. By focusing on policy, systems, and environmental changes – or implementing programs in a broad, systematic way – communities across your state will see the most substantial improvements over time.
• To further shine a light on health inequities at the local level, refer to the Dig Deeper section of the Use the Data tool to identify sources of data beyond those provided in your county-level snapshot. Find out what types of sub-county and/or demographic data are available for your state in the Find More Data section of this tool. Work with community leaders and members to help share individual stories that bring these data to life.

Addressing inequities effectively requires the early and continued involvement and empowerment of community members who are most affected by poor health outcomes. Community leaders and residents bring important contributions including knowledge of the community, key contacts and resources, potential partners, existing assets, and potential barriers. Ensure that everyone—especially those disproportionately affected —has a say in identifying and prioritizing health needs and that they have support for working collectively to address these needs and barriers.

The process of establishing relationships and building trust within a community can take several years. If you do not already have relationships with a community, meet with leaders in the community to respectfully seek their advice and offer your support as an ally. Use Building a Contact List to identify people you already know who can introduce you to key leaders in the community. Work with these leaders to build an agenda that ensures everyone in the community has opportunities for good health.

NOTE: Every community has a unique way of bringing people together to work on health issues, ranging from informal groups of leaders to voluntary coalitions to formal alliances. For the purpose of this guidance, we will refer to any such group as a “partnership.” 

Research shows us that working together can yield better results than working alone.^{1, 2} 

As you work to improve health in your community, your partnership will be stronger if it includes people from multiple sectors AND people most affected by the problem. Our Partner Center can help you identify the right partners and explore tips to engage them. 

The following are key steps for strategically recruiting diverse stakeholders to your partnership: 

• Consider whether your partnership reflects the demographic make-up of your community and work to meaningfully engage culturally and racially diverse members. The Planner's Playbook shares insights and strategies for centering the participation and input of community members in planning process, especially those who have traditionally been left out of planning conversations s (pp. 22-28). 
• Leverage a diverse set of skills and expertise to help your partnership work to advance health for all in your community. A Practitioner’s Guide for Advancing Health Equity provides guidance and ideas for developing partnerships as well as questions for reflection (pp. 14-17). 
• Engage new groups especially those interested in policy or systems change. Building a Contact List can help you brainstorm and recruit diverse partners. 
• Stay open to recruiting new members. Recruitment is an ongoing process and membership may need to change over time as the focus narrows to specific policies or systems changes, requiring different expertise or influence in the group. Adapt the Coalition Core Competencies Checklist with your partnership to discuss where your strengths are and where additional skills, knowledge, and/or resources may be needed. 
• Build relationships as you go. Even if someone says they don’t wish to become involved at this time, they may be able and willing to help at some future point or to share insights about other potential partners. 
• Consider the culture of your partnership. How will you welcome and mentor new members in a way that will help them become engaged and active members rather than observers? Read more about this in Build Relationships and Reinforce Healthy Partnership Practices. 
• If you want to recruit a new individual or organization to your coalition, Effective Recruitment of Coalition Members helps you analyze “what’s in it for them?” 

In their book Boundary Spanning Leadership, Chris Ernst and Donna Chrobot-Mason, identify five types of boundaries that are universal: 

• Vertical boundaries between hierarchical levels of an organization
• Horizontal boundaries between functions within an organization
• Stakeholder boundaries with those external to the organization that impact or are impacted by our work
• Demographic boundaries in working with people from diverse groups
• Geographic boundaries of distance and region¹

For diverse stakeholders to effectively cross boundaries and work together, partners must first define and understand the lines that differentiate them. You must be able to clearly see group boundaries before you can span them. This important step is often skipped in forming new partnerships.¹

As stakeholders come together, members come with their own goals as well as fears and concerns about what working together might mean for their organization. Making the boundaries that exist between partners visible provides a safety net. It eliminates the unknowns that may create insecurity and perception of threat to groups. Defining Team Boundaries helps partners clearly define what does and doesn’t belong in the work of the partnership. 

Once you explore the boundaries that exist among the members of your partnership, you’ll want to help members feel connected as a group. Some simple ways you can help build relationships include: 

• Reserving time for a personal check-in at the beginning of meetings. With more meetings going virtual, it's important to make sure that all participants are comfortable with new technology platforms and have the tools they need, like adequate internet bandwidth, webcams, microphones. Consider checking in with participants in advance to troubleshoot these issues so everyone is prepared to fully engage. 
• Starting your meeting with an icebreaker that introduces exploration of members’ background to surface the diversity and similarities within the group. For examples Mementos, where members share an object that holds personal significance so everyone can learn more about each other.
• Setting up “buddy systems” to encourage one-on-one relationships. This can be a helpful way to introduce people. 
• Have fun. 

You can also use Social Identity Mapping to engage partners in deeper dialogue about who group members are and to move beyond typical introductions. You may want to have an experienced, neutral facilitator guide your group through team building to ensure a safe learning environment for all. 

To achieve a shared understanding, start to develop a common knowledge base and common language. For example, plan sessions for the full partnership to help build a common understanding of the issue you’re addressing and the potential strategies to address it. Establish guidelines for communication, such as spelling out acronyms and avoiding potentially confusing jargon. 

Explore the County Health Rankings model as a group to learn more about the multiple factors that impact health. You can also learn more about policy and systems change approaches and the value of a multi-sector approach by viewing County Health Rankings & Roadmaps webinars. Reviewing A New Way to Talk About the Social Determinants of Health together can provide a common understanding of the social determinants of health as well as give your partnership some common language to use.

A vision statement answers the questions: Where do we want to be in the future? How great can we become? What do we want to create together? 

A core values statement describes deeply held commitments that translate directly into behavior. Beliefs are an expression of what we believe to be true, while values are what we do as a result of what we believe. 

A mission statement answers the question, “Why do we exist?” If your group already has a mission statement, this is an opportunity to review, revise, and refresh their mission.  

A number of tools are available to help lead a group in writing vision, core values, and mission statements, including Making Decisions Tool #1: Brainstorming Techniques; Brainwriting a Mission Statement (to identify what are we here to do and for whom, how will we accomplish our aim, and why do we exist?); and The 27-9-3 Rule: Developing your Persuasive Message (a process for creating powerful, succinct, messages—no more than 27 words, delivered in nine seconds, containing just three or fewer ideas). You can use this last tool to create or modify a mission statement.

Choosing Your Organization's Structure can help you decide the type of structure that’s right for you. If you decide to move from an informal partnership to a coalition, To Be (a Coalition) or Not To Be (a Coalition) lays out issues you should consider as well as ground rules and expectations to develop early in the process. 

Use the Team Blueprint to guide your discussion around your partnership’s goals, project scope, meeting processes, partner roles and responsibilities, and how you will work together. 

You’ll also want to discuss leadership for the organization: How will decisions be made? How will leadership be structured (e.g., executive director, steering team, executive committee)? Decide who will serve in leadership positions and whether the same people will be responsible for overseeing each step of the process to improve health. Remember to consider power dynamics within the group and ensure community members are empowered to influence decisions. 

Also consider who will provide coordination and supporting infrastructure. The Collective Impact model calls for a “backbone organization” to serve this role for multi-organization initiatives. Depending on the needs of the initiative, backbone functions can be fulfilled by different types of organizations, such as new or existing nonprofits or intermediaries like community foundations, United Ways, and government agencies. Backbone functions can also be shared across several organizations.¹ 

As your partnership develops, you’ll likely go through five predictable stages of group development: Forming, Storming, Norming, Performing, and Mourning/Re-forming. Create a common understanding of the Stages of Team Building, including the challenges at each stage and strategies for addressing them.

Below are some critical skills for coalition leaders that are addressed in Tom Wolff’s Coalition Leadership. These qualities are likely to reside in a group of leaders rather than a single individual. Who in your coalition has these qualities? Which qualities does the partnership need to develop more?

• Inclusive and welcoming: Set the tone for bringing in new members, orienting members, and giving them active roles. 
• Excellent verbal and written communication skills: Make complex materials understandable for all audiences.
• Group facilitation skills: Able to guide meetings, allowing everyone to have their say while moving through problem-solving and decision-making.
• Conflict resolution: Appreciating its benefits, recognizing self-interests, seeing common ground, and seeking compromises.
• Sharing the spotlight: Share glory with other coalition members and groups and celebrating the successes of the coalition.
• Trust: Engender trust in others; reliable, honest and true to commitments.
• Energy and hope: Bringing energy and hope to the coalition through style and actions.
• Action-oriented: Knowing how to move forward without getting bogged down and moving the coalition toward action and accomplishments. 

Individual members can also use Am I a High Functioning Coalition Member? to reflect on their participation in the partnership.

People in your coalition may come and go and leadership may change over time. Consider how to create reliance on systems instead of individuals. Succession Planning: The Elephant in the Room provides tips for developing a systems-focused plan.

You may want to take time to consider how your organizational structure will guide your partnership in addressing changing membership, as members leave and new partners join. See Determine Your Organizational Structure for related tools and guidance.

Consider asking members what assets and skills they’d like to share with your partnership and how they’d like to be involved. You can build a member assessment into your new member orientation process to capture this information. You may want to define specific levels of involvement as part of your organizational structure (see Determine an Organizational Structure).

Running effective meetings is another important way to ensure members of your partnership feel their time is valued. An important first step in planning meetings is to make sure everyone in the partnership is able to participate and feels comfortable doing so, especially community members. Factors to consider include:

• Is the location of the in-person meeting a place that is easy for partners to get to? Will they feel safe and comfortable in that setting?
• If the meeting is virtual, does everyone in your partnership have access to the right technology?
• Is the time and day of your meeting convenient for partners?

Effective meetings include:

• A designated facilitator or chairperson/group leader
• Written agendas
• Ground rules
• Shared meeting roles
• Documentation
• Clear next steps with assigned roles
• Periodic meeting evaluations

Periodically evaluate your membership and participation, decision-making processes, and meeting times and locations to help ensure that you’re creating space for meaningful and new voices and perspectives. The Meeting Effectiveness Inventory provides feedback about leadership, conflict management, and other issues. Build simple evaluations into your meetings to get information that will help you improve future meetings, by asking what went well with the meeting process and what could be improved for next time? Learn more about evaluating your coalition in our Evaluate Actions Guide.