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«Charlene Connolly B alance!—A critical factor for success for an individual perched precariously high above a hushed circus crowd taking ...»

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Principle 4: The partnership balances

the power among partners and enables

resources among partners to be shared Connolly

Charlene Connolly

B

alance!—A critical factor for success for an individual perched precariously

high above a hushed circus crowd taking deliberate, precise steps across a high

wire, or purposefully entwined as a dynamic component of power within a

partnership in action. The latter, perhaps, is more difficult and challenging to maneuver as it involves the coalescence of individual actions into a shared process. It is the process of sharing power among partners, especially in an academic-community partnership, that must be held as a priority—not only to share available resources, but also, even more importantly, to increase the resource infrastructure or capacity building of the partnership.

Traditional thinking directs partners to create “collaborative” agendas that, while possibly including the interests of all of the partners, tend to be unfairly power-weighted towards the interests of the larger partners with broader scope of services, greater fiscal resources, or better-marketed reputations. This approach includes many challenges or impediments and is not healthy for a partnership; it creates attitudes that are devaluing and distrustful and forces individual agendas to remain hidden. However, by initially including the facilitators of respecting the value of each partner and acknowledging the importance of the unique resources of each partner as the partnership is developed, the work of creating a balance of power begins.

There are numerous facilitators and challenges, including:

Challenges/Impediments Facilitators

• Traditional thinking

• Future thinking

• Institutional resistance to change

• Advocacy for new initiatives

• Understanding the cultural

• Respect the value of each partner parameters of partners

• Acknowledge the importance of

• Territory, turf and limited resources partner resources

• Distrust of project at the

• Inclusion of self-directed agenda grassroots level

• Allow for control and account Agendas given priority or hidden ability of different interests

• Competing interests power Ability to develop larger projects brokering and attract resources

• Relying on partners resources

• Mutually establish

–  –  –

Discussion in the A Model Community-Campus Partnership In 1995, an innovative academic-community model partnership planning process consisting of Northern Virginia Community College (NVCC) and thirty community-based agencies was formed to create a Nurseencouraged open Managed Health Center Network (Network). The Network project has two main goals: to provide practice sites in community-based expression of how the primary care settings to serve as student clinical rotations; and to increase access to free primary health care, including health partnership could promotion and disease prevention for disadvantaged, underserved individuals in northern Virginia. The Network serves over 5,000 assist each partner in individuals annually. Using a process that encouraged each partner to define the value that they believed they brought or represented, the meeting their agenda, Network partnership has implemented over ten community-based primary care clinics composed of faculty-student practices. While which could be some of the community-based agencies were small in comparison to NVCC, they had resources that NVCC could not provide, i.e., community trust, interpreters, cultural expertise, and translation strengthened as a services. By incorporating a process that acknowledged the value of these unique resources, the partnership began with a power-sharing result of shared understanding. During the formative stage of partnership development, it was established clearly that meeting an agency’s own resources. agenda through the partnership was to be the expectation rather than the exception. Discussion in the planning process encouraged open expression of how the partnership could assist each partner in meeting their agenda, which could be strengthened as a result of shared resources.

Resources can be shared within a community organization and academic institution partnership in many ways. First, each partner must define the resources important to the partnership; each also must define their needs.

A need for one partner might become an important resource to another.

Various examples of Network programs will be used to illustrate how the need to provide free primary care services for thousands of individuals has become a significant resource for the partnership.

Opportunities of Resource Sharing and Balance of Power Sharing Staff, Space, & Financial Resources

• NVCC and The George Washington University Medical Center’s Breast Health Mobile Mammography Program (the GW program) each had a resource and a need. A major outreach of the GW program is to provide free clinical breast examinations and mammograms to disadvantaged women. They had the resources of a mobile mammography unit and radiographer, but no resources to provide the clinical breast examinations (CBE). NVCC had the faculty and students who could readily provide the CBEs and self-breast exam education, but no First, each partner must resources to provide free mammograms. Through the partnership, each institution was able to meet their agenda, define the resources which was strengthened as a result of the collaboration.





• Through the Network, NVCC sought to increase clinical important to the rotations for nursing students in community-based settings and had the resources of nurse practitioner-prepared faculty partnership; each also and students, but they did not have direct access or space to provide care within the community. Several non-profit must define their needs.

agencies in the region—such as the Ethiopian Community Development Council, a refugee resettlement agency; Culmore A need for one partner Community Center, a local center providing social services to a predominantly Latino population; the Franconia Family might become an Resource Center, a center providing services for Latino and African-American populations; and the LAMB Center, a dayimportant resource to time drop in center for the homeless and needy—had thousands of clients, but no way to provide health care another.

services. By community agencies’ agreeing to join the Network as “Clinical Network Partners,” they committed to providing referrals to the Network Clinics for individuals with little or no access to health care, as well as providing other resources, such as space for clinics within their agencies. The community-based clinical rotations for the students have become rich and diversely robust experiences and the capacity of these agencies to provide health care services has greatly increased as a result of this partnership.

• A similar capacity building outcome occurred between the Network and the American Lung Association of Northern Virginia (ALA). The ALA identified a community outreach mission that went beyond lung health to include other disease prevention efforts. The agency’s goal, which they believed was readily achievable, was to raise enough capital to purchase a “Lung Mobile” to provide health care services within the region, yet they had no way to staff the project. In the initial planning for the Network, the NVCC included the use of a mobile van, but had no funding to purchase it. Creating a partnership between the two groups resulted in the sharing of resources—ALA donated funds to NVCC to purchase a van. The NVCC and ALA partnership then was able to provide free health care screenings and primary care at three pediatric school-based asthma clinics and five community-based women’s health centers, focusing on early detection of cervical and breast cancer and HIV/STD prevention.

Sharing Resources to Obtain Funding

• Other ways of sharing resources involve combining efforts in obtaining external funding using the sustainability of the academic institution and the networking established through community-based organizations.

Because of the successful outcomes that academic-community partnerships have demonstrated, more and more funding sources are requiring a relationship among the applicants, specifically requiring institutions of higher education to collaborate with community-based agencies. The balance of this partnering centers on the resources brought into the partnership by the community-based group of having reached significant stakeholders and garnering community trust through outreach and collaborating with the academic institution’s resources such as grant writing experience and academic department support.

Sharing Cultural Knowledge & Skills

• Sharing resources within an academic-community partnership providing health care might involve the use of the community-based agency’s interpretation and translation services in support of partnership goals.

Paramount to this are the significant resources that community-based agencies possess regarding the knowledge of various cultures of persons served and how the mores and norms of those cultures influence the use of health care services. Sharing this knowledge with practitioners and students as part of direct health care services can involve many different components. For example, the community partner may be able to teach the clinical/academic partner how to approach the topic of HIV prevention or sexuality in women whose cultures do not acknowledge the existence of certain diseases or do not allow their involvement in making decisions about themselves. These are resources, shared by the community partner, which are vital to the success of many projects.

These examples of shared resources weave a tapestry depicting the benefits of shared power and resources within a partnership. Completing the fabric of such benefits, one must also look at other advantages that occur, such as the ability to develop larger projects than those that could be accomplished by each individual partner, the increased capability to attract new sources of funds and the potential for a positive influence in the future of the community.

Benefits of the Facilitators Using the facilitators to build a partnership results in a stronger commitment and clarity of partners as part of the project’s asset base. Clarity of partners associated with the valuing of their particular resources is essential to a productive partnership and should be a part of the planning process. In identifying different types of partners, a project begins to establish responsibility and authority. For the Network, partner categories were established that included Clinical Network Sites, Referral (to and from the 36 Network Clinics), Funding, Resource, and Service. Each partner identified themselves with one or more partner categories, creating a balance of power and control and making a productive partnership achievable, which benefited each partner and the project as a whole.

Another way power and resources are shared is by establishing a Project Advisory Board consisting of members drawn from a wide range of expertise and experience, including individuals served by the project and community leaders. Power is redistributed among the group through joint planning and decision-making responsibilities, including policy making, project direction, accountability, and management of assets. Accessibility to public, private, or community interests and influence is immediately apparent through this model. Sharing power and resources enhances the education of each partner regarding the mission and focus of each agency while helping to increase the “championing” of the purpose of the project.

Tensions in the Resource Sharing Process Finding consensus is not always easy, particularly around the facilitators of inclusion of a self-directed agenda and allowing for control and accountability of different interests for each partner. For the Network, the members of the partnership represented a diverse group of agencies and institutions whose unique differences, the very reasons for inclusion in the partnership, became barriers to sharing resources that had to be overcome.

Challenges facing the partnership process early on included cultural influences that prohibited comfort with voicing an agency’s interest as part of the interest of the group and the perception of community agencies that academic institutions were huge “agenda-driving” dominating Challenges facing the monoliths. In some cases, previous academic-community partnerships were viewed by the community as having partnership process early on “used” the community for the other partner’s agenda.

Community agencies also distrusted partners with whom included cultural influences they had not previously worked at the grassroots level.

Group dynamic processes leading towards consensus were...and the perception of put into action focusing on self-directed agendas and sharing resources and actually had partners repeating the community agencies that mantra of “This is what I want to gain from this partnership” or “By sharing the resources we have with you I can academic institutions were achieve...for our clients.” Working through these issues was critical to the partnership. Permitting the partners to reach huge “agenda-driving” a comfort level with their different interests resulted in an ability to develop larger projects, provide more services, and dominating monoliths.

attract new resources through the partnership.

Commitments to share resources between the community and academic institutions were reached through this open process.

Sometimes resources that could be shared are not brought to the partnership table, as a community agency may view them as insignificant when compared to those that an academic institution or larger community-based agency might provide. An example of this is the provision of transportation vouchers for use to and from Network clinics for disadvantaged individuals, thereby increasing their access to health care services—critical for those families who otherwise would be prevented from accessing the clinic.

While this may be a relatively small budget item for community agencies, it is something that academic institutions can rarely fund.



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