The Use of Multi-Stakeholder Coalitions to Integrate Healthcare and Social Services

Abstract

The United States healthcare system is looking to reduce healthcare costs and improve healthcare outcomes by traversing traditional healthcare boundaries to address not only the clinical but also the social needs of patients. Coalitions between healthcare systems, social service organizations, and government entities are one way to address gaps in the healthcare and social service systems. The Washtenaw Health Initiative (WHI) is a multi-stakeholder collaborative in Michigan working to integrate healthcare and social services through use of the Collective Impact model. Using participant observation and in-depth interviews, this dissertation aims to 1) evaluate the implications of WHI’s alignment with and departures from the Collective Impact model and other coalition theories and 2) to explore opportunities and challenges for all coalitions working to integrate healthcare and social services. The WHI is partially aligned with the Collective Impact model, in that it has a common agenda of promoting community connections and a strong backbone organization. It does not strongly align with the other pillars of Collective Impact: shared measurement, mutually reinforcing activities, and continuous communication. Drawing on other coalition theories, the WHI may benefit from more clearly defined roles and structure, explicit meeting norms, and a process for embarking on new activities—including an emphasis on community engagement. Through these changes, the WHI may become more effective by aligning its approach to creating change and its activities with its mission. Coalitions have an opportunity to help providers navigate the tricky interface between healthcare and social services by sharing and collaborating on different approaches to addressing patients’ social needs. Yet, to effectively address the root causes of social conditions, coalitions face the challenges of engaging their diverse members, equalizing power dynamics, and building trust. Overcoming these challenges requires strengthening relationships amongst coalition members through active facilitation to create an environment to hold difficult conversations about power, resource distribution, and problems in the coalition’s local healthcare system. By using coalition models to refine processes and structures, multi-stakeholder coalitions can build an environment which uncovers and addresses the underlying issues that cause gaps in the U.S. healthcare and social service systems.