Sustaining The Effort

by Joe Flower


This article was published as part of the Healthcare Forum's Healthy Communities Action Kits, Module 3, in 1994
International Copyright 1994 Joe Flower All Rights Reserved
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The Center for Health Promotion at Group Health Cooperative of Puget Sound has conducted an extensive seven-year study of programs in 30 different communities in the West for the Henry J. Kaiser Family Foundation.

These studies looked at sustainability, among other things, and much of what they found refuted conventional wisdom. Bill Beery, the head of the Center, paraphrased those findings for us in a recent conversation:

"The conventional wisdom says if someone gives you money, take it.

"The reality is that's not always a good idea. `The more money the better' is often not the case. Sometimes there really is not enough money to do anything. But when there is a considerable amount of money, it attracts the attention of organizations and people who are just saying, `How can I get a piece of that money, to do what I want to do?' When there's more money, typically people just hire more staff, because that's the easiest way to spend money.

"The conventional wisdom says you should select your targets based on scientific data.

"The reality is you should ground your selection of targets not only in objective facts but in the subjective wants of that community. It's okay to be `data driven,' but data can come from a variety of sources. You have to do a `wants assessment,' as well as a `needs assessment.'

"The conventional wisdom says that the community knows best -- all you need to do to sustain the project and keep it vital is to get the community on board.

"The reality is that there is an important role for expertise at a number of levels. We need to expand the idea of `community' to include the expertise that is available.

"The conventional wisdom says that state-of-the-art interventions exist, and what coalitions need to do is find them and implement them.

"The reality is if there is any state of the art, we couldn't find it. Coalitions and partnerships need to face the fact that their efforts should be an adaptation, rather than an implementation of somebody else's off-the-shelf program. There is no silver bullet. You have to find out what will work where you are.

"The conventional wisdom says if your program is well-organized, effective, and visible, it will continue.

"The reality is you have to have an active, ongoing resource mobilization campaign. The program has to acquire resources continually. You have to face that, identify what resources you need, and get about the business of gathering them.

"The conventional wisdom says you should always form a community coalition.

"The reality is that it's worth considering putting a coalition together. But sometimes the climate, the interest, or the leadership just isn't there, so you shouldn't do it until people are committed to sustaining it. Some people are in the business of creating coalitions. If it's the wrong thing to do at this moment for this particular goal, you're going to throw away a lot of time and effort and credibility.

"The conventional wisdom says when you form a coalition, you always want to be as broadly representative as possible.

"The reality is you can get stuck with the feeling that you can't get going until every conceivable group is represented. The quality of the people in the coalition is as important as the breadth. You need to have people who are truly committed. Once you get going, you'll find that it is easier to attract quality people if you've got good, important things going on."

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