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Collective Impact as Means to Create Change: A Cautionary Tale

Glenn LandersBy Glenn Landers
Director, Health Systems, Georgia Health Policy Center

Cutting poverty. Improving high school graduation rates. Reducing health disparities. Progress towards these ambitious goals can be slow, as the work towards achieving large-scale social impact is complex.

Seven years ago, the publication of John Kania and Mark Kramer’s influential paper defining “collective impact,” the commitment of a group of diverse organizations from different sectors to a common agenda for solving a specific social problem, caught the attention of organizations across sectors. This included nonprofit organizations, national, state, and local governments, and philanthropies.

The authors suggested the government and nonprofit sectors traditionally supported “isolated impact” — directing resources to individual organizations thought to be the best changemakers in specific areas. They acknowledged that this strategy had not resulted in the innovation needed to address large, complex social problems.

Instead, what was needed was cross-sector partners engaged with those outside the government and nonprofit sectors — a strategy they called collective impact. Recent work by the Georgia Health Policy Center (GHPC) shows that, while popular, collective impact is not always the right approach for every large challenge.

While collaboration is not a new concept, Kania and Kramer tried to apply structure and rigor to collaboration. They suggested true collective impact is built on five pillars:

  • A common agenda
  • Shared measurement systems
  • Mutually reinforcing activities
  • Continuous communication
  • A standalone backbone support structure, including an entity to keep the work moving along.

GHPC worked with the Colorado Health Foundation from 2015 to 2017, evaluating an effort to create greater leverage and effectiveness with the foundation’s portfolio in health delivery systems and health provider payment reform. The foundation encouraged a collective impact effort among individually supported grantees. Despite several years of work and investment, the initiative was dissolved at the end of 2016 by agreement of the grantees and the foundation.

While collective impact continues to be a widely favored framework for creating positive change, GHPC’s evaluation in Colorado surfaced several important lessons. First, while the concept of collaboration is not new, collective impact is innovative, particularly in the realm of health systems, which have seen fewer applications of the framework than the field of social services. Collective impact participants need to embrace their role as innovators and accept that the road to greater effectiveness in tackling a complex social problem may be unpredictable.

Second, it matters who initiates collective impact. Stakeholders typically approach a funder to support a collective impact movement that has already been emerging. In the Colorado case, the funder proposed collective impact as a model and asked stakeholders to come to the table.

While the foundation’s intentions were laudable, the perceived imbalance of power between funder and grantees may have been insurmountable. A funder taking on the leadership role introduces another layer of complexity to the dynamic.

Finally, adaptive leadership is needed in unpredictable, complex situations involving multiple partners. It can come from within the group or it can be ceded to a high-performing backbone organization.

A great example of putting these lessons into action is the Atlanta Regional Collaborative for Health Improvement, or ARCHI. ARCHI includes more than 100 Atlanta-area organizations working together to increase healthy behaviors, coordinate care, expand insurance and strengthen family pathways to success. By 2040, ARCHI aims to lower health care costs by 13 percent, increase worker productivity by 7 percent and lower emergency room visits that do not require immediate care, such as treatment for a common cold, by 45 percent.

Collective impact continues to evolve, and some have even questioned its validity as means of effective collaboration. Not all collective impact initiatives will succeed, but we can learn from these efforts to drive further change.

Glenn Landers, Sc.D., is a research assistant professor in the Andrew Young School of Policy Studies at Georgia State University and is director of health systems at the Georgia Health Policy Center, also at Georgia State. He plays a lead role in the center’s approaches to evaluation, collective impact and health system transformation.


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