Establishing Strong, Sustainable, Cross-Sector Collaborations

Organizational equity assessments provide insights into practices that promote or stifle equity in the workplace. These assessments can provide a shared understanding of equity that facilitates the coalition’s efforts to address the root causes of health inequities.

• EMBRACe members conducted organizational equity assessments and worked individually to improve diversity, equity, and inclusion in their respective organizations.  This work has created a common vocabulary among coalition members and has better equipped them to address equity as a group.
• Leadership from each of EMBRACe’s member organizations expressed a desire to learn more about diversity, equity, and inclusion after seeing the results of the organizational equity assessments.

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Seek shared funding that draws people to the table. Given the infrastructure needed to manage grants, the public health department may be best fit to receive funding. However, it is important to distribute funding to coalition members in a way that ensures the coalition meets its collaborative goals.

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Successful coalitions require a great deal of work that typically is not listed as a grant deliverable, such as:

• nurturing and tending to relationships, 
• providing the time and effort to engage community members in discussions and center the community’s voice in coalition efforts, 
• revising plans and making course corrections that result from using an equity lens to plan and execute programs, and 
• ensuring that coalition members are accountable for their commitments. 

Without dedicated staff time for these efforts, coalitions may be much less productive, or they may even dissolve altogether. Therefore, when writing up grants, it is important to request funding that not only supports grant deliverables but also supports these aspects of maintaining a robust and effective coalition.

• After the initial two-year grant, EMBRACe received another grant that listed system alignment as one of its three overarching goals. Funding for system alignment supports training for, and implementation of, structured facilitation; development of a communication network across prenatal providers; and training on equity for EMBRACe. Collectively, these actions support a system for continuous community engagement and decision-making.

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As a result of its work, EMBRACe has received several additional grants to further support its efforts to decrease birth inequities.

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Several more non-profit organizations have asked to join EMBRACe, demonstrating that this collaboration structure is gaining visibility within the community. It is anticipated that additional partners will increase the coalition’s impact on birth inequities.

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The story circles for providers with lived experience offers space for them to voice their frustrations due to difficulties of providing care in a community with limited resources and from within a system with systemic difficulties. These perspectives add avenues for growth in advancing health equity in the county and offer additional avenues.

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The Chatham Hospital Maternity Care Center is still open and a UNC-led community taskforce and Keep the MCC Open Coalition are actively engaged in finding solutions to sustain and stabilize the unit for at least three more years.

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When a coalition is overseen by a team of executives, work can be delayed because it may be difficult to find mutually agreeable times for all to participate, the coalition may not be viewed as a priority, and executives may not have enough bandwidth for this work. To avoid these potential barriers, EMBRACe developed a multi-level oversight structure to ensure that the coalition could progress in its efforts without needing leadership approval for every decision. The steering committee provides broad oversight and support for staff participation. A coordinating team, comprising senior staff of member organizations, is responsible for leading coalition meetings and activities. Within this structure, it was possible for EMBRACe to call the emergency meeting described above without the express permission of the hospital.  

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It is important to engage clinical providers when working on clinical practices. This is most easily accomplished by meeting with providers after work hours, and it is helpful for participating health care organizations to allow administrative time for providers that includes coalition work. 

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A cohesive partnership may take years of concerted effort to build. As coalition membership changes due to staff attrition and the addition of new organizations, foster trust between new and existing members of the group by conducting intentional relational meetings with new and existing members, establishing "rules of engagement" that prioritize transparency, inclusion, and relational power within the collaborative structure. This also includes calling partners "in not out" when issues emerge, i.e., bringing partners into a constructive conversation instead of openly criticizing them.  

• For example, the EMBRACe partners chose to call in Chatham Hospital leadership when they learned about the potential closure of the MCC. Despite feeling blindsided and frustrated, leaders in the group chose to leverage the partnership to show support and a shared commitment to the MCC’s success. 

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Governments, hospital systems, academic institutions, and other potential partners can have a lot of red tape to navigate. Rather than making a pre-determination that a specific action will not occur as a result, commit to finding a way around the bureaucratic barrier. 

• The EMBRACe Coordinating Committee realized that they were most effective by building a bridge between the system and the community, and by staying grounded in two fundamental priorities: equity and accountability to the community. By investing in this values-driven, bridge-building work, EMBRACe has been able to operate outside of many bureaucratic barriers faced by other coalitions.

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