President and CEO
Palm Health Foundation
Vice President, Grants & Community Investments
Palm Health Foundation
Six years ago, Palm Health Foundation made a risky decision. Dissatisfied with the short-term gains of traditional responsive grantmaking, we launched the Healthier Together initiative in an effort to forge a deeper connection to community through the social determinants of health. The foundation transformed from a traditional funder to a local steward of shared resources, granting $1 million to six communities, and asked residents to lead the way in creating lasting, systemic change.
Forging Deeper Connections to Community by Shifting Power Dynamics
Healthier Together began as a community-led solution to improve health disparities in diabetes, behavioral health, and family caregiving in six Palm Beach County, Florida communities. The initiative puts residents at the core of developing health solutions around their own needs rather than force-fitting a system that does not always recognize the complexity, culture, context, and circumstances of diverse communities. It is the pursuit of systemic, fundamental change through capacity building where residents take action for policy and systems change.
Early in the initiative, one of our biggest challenges was shifting power dynamics between the foundation and the communities and within the communities themselves. Palm Health Foundation had to be mindful of real and perceived power dynamics that were influencing the very behaviors that needed to change for community change work to happen. We realized that the most challenging power differential was our hold on the purse strings. To make the shift from a traditional foundation mindset of “our grant dollars” to “your community’s dollars” required investment in resident leadership capacity building. Through this process we learned that:
- The community is full of natural strengths, and they need opportunities to learn.
Investing in resident leaders to take part in community leadership training through the Tamarack Institute proved to be a game changer for Healthier Together. Residents were empowered to become more civically engaged and influence policy change.
- Learning communities are essential for sharing knowledge and experiences.
We created a formal process for bringing together the resident leaders of all Healthier Together communities five to six times per year for retreats. As they saw how much they could learn from one another, they began to communicate frequently to share ideas and overcome challenges.
- Residents and systems must embrace adaptive leadership.
Community members were not accustomed to being heard by system leaders and did not trust that their opinions mattered. Galvanizing the voices of community members to give them the confidence that they were on equal footing with system partners became one of the most significant investments in building resident leader capacity.
The concept of “emergence” within an initiative is embracing that community solutions “emerge” out of the context of a situation, rather than being pre-determined. The accepted grantmaking norm is the funder bestowing resources to the grantee to follow best practices and achieve predetermined results in a specific amount of time. Healthier Together had to abandon the constraints of best practices as a baked-in solution and accept that there are myriad ways of looking at root causes, symptoms, and what a good outcome might look like.
We learned that willingness to try things outside the norm is critical. Embracing emergence put everyone on the same baseline—the residents saw that the foundation did not have the answers and they were not there to impose a solution on the community. As the work progressed, we shared our vulnerabilities with the residents, allowing them to see that this was not an “us vs. them” initiative, it was “we.”
Embracing emergence motivated us to abandon our initial five-year finish line for the initiative and instead identify meaningful changes we wanted to see without setting hard deadlines. Letting go of rigid structure fostered safe-to-fail experimentation and encouraged innovation and adaptiveness by the people who were showing up and willing to roll up their sleeves.
Redefining the Evaluation Process
The biggest challenge Healthier Together faced was shifting from measuring impact to evaluating impact. Everyone had to embrace a framework for process outcomes that could not easily be quantified. They also had to accept that measuring traditional health outcomes did not apply in their emergent community change approach. “Signals” became the way to recognize readiness, growth, and transformation. Three types of “wins” underpinning the signals helped communities shape direction, and either amplify or alter approaches:
- Outcome Wins are actual results that answer the question, “Who is better off?” at an individual or community level. They can be process, health-related, or policy wins.
- Insight Wins include key learning, sometimes from failure, sometimes from research, and often from day-to-day experiences from which patterns and signals may emerge.
- Capability Wins are new skills or capacities that are developed among individuals and groups and can include system or process enhancements.
This new way of evaluation created conditions where project directors and residents could explore opportunities without the constraints of traditional grant assessment structures.
The Healthier Together initiative shifted the bedrock of Palm Health Foundation: transforming us from a traditional funder to a local steward of shared resources, from investing in systems to investing in residents, and from a learning organization into an organization building a learning culture. It tested our adaptability and influenced a transformation in power dynamics and a new way of evaluating our work. And it was a risk, seasoned with doses of conflict, doubt, and fear.
We are still learning how to work in complexity—today’s new norm—and embrace adaptability by listening to the voice of the community and recognizing outcomes that value social capital, human capital, and developing people’s capacity. Our partners have learned alongside us, joining us in creating a movement where we share responsibility for seeding, stoking, and building a system that will produce better health and well-being for all.
We have come to understand that Healthier Together is a unique model given that community change approaches are, by their nature, context dependent and relational, but our learning may offer important insight and guidance for those interested in working in similar ways to achieve similar impact.
Read more about Palm Health Foundation’s learning journey by reading our report, A Shared Purpose: Transforming Communities Through the Social Determinants of Health, Lessons Learned from the First Five Years of Palm Health Foundation’s Healthier Together Initiative or by visiting www.HealthierTogetherpbc.org.