Collaborative Infrastructure Framework

WHO SHOULD USE THIS TOOL? 
The Collaborative Infrastructure Framework is a tool designed for organizations, health departments, leaders, and coalitions to think about with whom, how, and why they collaborate with others to advance health equity, either within a community or on a specific project. Whether part of a national organization, a small local nonprofit, or an individual leader, this framework aims to help users ask the right questions, make strategic decisions, and form partnerships that drive impact. The only criteria are that those using it be engaged, or interested in engaging, in authentic and honest partnership with others to improve some aspect of health equity within a community.

HOW SHOULD THIS TOOL BE USED?
The framework is organized in four main chapters (1: Understanding, 2: Defining, 3: Focusing, 4: Sustaining), though the framework’s pieces can be mixed, matched, and adapted as needed. In this way, partnerships at any stage can benefit from the framework. 

Importantly, the framework is neither an assessment nor a directive reinforcing the power dynamics we’re trying to uproot. It is a set of interactive tools and exercises, resources, and case studies offering ways to think about effectively executing collaborations and learn from the lessons of powerful collaborative networks.  Its offerings should be viewed as a compliment to the incredible knowledge base that exists within the community.

The overarching flow of the framework offers a potential roadmap to building collaborative infrastructure from the ground up. Each chapter asks key strategic questions aimed at addressing stages of a collaboration’s lifespan and guiding next steps to answer those questions collectively. The user guide illustrates ways in which different types of organizations might use parts of the framework, depending on their reason for use.

The framework’s tools and strategic guidance can also be considered through another lens: domains of action. In this way, it offers strategic guidance and supportive tools for enabling more efficient and effective action to improve health equity within and across organizations, determining community-specific offerings, elevating community voices and strengths, and sustaining wider ecosystem-level systems change. 

Of particular note, the framework outlines seven key pillars of collaborative infrastructure foundational to successful collaboration in the context of health equity. We have found that organizing the work of collaborative infrastructure and reflecting on challenges related to each of these pillars helps define objectives and roles within a collaborative as a means of building towards a stronger collaborative infrastructure in service of health equity. The framework provides templates and exercises for members of a coalition to consider these pillars and the challenges associated with each.

Below are summaries of the framework’s chapters and several key tools and exercises associated with each. Please note these are best considered within the more comprehensive full framework, which includes more context, detail, and resources.

Chapter 1: Understanding Health Equity Within Your Community

Before an organization or collaborative can act to improve health equity, it is critical to first understand the community. Perhaps the most essential element to understand is the state of health outcomes—and the inequities inherent in those outcomes—in the community, though groups should also consider the many other characteristics shaping the community and the lives of those who live there before establishing any goals or methods.

Collaboratives must build relationships and leverage research and established tools to understand and explore the experiences of those living in the community. This information can include population characteristics, demographics, and economic patterns; historical context; available resources and supports within the community; and both existing and potential actors. This background can help establish a baseline to gain detailed insight underlying health equity barriers and drivers that will serve as the ultimate foundation for collaborative work to improve health equity. This knowledge can help form a vision of what the future would look like if everyone had a fair and just opportunity to attain their highest potential of health and wellness. It can align a wide array of actors and collaborators on a vision and prioritize areas of focus so they can move forward with purpose and a shared mission. 

Chapter 1 of the framework outlines a pathway for actors to better understand the communities in which they are working and establish these well-informed goals for health equity, informed by community voice and needs. 

PIH-US developed a Landscaping Guide for Health Equity that can help users understand the underlying context of health equity within a community by leveraging existing research and elevating lived experiences of those within a community.

The framework offers a Local Health Ecosystem Mapping exercise and template to help map and understand the array of diverse actors and their perspectives or roles in a community health ecosystem. This mapping exercise can encourage actors and coalitions to think holistically about actors who influence health equity to identify potential collaborators who may often be excluded from collaborations and bring them into the fold to more authentically advance health equity. 

Chapter 2: Defining Your Role in Collaboration

The second chapter of the Collaborative Infrastructure Framework provides tools and guidance to help define a focus and establish the roles required to achieve a coalition’s health equity vision. 

Understanding that health inequities have many multifaceted causes and complex potential solutions, organizations should be thoughtful to choose how and where to devote finite resources and leverage expertise. A well-defined scope can enable focused action leading to targeted impact and more effective resource allocation. Additionally, defined roles for members of a collaborative allow groups to identify key gaps and incorporate necessary skill sets to advance health equity.

The framework outlines eight key roles common within collaborative efforts to advance health equity. Organizations may view themselves in one or more roles within a collaboration—and this can change dynamically over time or in different collaborative projects—depending on the community context, organizations involved, projected impact, and more. It is important for each organization to critically and honestly consider its own best and potentially most impactful skill sets and allow roles to be filled by others if they may be better equipped—putting aside power dynamics and ceding control when possible. This is the best way to maximize efficiency and strengths, move with speed and purpose, and share power to move the needle towards justice. 

The Ecosystem Mapping Template from Visible Network Labs can help organizations and collaboratives further establish clear relationships and linkages—both ongoing and potential—within an ecosystem. The relationships within and across partnerships often evolves over time; thus, these types of mapping exercises should be revisited periodically throughout the life of a collaborative. 

Chapter 3: Focusing Your Collaborative Efforts

Once a collaborative has determined a health equity vision and the roles required to achieve that vision, it must focus collective efforts, ultimately deciding how to mobilize to take collaborative action, which roles and functions require partnership, and identifying those partners to carry out the necessary functions. Chapter 3 of the Collaborative Infrastructure Framework provides guidance to bring together the “what” of what must be in place to drive collaborative work with the “how” to drive a health equity mission. The pillars of collaborative infrastructure offer framing to understand the dynamics organizations must navigate, while the roles outline possible functions organizations within a collaborative can play.

Collaborators refine their vision and operational plan for collaboration by 1) understanding what functions are truly needed, 2) evaluating which functions can be met internally and which are better served by external partners, 3) considering the functions each partner can play, and 4) outlining the tradeoffs they may need to make to prioritize limited time and effort.

Evaluating these strategic tradeoffs—such as whether to focus on a singular health topic or more broadly on equity within a community, or to prioritize relationships with those aligned with one’s own ideology and vision versus work with a wider network of groups that may have a variety of perspectives, for instance—can help coalitions understand who is best placed to play a specific role and to outline the resultant implications for programming or support from others. Each decision point has a range of implications that should be considered, so determining areas ripe for compromise is key. 

This role articulation exercise helps organizations discern what roles are ideally required to successfully act on the defined goals of a coalition and identify their own specialties and places where it is best to collaborate externally to act in service of health equity. This should be completed by each partnering group. 

Strategic tradeoffs may be considered with this example and worksheet, which are useful as conversation starters to determine how to inform your collaborative strategy and focus your efforts, both as a collaborative and within your own role. 

Chapter 4: Achieving and Sustaining Collaboration Capacity

The fourth chapter of the framework provides guidance on navigating the period after a collaborative has been launched. Once necessary partners are identified and invited to collaborate, coalitions remain dynamic and advance through stages of maturity as they continuously renegotiate relationships and respond to emerging needs and challenges in their communities. Careful attention to managing these complex cooperations and evaluating their impact is critical to sustaining collaborations and ensuring they remain effective, healthy, and flexible into the future. 

It is important to note that the maturity of a collaboration (which can be reflected in how long it’s been underway or in its degree of alignment) on the spectrum of emerging to transforming will affect the tactics, resources, and infrastructure required to move the partnerships along the continuum of progress. Partnerships may also go back and forth along the stages of maturity, as circumstances change and relationships are renegotiated. 

Platform C’s Change Cycle Progress Mapping Tool is an adaptable activity-based tool to guide diverse stakeholders within an initiative to support the development of shared understanding and an agreed path forward, and ultimately to identify the current phase of a partnership. The tool identifies five interlinked phases each featuring critical enabling capabilities required to achieve and sustain progress. Once partners understand where they are in the process they are better equipped to identify useful exercises and resources to help move the collaborative further.  

The framework highlights a variety of publicly available tools depending on collaboration stage and actions needed to progress.