Fannie E. Rippel Foundation

Seeding innovations in health
Home > ReThink Health > Managing the Health… > Activities
ReThink Health

Managing the Health Commons

The initial focus of Managing the Health Commons is to understand the patterns of health care collaboration in three communities: Grand Junction, CO, Cedar Rapids, IA, and Bloomington, IN. The primary goal is to determine which factors contribute to the dynamic expansion and contraction of stakeholder relationships and coordination. Working with a community advisory board in each site, researchers have conducted extensive cross-sector interviews eliciting personal experiences – positive and negative – related to multi-stakeholder collaborations. The team is also identifying the economic interests and professional values of key stakeholders and the financial, physical, human, and social resources critical to the sustainability of the regional health system. The community advisory boards will also provide pilot test sites for the resulting set of principles and a self-assessment tool to help identify the critical factors that affect a community’s capacity for collective action.

With many different forms of stakeholder collaboration having been tried – including managed care organizations, HMOs, integrated hospital-physician systems, community health cooperatives, accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) – to be effective in real-world settings, collaborative stewardship must allow room for stakeholders to protect their core interests, including maintaining financial viability. The project will develop a conceptual framework to help health care professionals, community leaders and citizens understand these alternatives so they can better appreciate and identify the delicate balance between legitimate competition and necessary coordination and take more informed action.

Building on basic principles identified by Dr. Ostrom, and adding additional factors specific to the delivery of medical care, the Managing the Health Commons research team has concluded that the following factors enhance collaborative stewardship in health:

  • A formal or informal leadership team involving all (or most) local stakeholder groups which are critical in shaping health care practices and health outcomes in that region.
  • The team has been given the authority (or has taken upon itself the responsibility) to manage that community’s resources by collectively crafting rules and procedures regarding local health care practices and health promotion activities.
  • These rules and procedures fit local circumstances and participants consider the resulting distribution of the costs and benefits of their collective action to be fair and equitable.
  • Participants have routine access to information generated through monitoring of actions and health outcomes, with monitors held accountable for their work.
  • Participants who violate agreements are subjected to a graduated series of increasingly severe sanctions, but rule violators are also given opportunities to regain the trust of others.
  • Participants can resolve disputes among themselves or with the help of others, and these procedures do not take an unreasonable amount of time and are not too costly.
  • When the group is working on a complex problem or an inter-related set of goals, the team can break itself down into sub-teams to focus on achieving specific goals.
  • Regular channels of communication facilitate identification of shared goals and help team members develop a common understanding of the system within which they are operating as well as nurturing a sense of trust in each other and reinforcing shared norms.Team and sub-team leaders keep discussions going in productive directions and actively pursue opportunities to reach out to stakeholders not yet included on the team.