Partnerships: Analysis and Advice Stephen H. Linder, Ph.D. Interim Director, Institute for Health Policy The University of Texas School of Public Health.

Partnerships:Partnerships:Analysis and AdviceAnalysis and Advice

Stephen H. Linder, Ph.D.Stephen H. Linder, Ph.D.

Interim Director, Institute for Health PolicyInterim Director, Institute for Health Policy

The University of Texas School of Public HealthThe University of Texas School of Public Health

Institute for Health Policy StepheInstitute for Health Policy Stephen Linder, Ph.D.n Linder, Ph.D.

OriginsOrigins

Roman Law of InheritanceRoman Law of Inheritance Medieval Property PartitionsMedieval Property Partitions DiplomacyDiplomacy CommerceCommerce ProfessionsProfessions


Commercial CodeCommercial Code

Jointness + Fair DivisionJointness + Fair Division

Sharing Profits and LossesSharing Profits and Losses Bear some risk, Bear some risk, pay some cost, pay some cost, share some gainshare some gain


Positive ConnotationsPositive Connotations

Diplomacy – “peace, neighborliness, Diplomacy – “peace, neighborliness, prosperity”prosperity”

Professions – “proven and Professions – “proven and accomplished”accomplished”

Commerce – “shrewd, Commerce – “shrewd, entrepreneurial and efficient” entrepreneurial and efficient”


Separating RolesSeparating Roles

Partners v.Partners v.CompetitorsCompetitors

ClientsClients

CustomersCustomers

AgentsAgents

ContractorsContractors

SubordinatesSubordinates


The Feds and FoundationsThe Feds and Foundations

Partners to share the burdensPartners to share the burdens Partners to assume responsibilitiesPartners to assume responsibilities Partners to leverage resourcesPartners to leverage resources Partners for cooperationPartners for cooperation Partners as mid-way to privatization Partners as mid-way to privatization


Principal-Agent v. Principal-Agent v. PartnershipPartnership

Resource FlowsResource Flows Know-HowKnow-How ControlControl


The Symmetry TestThe Symmetry Test

Formulation Formulation Measure of Control Over TermsMeasure of Control Over Terms

FunctionFunction Resource CommitmentResource Commitment Shared FateShared Fate

“ “Fair Division” Fair Division” “Fair Division” “Fair Division”


From Potential Ally to From Potential Ally to PartnerPartner

Less DemandingLess Demanding

1.1. Perceived mutual advantagePerceived mutual advantage

2.2. Mutually agreed upon objectivesMutually agreed upon objectives

3.3. Shared commitmentShared commitment

4.4. Pooled resourcesPooled resources

5.5. Shared accountabilityShared accountability

6.6. Shared formulation and functionShared formulation and function

More DemandingMore Demanding


Relationships between stakeholdersRelationships between stakeholders

Less DemandingLess Demanding

1.1. Networking – exchange informationNetworking – exchange information

2.2. Coordination – alter activity to avoid conflicts Coordination – alter activity to avoid conflicts

3.3. Cooperation – share resourcesCooperation – share resources

4.4. Collaboration – share risks and rewardsCollaboration – share risks and rewards

5.5. Partnership – stable, fair divisionPartnership – stable, fair division

More DemandingMore Demanding


MotivesMotives

Why partner?Why partner?

Economic reasonsEconomic reasons

Leverage Resources – New CapitalLeverage Resources – New Capital Complement Assets – know-how, expertiseComplement Assets – know-how, expertise Shortcut Administrative ChannelsShortcut Administrative Channels Efficiency GainsEfficiency Gains


Why Partner?Why Partner?

Social reasonsSocial reasons Nurture Civic CultureNurture Civic Culture Reduce ConflictReduce Conflict Promote EngagementPromote Engagement Encourage CooperationEncourage Cooperation Community-BuildingCommunity-Building Symbolize SuccessSymbolize Success SustainabilitySustainability


Why Partner?Why Partner?

Political ReasonsPolitical Reasons

Expand Legitimacy & SupportExpand Legitimacy & Support Spread ResponsibilitySpread Responsibility Increase InfluenceIncrease Influence Avoid Narrow AccountabilityAvoid Narrow Accountability Cooptation of Potential RivalsCooptation of Potential Rivals Promote Market-Oriented ValuesPromote Market-Oriented Values


Our Sectoral ComplexOur Sectoral Complex What is public and what is private?What is public and what is private?

Changing American ideasChanging American ideas

Domains -- economy, householdDomains -- economy, household Rights claimsRights claims Limited governmentLimited government


Efforts to keep Public and Private separateEfforts to keep Public and Private separate

Use Organization typesUse Organization types

Government (courts, agencies, elected officials)Government (courts, agencies, elected officials) Business (e.g., Microsoft Corporation) Business (e.g., Microsoft Corporation) Voluntary Private Organizations (e.g., Planned Voluntary Private Organizations (e.g., Planned

Parenthood) Parenthood) Non-governmental Organizations (e.g., United Way)Non-governmental Organizations (e.g., United Way)


More Efforts to keep Public and Private More Efforts to keep Public and Private separate separate

Use Legal definitionsUse Legal definitions

Public -- taxes and sovereign immunityPublic -- taxes and sovereign immunity For-profit -- commerce and incorporation For-profit -- commerce and incorporation Nonprofit -- gifts and tax breaksNonprofit -- gifts and tax breaks

Use forms of governanceUse forms of governance

The State -- Elected Officeholders for VotersThe State -- Elected Officeholders for Voters The Firm -- Board of Directors for StockholdersThe Firm -- Board of Directors for Stockholders The Organization -- Community BoardThe Organization -- Community Board


Post World War II Consensus Post World War II Consensus

(Limited Welfare State)(Limited Welfare State)

Public – common defense and market Public – common defense and market interventionintervention

Private – economic growth and employmentPrivate – economic growth and employment

Voluntary – social stability and inequalityVoluntary – social stability and inequality


Post-Reagan Consensus Post-Reagan Consensus

(Devolution)(Devolution)

Privatization (Government Privatization (Government Business) Business)

Substitution (Government Substitution (Government PVOs) PVOs)


New Governance (Strategic Alliances)New Governance (Strategic Alliances)

Collaboration (Government + NGOs)Collaboration (Government + NGOs)

Partnering (Government + Business)Partnering (Government + Business)

Convergence (NGOs Convergence (NGOs Business) Business)


Conventional Sector x Conventional Sector x RevenueRevenue

TaxesTaxes CommerceCommerce GiftsGifts

PublicPublic

SectorSectorGovernmenGovernmen

tt

PrivatePrivate

SectorSectorFirmsFirms

VoluntarVoluntaryy

SectorSector

Non-ProfitNon-Profit

OrganizationOrganizationss


FirmsFirms


PublicPublic


ttpartnershipspartnerships

PrivatePrivate

SectorSectorcontractscontracts FirmsFirms affiliationsaffiliations

VoluntarVoluntaryy

SectorSector

sponsorshipssponsorshipsNon-ProfitNon-Profit



GovernmentGovernment


PublicPublic


ttasset salesasset sales grantsgrants

PrivatePrivate

SectorSector

procuremeprocurementnt

contractscontractsFirmsFirms subsidiessubsidies

VoluntarVoluntaryy

SectorSector

serviceservice

contractscontractsNon-ProfitNon-Profit



NonprofitsNonprofits


PublicPublic


ttgrant grant

proposalsproposals

PrivatePrivate

SectorSectorFirmsFirms campaignscampaigns

VoluntarVoluntaryy

SectorSector

lobbyinglobbying brandingbrandingNon-ProfitNon-Profit



The MBA ChecklistThe MBA Checklist

What is your mission, goals and affiliations?What is your mission, goals and affiliations?

What do you hope to gain through the What do you hope to gain through the partnership? What are you willing to partnership? What are you willing to forego?forego?

What are you willing to contribute? What What are you willing to contribute? What are you not willing to contribute?are you not willing to contribute?


What degree of autonomy are you willing to What degree of autonomy are you willing to give up?give up?

Will management support and reward Will management support and reward collaboration and partnership?collaboration and partnership?

What are your non-negotiables? What do What are your non-negotiables? What do

you fear most about collaboration and you fear most about collaboration and partnership?partnership?


Relationship IssuesRelationship Issues

Shirking Shirking ? ? Self-Seeking Self-Seeking Trust Trust

ObstaclesObstacles Suspicions or preconceived notions of the Suspicions or preconceived notions of the

other other No history of working togetherNo history of working together Poor communicationPoor communication ReputationReputation


Leadership IssuesLeadership Issues

Encouraging collaborationEncouraging collaboration Nurturing versus controllingNurturing versus controlling Persistence and enduring commitmentPersistence and enduring commitment

ObstaclesObstacles

Lack of commitmentLack of commitment Opposition from withinOpposition from within Few shared goalsFew shared goals Lack of adequate planning and integrated supportLack of adequate planning and integrated support Inability to institutionalize trust and confidenceInability to institutionalize trust and confidence



Who’s In and Who’s NotProcess Partners: 132 Organizations

56% Statewide (have Texas in their name)

8% Academic Orgs.

~6% Nonprofit Community Orgs.

<1% For-profit Organizations

Work Groups: 12 with 24 co-chairs

~50% Statewide

16% Academic Orgs.

<3% Nonprofit Community

0% For-profit Organizations


National Public Health National Public Health Performance ProgramPerformance Program

Categorical RepresentationCategorical RepresentationCommunity OrganizationsCommunity Organizations

Local Businesses and EmployersLocal Businesses and Employers

Neighborhood OrganizationsNeighborhood Organizations

Faith InstitutionsFaith Institutions

Transportation ProvidersTransportation Providers

Civic OrganizationsCivic Organizations

Educational InstitutionsEducational Institutions

Public Safety OrganizationsPublic Safety Organizations


CBPR is a collaborative research approach that is designed to ensure and establish structures for participation by communities affected by the issue being studied, representatives of organizations, and researchers to improve health and well-being through taking action, including social change.

To expand this definition, we conclude that CBPR emphasizes:

(1) co-learning about issues of concern and reciprocal transfer of expertise;

(2) sharing of decisionmaking power; and (3) mutual ownership of the products and

processes of research.


A Mid-Course AdvisoryA Mid-Course Advisory

Pursue SymmetryPursue Symmetry Forget Public v. PrivateForget Public v. Private Cultivate Unlikely PartnersCultivate Unlikely Partners Trust SubsidiarityTrust Subsidiarity Nest the RestNest the Rest


A Final NoteA Final Note

““We have found that there are many ways We have found that there are many ways to achieve partnership…There is no ideal to achieve partnership…There is no ideal partner or partnership arrangement. partner or partnership arrangement.

Successful building of partnerships requires Successful building of partnerships requires an open and proactive spirit. The craft an open and proactive spirit. The craft and tactics can be learned.”and tactics can be learned.”

-- Soros Foundation-- Soros Foundation

Partnerships: Analysis and Advice Stephen H. Linder, Ph.D. Interim Director, Institute for Health Policy The University of Texas School of Public Health.

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