The need for alignment across sectors, cultures and goals is crucial because it is related to and can impact a variety of barriers. Without having shared agreement on health terminology, strategies, and goals, it is more difficult to collaborate on other foundational elements such as data infrastructure/population metrics and financing/payment models. Stephen Shortell captures this notion in A Bold Proposal for Advancing Population Health, “How is it possible to achieve sufficient cultural “buy-in” from the three sectors to work together in meeting agreed-upon population health goals? The common financial payment, while helpful, is not sufficient… Without the cultural component…only temporary effects will take place.”

Care delivery alignment and collaboration among the three main sectors – health care, public health, and social services – is supported by several components such as relationship building, common language/jargon translation, coordinated training and education, a centralized driving entity/force to create change, and most importantly, trust and willingness to share risk and rewards. Creating conditions for relationships to develop and grow, while providing opportunities for cross-sector collaboration and engagement among these leaders begins to build bridges that can lead to common goal-setting. Once meaningful and sustainable relationships start to form across various sectors, trust can develop between them. Trust is a key component needed in order to work more intentionally together to form initiatives that improve community-wide health. Often, because the risk is so great, no one entity alone is willing to proceed on its own without trust and confirmation that others share some risk and accountability.

For communities to effectively build and nurture strong cross-sector relationship for the purposes of improving the overall population health, we ask the following questions:

  • How are health care and social services currently delivered among the partners/community? Who are the key providers of those services?
  • What are the desired shared outcomes/goals from these multi-sector interventions?
  • What key clinical and non-clinical care delivery interventions do the collaborative partners want to undertake? Can social services be integrated and coordinated with clinical services?
  • Can health care providers and social services organizations share financial risk for performance?
  • How can the quality and capacity of the social services sector be ensured?

Other Organizations Exploring this Element

The cross-sector alignment foundational element was identified and informed by a multitude of interviews with key informants, thought leaders, health systems, and other community organizations immersed in these discussions. We recognize many other organizations and initiatives are exploring the multitude of issues related to building and supporting alignment across sectors, cultures, and goals.

  • Democracy Collaborative
  • America’s Essential Hospitals
  • County Health Rankings
  • Build Health Challenge
  • Invest Health
  • State Health Value Strategies
  • Moving Health Care Upstream
  • Rethink (Venture Project)