Community Engagement

What is community engagement?
The definition of community engagement that CCCH supports is: “An exchange of information, ideas, and resources between individuals, community members and mainstream organizations or institutions.” To us, a key principle of community engagement is participation.

There are different kinds of communities. These include ethnic communities, religious communities, geographic communities, the medical community, the traveling basketball community, etc.

Community engagement, at its simplest, is a strategic tool for building relationships and creating shared ownership of problems. This leads to sustainable results. Community engagement is also a mechanism that ensures the outcomes and processes for solving problems are culturally sensitive. It is a method for creating collective change and supports individual change.

But community engagement is not a one-size-fits-all activity. Nor is it a magic bullet. It is not a black hole. And it is not about giving up power or control.

Why does CCCH support community engagement?
First: The challenges facing healthcare are more numerous than any one group can meet alone. Medicine cannot eliminate health disparities, increase quality, improve outcomes, and standardize care without a community’s involvement and cooperation, and neither can communities reach their highest potential for health and wellness without medical institutions and healthcare providers. Together we can create new solutions.
Second: According to a report by Policy Link entitled Reducing Health Disparities Through a Focus on Communities, only 10% of total mortality is linked to lack of access. Up to 90% results from conditions related to community: cultural, racial, and socioeconomic factors that are the root cause of illness and disease. 
Third: Community engagement provides an opportunity to address the systemic, underlying causes of poor health. It gives us a chance to ask Why? and to keep asking Why? until we understand what is going on.
Fourth: Community engagement develops social capital by creating new networks and new ways of being together. People are challenged to learn new ways of acting. Opportunities are created for people to gain new leadership skills, to analyze policy, and to build new, more powerful relationships.

How Does the Center Support Community Engagement?
To start with, we have developed a framework to help organizations understand and demystify community engagement. The heart of the framework are these questions:

  • Who names the problem or issue?
  • Who decides, plans, implements, and evaluates the steps that address the problem?
  • Who measures and owns the outcomes?
  • Who generates and contributes the resources of time, talent, and money?
  • Where are the outcomes focused – on the individual, on the community, or on the root causes? 

Download 5 approaches to community engagement.

These questions begin to develop the core of the distinctions between the five approaches. They are clearly not the only ones, but they are a start. Questions 1–4 speak to who has the power to make decisions about the problem and its solutions. They also address the concepts of ownership and sustainability. Those who have defined the problem and have assigned the resources to solve the problem are allowed an opportunity to define those outcomes and identify what they measure. Inversely, if they do not have a voice into the problem or the process, they have little ownership. 

The final question — number 5 — also has important implications. In fact, it may be one of the reasons why community engagement bewilders organizations, especially healthcare organizations.  Most health care institutions and professionals want outcomes that are objective: real and tangible outcomes that can be measured. The way outcomes are measured is at the individual level. Hemoglobin A1C levels and foot checks may be important predictors of diabetes morbidity and outcomes, but they do not matter much to the community. What matters to community members is being around for their children, or being able to work. One does not seem related to the other.

The lay person — or in this example, the community — understands outcomes as subjective, or more personal in nature. A community wants its residents to be healthier, its citizens to be wealthier, and it wants better access to fresh foods. A community also wants to build its power — its capacity through the process — more people taking on a leadership role, more people getting involved, better use of resources, skills, etc.
You can see the disconnect. If we continue to engage folks in the old ways, the disconnect remains. Our challenge, then, is to find new ways to engage people, find new ideas that build on our common interests’ intersection.
It Sounds Complicated. Where Do We Begin?
Begin with a willingness to do something different. We need to develop different expectations, because working with people is not an exact science. It will take more time than we anticipate, but be much more rewarding than you ever expected. 

We have years of expertise with building cross-cultural partnerships and in nurturing authentic relationships. We can guide you through the process, whether you are just starting out or think you are ready to partner with a group. Careful consideration needs to be given to the level of engagement and whether it is appropriate, the method(s) of engagement in relation to the community involved, and the objectives of engagement.

The Center for Cross-Cultural Health has the expertise and the experience to help:
  • Determine appropriate community engagement approaches that fit within constraints and skills of your organization and project objectives.
  • Advance the supportive culture needed to implement, sustain, and embed community engagement programs within the organization. 
  • Develop a strategic plan, taking into account resources and objectives. 
  • Clarify the roles and responsibilities of each stakeholder. 
  • Identify and secure community-based partners.
  • Manage expectations, negotiate goals, and address potential areas of conflict. 
  • Facilitate the community engagement project.
  • Evaluate the plan according to mutually agreed-upon criteria and indicators.

One Last Question: Isn’t What We Are Doing Enough?
Good question! We will give you three reasons and then have someone else answer it! Programs designed though strong community engagement practices have the potential to achieve better outcomes in three ways:

  • When a community can influence change within itself, more responsive and more innovative programs will be developed.
  • Research shows that because the health of individuals is rooted in the social determinants of health, programs developed by health professionals without community engagement will most likely not have sustained positive benefits.
  • Cost savings achieved through community engagement and community governance has been realized through a decrease in health service use: healthier individuals use fewer services.

“ICSI's mission is to help Minnesota transform healthcare so that we decrease the per-capita cost of care and increase the quality of care for each patient. Engaging the community in a true partnership between patients and the healthcare establishment will be necessary if we are ever to really create the healthcare system we all so desperately need and want.” 

Kent Bottles, MD. Executive Director, Institute for Clinical Systems Improvement

“We know from our own work that clinical improvements in our visits with patients are only part of the story.  We need to understand much more about what motivates our patients to improve their health through a better understanding of their community and by working together on community based care that will complement our clinical care.”

Donna Zimmerman, Vice President, Government & Community Relations,
Health Partners