Turning Point has been up and running for nine months, the same amount of time it takes to create a newborn. We've all discovered that developing a working partnership with a common vision takes significantly more time! Social scientists continue to debate the ingredients of successful partnership development, but most agree that a strong commitment and shared vision are essential. Since Turning Point is a national laboratory, both National Program Offices have the privilege of learning from efforts of those participating. Thus, this article focuses on sharing the salient, albeit early, lessons and insights gleaned from the field. Our perspectives are based on early impressions from our interactions with the Turning Point partnerships during the past nine months.

Nurturing a Partnership Is Hard Work

No kidding. While this may be stating the obvious, we're witnessing firsthand the validity of this conventional wisdom. Despite the tasks that lie ahead, we're truly encouraged by the vigorous efforts of many to build a wider constituency committed to protecting the public's health. We have seen improvements in state and community relations, in both frequency and quality of interaction. These linkages require constant attention and cannot be overlooked or undervalued.

Conventional wisdom also suggests that partnerships with a history and subsequent track-record of collaboration will likely be more successful. While it is premature to assess this premise, at the community level, there is little indication of its validity. Moreover, what is seemingly more important is the ability of the partnership to develop a shared vision of what the Turning Point process will create as a product. There's an old clich‚ that purports, "If you don't know where you're going, any road will take you there." For Turning Point's purpose, it's essential that partnerships have a relatively clear idea  of where they're going and where they'd like to end up. The stronger partnerships  will decide on a destination up front, while acknowledging that adjustments will be made along the way.

Community Health Assessment Process

At the community level, a tremendous amount of energy is being expended on community health assessments. While a community assessment process can help to strengthen partnerships and produce useful data, the assessment process must not be viewed as an end in itself. The assessment process is but one piece of a complex puzzle and can be a highly effective medium for engaging grassroots interests. The lesson here is simply to keep the role of assessment in proper perspective and use it to evaluate the gaps in your system that make it difficult to produce a comprehensive assessment. This may entail deciding ahead of time what you will do with the data once it is available. Using data to inform community members about critical health problems and creating sound program and policy decisions requires adequate infrastructure. This infrastructure consists, in part, of data analysis and communication technology, a workforce skilled in epidimiology, communication, policy development and leadership, and a link with  statewide and community-specific data. At every step in your community assessment process, think about what you need to  improve the system that contributes to or detracts from your ability to move ahead.

Role of Environmental Health

Many partnerships are challenged by the need to integrate environmental health into the strategic planning process. This difficulty further exemplifies the growing fragmentation and increased fragility of the public health system. At this early juncture, it appears as if partnerships with the strongest environmental linkages adopted a broad-based approach to environmental public health, including crime prevention, safe and affordable housing, and economic development in their scope of work. We plan to address the integration of environmental health issues more formally on a national level beginning in 1999 and welcome input from the field about strategies that might be most advantageous.

Engaging Business in  Strategic Planning

We want to see business knocking down the doors of health-related agencies and  departments, local hospitals, and faith-based groups to participate in public health  strategic planning efforts! Personal contacts can provide important opportunities to  involve representatives from the business sector and to discuss the value of their  involvement in strategic planning and  systems change. Business will want to participate in "action-based agenda setting," a goal of indisputable merit. Some partnerships are managing to balance the systems change approach with the more immediate need to target actions to resolve specific problems. This approach takes advantage of the early win theory, which may be effective provided such activities are not viewed as endpoints but as steps in identifying and improving weaknesses in the system.

The Media as Advocate

Within the past nine months, numerous  articles appeared across the 14 states and 41 communities describing partnership's  activities. These early efforts to engage the media appear to be paying off for many. It may be worthwhile to discuss this issue among your community and statewide partnership so that a comprehensive  media plan can be developed with the goal of building a wider constituency for  public health.

Charting the Road to Success

Some know the road they're on; others are building the route as they go. As we  engage in insightful discussion through conference calls and site visits, there are a few ideas that come to the fore:
1) Ask your partners if they have read the Turning Point Call for Proposals and subsequent letter of intent and proposals developed by the partnership. You may be surprised at how many partners have not read these documents. It may be quite useful to revisit your original proposal as a barometer check.
2) Consider developing a Turning Point orientation packet and process. Some partnerships are finding that establishing a process with a separate meeting time to orient new partners to the goals of the  initiative reduces the propensity to rehash the same issues during the planning meetings;
3) Develop your own performance indicators for systems change. Many partnerships are collecting sample materials from across the nation used to monitor system performance and some are developing their own region-specific performance  indicators, a process that can help keep the spotlight on systems issues. The National Program Offices will be collecting and sharing these valuable resources with the field; and
4) Build in an evaluation component for your activities. While the overall initiative is being evaluated from a cross-cutting perspective, process and outcome measures should be tracked by individual partnerships. These measures can be useful in making immediate adjustments, and should include coverage of organizational and public policy issues. Consider recruiting a volunteer to keep a "partnership journal" to track qualitative changes that occur over time.

A Sense of Optimism

As we prepare for the next phase of our work, a sense of optimism engulfs both National Program Offices. Systems change efforts require a new focus on how we create a system that supports healthy people living in healthy communities. Transforming the public health system is a tall order, and while the journey is often turbulent, it's encouraging to see how many have set out to achieve a wider vision of public health.