You already know children’s health is shaped more by what happens outside the hospital than inside it.
And you have ideas to make a difference: Partnerships with schools to address mental health. Home visits to prevent asthma admissions. Medical-legal collaborations to keep families housed. Programs to increase food access.
The opportunities feel endless.
But so do the challenges. Promising programs don’t get off the ground. Others get going but then stall out. There’s not enough staff or funding. The data doesn’t align. Community partners are stretched thin — or worse, don’t trust you.
These common obstacles — and their solutions — to moving beyond a sick-care model toward prevention and community health were examined using an implementation science framework in a study in the International Journal for Quality in Health Care.
“Over the past few years, children’s hospitals have been really active in trying to address the social drivers of health with the goal that once kids go home, they’ll have the best possible chances of having a successful outcome,” said Ulfat Shaikh, MD, MPH, pediatrician at the University of California Davis Children’s Hospital, medical director of health care quality at the University of California Davis Health, and lead author of the study.
Using confidential interviews and an analysis of Community Health Needs Assessments from children’s hospitals across the country, the study set out to answer a deceptively simple question: What does multisector collaboration look like in practice?
“There’s enthusiasm to learn from hospitals that are doing a lot in this space,” Shaikh said. “We found there’s a lot of variation in how this work shows up.”
The researchers studied hospitals at different stages of maturity, working with different partners, and operating under different constraints. Across geographies and hospital sizes, no single model emerged. What did emerge was a set of intentional choices — about strategy, relationships, measurement, staffing, and expectations — that made collaborations more likely to endure.
What follows are 15 lessons drawn from those findings (along with quotes from the interviews) that can mean the difference between partnerships and programs that struggle and those that last.
1. Embed community collaboration into enterprise strategy.
When community work is treated as discretionary or grant-driven, it remains fragile. Hospitals that elevated community impact to a strategic priority created more successful and sustainable programs.
“Our last strategic plan had an entire pillar dedicated to community impact.”
2. Secure internal alignment and buy-in.
Clear strategic positioning — as well as staff dedicated to coordinating across teams — made it easier to align clinical leaders, quality teams, philanthropy, and government relations around shared goals.
“I think a lot of the stuff that we do could be considered non-value added. It’s a difficult conversation to have.”
3. Begin with community priorities, not hospital solutions.
Approaching new partnerships with curiosity rather than proposals allowed hospitals to complement existing efforts, encourage collaboration, and gain trust. Partnering with respected local organizations established credibility more quickly and avoided early missteps.
“Going hand-in-hand with another trusted community partner … helps open the door.”
4. Design interventions with communities.
Intentional co-design, through a formal process, helped ensure programs reflected lived experience, addressed real needs, and gained community buy-in. Also, mapping what organizations were already doing helped avoid duplication and identify gaps.
“Two elements to our strategy: person-centered design and community-centered design… We hire a nonprofit from the community to run formal design sessions.”
5. Know your role.
In successful collaborations, hospitals understood their strengths and weaknesses and established their role accordingly.
“These are the things that we do really well … Here are the things that other teams do better than us. And here is where we paid or gifted to this community-based organization because they know how to do it even better than we do.”
6. Keep things as close as possible.
Locating different services in one place made it easier for families to navigate. Having ties to communities near the hospital provided extra opportunities to meet immediate needs.
“We co-locate our food work and our navigation work [at schools] to really make sure that we’re not duplicating efforts, and that we’re reducing the barriers for families, and they’re not confused about where they can go to get some help with these resources.”
7. Be transparent.
Openly sharing budgets and decision processes helped rebalance power dynamics and signaled genuine partnership.
“It’s a far more daunting challenge of overcoming mistrust … The first thing that we did was take our budget and open it to the public.”
8. Embed community members into hospital teams.
Bringing community members into the initiative’s governance and leadership structure built trust, enhanced collaboration, and ensured alignment with community needs.
“Any community member who is working with us, we pay them for their time and effort.”
9. Assign clear owners.
Designating points of contact strengthened continuity and made partnerships more personal and reliable.
“Each program has a face to it.”
10. Formalize expectations.
Memorandums of Understanding helped clarify scope, data sharing, and responsibilities, especially as staff or leadership changed.
“The best partnerships that we have are the ones where we have really spelled out expectations and roles.”
11. Plan for partner limitations.
Hospitals that acknowledged staffing instability and resource constraints in community organizations were better able to design feasible timelines.
“They don’t have enough staff … their staff turns over very frequently.”
12. Apply quality improvement methods.
Using plan-do-study-act (PDSA) cycles and improvement science for community work led to better and more reliable initiatives.
“Quality improvement [teams aren’t] used to working in the population health arena … and yet we know its importance.”
13. Train community partners.
Building skills in data collection, reporting, and quality improvement expanded collective capacity and reduced dependence on the hospital.
“We’ve worked with partners in trying to develop common metrics across all of the programs.”
14. Build dedicated data infrastructure.
Analytics propelled efforts and allowed hospitals to track trends rather than isolated outcomes. Elevating these measures alongside clinical and quality indicators reinforced legitimacy and leadership attention.
“These metrics go up to the quality executive and to our CEO.”
14. Design for the long haul.
Hospitals that planned for multiyear relationship building were better positioned to sustain momentum. A program infrastructure built for sustainability and scale was key, especially to mitigate staff turnover.
“To really show impact, it takes a minimum of seven to 10 years.”
Sustained community health work isn’t about finding the perfect model — it’s about making deliberate, values‑driven choices that honor relationships, build trust, and invest for the long term. As children’s hospitals navigate the complexities of multisector collaboration, these lessons offer a roadmap for moving beyond good intentions toward meaningful, lasting impact.
