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Collaboration with Community

Collaboration with community occurs when a diverse array of community stakeholders who stand to be impacted by the collaborative’s efforts have the power to influence the direction, approach, and outcomes of the anchor collaborative. Authentic collaboration means residents and community organizations are valued as fellow experts and decision-makers, and relationships are grounded in mutual benefit, trust, and respect.

Building community wealth is a long-term project that requires meaningful and sustained collaboration between anchor institutions and community partners. Collaboration with community is especially important when anchor collaboratives seek to address health, social, and economic inequities within communities that have experienced histories of segregation, oppression, and disinvestment. To understand how the collaborative’s collective assets can be most effectively activated to improve community conditions, it is necessary to build trusting relationships with a wide range of community stakeholders—particularly those from lower-income and disinvested communities and communities of color— and develop a deep, shared understanding of community history, context, and resources.

Community engagement exists on a spectrum. Across anchor strategies there are many different decision points and processes that involve various stakeholders, ranging from individual residents to organizations representing the interests of residents, to other institutions. The goal of community engagement is to ensure that a diverse array of community stakeholders are able to engage in identifying needs and developing strategies, as well as engage in implementation and evaluation.

Table 4. Anchor-community engagement spectrum






Shared Governance


Provide balanced and objective information in a timely manner

Obtain feedback on analysis, issues, and alternative decisions

Work with community to ensure their vision and concerns are considered & understood

Partner with community in each aspect of decision-making

Final decision-making is shared between the community and the institution

Stakeholder Experience

I was updated on the work

I gave my input into the work

I gave my input and it is clear that it was considered in the design

I know that my interests are helping to shape the design because I am regularly at the table

My interests help(ed) shape the vision that is driving all the work

Example Strategies

Fact sheets


Open houses

Public comment

Focus groups


Public meetings


Deliberative polling


Community advisory committees


Participatory decision-making

Community oversight boards


Delegated decision-makers


Making sure the communications “land” and are meaningful

Agreement that the problem is a shared problem (developing a shared vision)

Setting aside individual interests to allow genuine collaboration

Generating genuine empathy and interest in building the capacity of the whole community

Getting people to efficiently and effectively work together from a shared intent

Source: CoCreativeSolutions, IAP2

This section describes how anchor collaboratives can create a shared understanding of community, assess community priorities and assets, deepen relationships with community stakeholders, and identify opportunities for shared decision making and co-creation.

[45] “Collaborating with Community Stakeholders: Anchor Community Engagement Spectrum,” Healthcare Anchor Network, (n.d.), accessed February 1, 2024,

Understanding and describing the community

Oftentimes in place-based work, the term community is used ambiguously to describe individuals living in a defined geographic area. It is important to be specific about who, where, what groups, and why the collaborative intends to engage in the many circles that comprise its community. As place-based institutions, members of the anchor collaborative (and the collaborative itself) are necessarily part of the social and economic fabric of the communities in which they are based.

Reflect on your understanding of the community

In other words, “the community” should not be simplified or generalized as an outside entity that the collaborative will pull in or invite to the table when the time is right. Rather, a community is a unique and complex set of formal and informal, overlapping groups of people with common perspectives, interests, and goals—all of whom stand to be impacted by the work of the anchor collaborative and have diverse skill sets, resources, and experiences to contribute to the collective effort of building community wealth.

Responding to Community Needs, Southside Institutions Neighborhood Alliance (SINA)

For decades, leaders from SINA institutions worked alongside community activists on issues of mutual concern, focusing largely on housing development and commercial revitalization. After the closure of an influential community organization and a steady decline in nonprofit service capacity, SINA leaders recognized in 2015 the need to restore community trust and increase civic participation in Hartford. The organization reaffirmed its commitment to the community by launching a new initiative focused on high-impact, high-visibility quality of life programs that address resident’s immediate needs around community safety and social service capacity, and by working in concert with legacy revitalization programs, the benefits of which often take longer to realize.

[46] Zev Alexander et al., From Silos to Collaborations: Building a Health Partner Investment Strategy (NeighborWorks and Center for Community Investment, 2022), page #19,

[47] “Our History,” Southside Institutions Neighborhood Alliance, last modified 2011, accessed February 1, 2024,

Assessing community priorities and assets

Successful anchor strategies center the needs and priorities of those most impacted by the racial and economic inequities. Many communities have organizations that have been working toward racial equity for decades. As discussed in section 3.1 Shared Imperative, members of multisector anchor collaboratives may approach their commitments to racial equity with different lenses, expertise, and vocabulary.

Similarly, community-based organizations have their own goals and approaches. Community groups and residents may have seen well-intended actors come and go over the years with little to show for it, which sowed distrust and may cause hesitancy to engage in new initiatives. For example, those in power may have involved residents and organizations in symbolic engagement as research subjects, constituents, or program participants, without producing any tangible outcomes for the community. As with any strong relationship, anchor collaboratives must prioritize mutual trust, respect, and reciprocity in approaching community-based organizations, community leaders, and residents. Further, the community wealth building framework emphasizes an asset-based approach—focusing on the opportunities and strengths within communities rather than focusing on deficits.

Common types of community partner organizations include: Mapping Community Assets and Stakeholders can help anchor collaboratives think in terms of assets, strengths, and key players within the communities they serve. As a starting point, anchor collaboratives can identify existing community improvement plans that were developed using a thorough community engagement process. Such plans may be conducted by city governments, regional planning groups, community-based organizations, advocacy groups or coalitions, and healthcare organizations—all of which are publicly available and easily accessible.

Before reaching out to new organizations, backbone organizations should map community organizations and understand how each anchor institution is currently engaging community partners, and what relationships may be already in place. For examples of how to align anchor assets with community priorities, see section 2.0 Understanding Anchor Strategies.

Co-creating solutions and shifting power

Racial Equity is a process of eliminating racial disparities and improving outcomes for everyone. It is the intentional and continual practice of changing policies, practices, systems, and structures by prioritizing measurable change in the lives of people of color.


How the anchor collaborative approaches equitable economic development and community wealth building matters. As one Healthcare Anchor Network (HAN) member reminds us, “process IS an outcome,” meaning the collaborative takes steps to ensure the processes and practices guiding its work are consistent with their commitments to equity. Racial segregation, oppression, and disinvestment in communities of color are the result of policies and practices that were designed to direct resources to some and not others on the basis of race. Mitigating the compounded damage caused by such policies requires intentional and equitable redistribution of resources and power.

Building community wealth is not a short-term project with a clear deadline, rather it requires taking a long-term view. This mindset may be inconsistent with institutional norms that prioritize speed and short-term results. The Collective Impact Forum’s Racial Equity Toolkit offers guidance to collaboratives on how to shift power. The toolkit pushes collaboratives to think about who holds power to make decisions or influence others, and why. Anchor institutions may overstate the degree to which they are collaborating with the community. Consistent with anchor mission principles, a critical examination of legacy systems is necessary to achieve shared decision-making, active and productive engagement by all parties, and establishment of policies and delivery of services that lead to healthier, more equitable communities.

Southwest Partnership

“For anchor collaboratives aspiring to transition to a true partnership model with their communities, it necessitates a sustained, long-term commitment—extending over a decade or even longer. Leadership within anchor institutions must be committed to true partnership and ensure that internal resources are in place to support this commitment. If commitment is not in place, it may lead to worsened relationships with the community and additional distrust, making subsequent efforts more challenging.”

- Elizabeth Weber, Program Director, Southwest Partnership

Active participation from local residents and organizations requires individuals to feel valued, heard, and confident that their concerns and needs will be taken into account. Once collaborators have identified community organizations, leaders, and other circles with whom they would like to engage, a first step can be to reach out to set up an introduction meeting in order to discuss the purpose and broad goals of the collaborative, and opportunities for co-creation and partnership. BUILD Health Challenge’s Community Health Workbook offers best practices for equitable community engagement that a collaborative can adopt from day one, summarized here:

Steps for getting started: Practices for equitable community engagement

  • Design activities that are additive, not extractive: be thoughtful about what you are asking of the community and what you are offering in return.

  • Take concrete steps to reduce structural barriers to participation:

  • Venue: Host meetings in venues the community is familiar with, rather than asking that community members come to you.

  • Language: Use the community’s preferred language and avoid jargon.

  • Compensation: If you are asking community members to contribute their time and expertise, compensate them as you would any other consultant, and consider providing additional support for childcare, transportation, stipends, and food.

  • Acknowledge how past interactions may influence the present-day dynamic: Community-driven anchor collaboratives present an opportunity to repair trust, especially when organizational leaders authentically acknowledge past harms and demonstrate what will be different moving forward.

  • Respect local norms and traditions: For example, consider specific dietary restrictions or avoid holding events on religious or other culturally-significant holidays.

  • Follow up in a timely manner: Community engagement is not a one-time event—it is an ongoing process of relationship building over time. Follow up with community groups, leaders, and residents as you would any colleagues in your workplace circles by sharing summaries, contact information, and invitations to stay in touch. If information was gathered, be transparent in how it will be incorporated into the collaborative’s plans and what the next steps are.

[48] Ellora Derenoncourt et al., “Wealth of Two Nations: The U.S. Racial Wealth Gap, 1860-2020,” Institute Working Paper 59 (2022),

[49] “The BUILD Health Challenge Community Health Workbook,” Change Lab Solutions, last modified 2023, accessed February 1, 2024,

Community-led decision making

Anchor collaboratives should ensure that community members have decision-making power in anchor mission initiatives. Engaging on an informational level is not enough. Community-led decision making means that community partners have the ability to influence the direction, approach, and outcomes of the collaborative. Whether community advisory council members become part of the executive committee or are given the ability to vote on motions introduced by the executive committee, elevating community voices in a way that is equitable and imparts decision-making ability on community members will lead to broader community buy-in and strategies with lasting impact. For more on community advisory councils, see section 3.3 Effective Governance.

Shared Governance, UC San Francisco (UCSF)

USCF utilizes a shared governance model for its anchor institution initiative, which aims to increase the economic security of under-resourced communities in the Bay Area by leveraging UCSF’s resources. An anchor institution steering committee is composed of representatives from UCSF and community-based organizations, and is co-chaired by one UCSF staff member and one community representative. Subcommittees for workforce development, procurement, and community investing include internal and external subject matter experts. These groups are responsible for creating work plans, drafting budgets, and providing recommendations on priority initiatives to the steering committee, which then makes final decisions.

Get to work with the community

With a firm understanding of community needs and priorities, anchor collaboratives can start working on projects, programs, and initiatives with community organizations. As one anchor collaborative leader put it:

Just get to work! Find real things you can actually do together. How big or small the project is matters less in the beginning than just getting started. The more you work together, the more you will learn how to work together better.”

Look to things like the human-centered design process that emphasize ideation, prototyping, and testing solutions to an identified problem. This process can be applied to any problem-solving endeavor, no matter how small. For instance, a human-centered approach to job design examines pay and benefits, employee supports, and opportunities for growth. Such processes provide opportunities for community members and local organizations to contribute through planning and implementation of anchor strategies. Community groups should remain involved with the collaborative through a regular cadence of meetings, events, or other defined decision-making roles. Community advisory boards with diverse representation from different sectors and backgrounds can provide consistent feedback, help the collaborative to iterate and refine its approach, and ensure that projects are culturally sensitive and genuinely address real issues, leading to higher acceptance and long-term impact.

For more on aligning anchor assets with community priorities, see section 2.0 Understanding Anchor Strategies, and for more on community advisory boards, see section 3.3 Effective Governance.

Participatory Action Research Informs Impact Purchasing Strategy in Brooklyn, NY

Brooklyn Communities Collaborative (BCC) is a partnership between 1199SEIU, the City University of New York (CUNY), Maimonides Health, One Brooklyn Health, SUNY Downstate Health Sciences University, and Wyckoff Heights Medical Center, as well as more than 100 community-based organizations serving Brooklyn, NY. BCC works with procurement leads at anchor hospitals on strategies to diversify and localize spending, and secured commitments from anchor institutions to increase spending with local minority- and women-owned business enterprises (MWBE) tenfold by 2030—an increase of $35-40 million annually. Rather than moving straight to tactics, BCC partnered with CUNY Hunter College to conduct a Participatory Action Research (PAR) study to better understand the needs and experience of Black business owners in the community.

Many Impact Purchasing strategies include efforts to certify minority-owned businesses, outreach and education events, and providing training for local business owners to create a pipeline of vendors for the anchor institution. Findings from the BCC study, which included thirty-two Black business owners, revealed mixed feelings on MWBE certifications, a history of contracting with large institutions, examples of race and gender discrimination, and challenges raising capital, including skepticism and mistrust of conventional banks. These insights are helping BCC build a procurement program that is based on the real experiences of Black business owners, rather than relying on assumptions about what business owners need. Since its inception, BCC has relied on a PAR methodology underpinned by a social determinants of health framework, generating studies that have informed community-based healthcare provision, new affordable housing development, wealth building strategies, workforce development, and career pipeline efforts. For more, visit

Utilizing Community Surveys by Memphis Medical District Collaborative (MMDC)

MMDC administers annual surveys to the community and anchor institutions. The annual community survey assesses whether individuals feel connected to the district, what businesses they want to see in the area, whether they feel safe within the community, and satisfaction with housing options in the Medical District. The results inform the collaborative’s key performance indicators for the following year. A separate survey is administered to the anchor institutions to understand each institution's priorities. For example, the 2022 survey identified safety as a priority for all anchor institutions. In 2023, MMDC hired more safety ambassadors for events hosted in the district and many of the lights in the district were changed to LED lights to provide better illumination at night. Finally, MMDC supported sidewalk repairs so that pedestrians could more easily and safely move about the neighborhoods. From 2022 to 2023, an analysis of the annual community survey indicated a 16 percent increase, from satisfied to very satisfied, regarding perceptions of safety within the community.

[50] Danny Fisher-Bruns, interviewed by Ndeye Boury Silla, Claire Brawdy, David Zuckerman, video interview, February 1, 2023.

[51] Sigmund Shipp et al., Report on Research with Black Entrepreneurs and Business Owners in East and Central Brooklyn: Participatory Action Research for the Brooklyn Health Enterprise Hub 2022-2023 (Brooklyn Communities Collaborative, 2022-2023), page #4-49,

Measuring anchor-community partnerships

In 2023, HAN convened a national community advisory committee to design metrics for assessing anchor-community partnerships. This committee consists of health system representatives and community advisors, including leaders of community-based organizations working on equitable economic development in urban, rural, and suburban geographies across the nation, often in partnership with anchor institutions. The council agreed that measurement can be used to build and strengthen partnerships between anchor institutions and communities, identify areas of improvement, and demonstrate impact. The information included in this section summarizes learnings from the community advisory committee.

Two core dimensions of anchor-community partnerships identified as important for measurement are:

  • the level of partnership, ranging from no partnership to a high-quality one, and

  • the impact of partnership, which shows how anchor institutions and communities have benefited from the partnership in the near-, mid-, and long-term. Partnership impact measures are closely tied to anchor strategy impact measures, as benefits from partnerships transcend anchor institutions, community-based organizations, and individuals who live and work in the community.

Elements of partnership exist on a continuum and each member of an anchor collaborative or partnership may perceive the elements differently. Early in a partnership, collaboratives should consider these core areas for measurement:

  • Shared goals: These are the foundation of partnerships, and a must-have for measuring the level of partnership.

  • Shared power: This is important to measure from the beginning, both as the level of partnership, and as a near-term impact of partnership.

  • Clear, ongoing, frequent communication: This is essential in any partnership and a must-have for measuring the level of partnership.

  • Ongoing relationships: Specifically, having agreements in place (formal or informal) for setting clear roles and expectations for each partner.

  • Mutual benefit: This is a key indicator that partnership is happening and an important measure of near-term impact of partnership.

Transparency and trust are additional aspects of partnership that may be important to measure in the early stages, or as the partnership matures, depending on the nature of the partnerships in place. As partnerships mature, measuring growth and sustainability, and markers of systems change will become important.

That said, it is vital not to rush into partnership measurement too soon. Develop a measurement approach that is meaningful for all partners, emphasizes assets and not deficits, does not burden organizations with limited capacity, and, critically, does not inadvertently weaken the partnerships through the provision of honest feedback from community members that could result in backlashes, such as loss of funding or loss of relationships.

Existing measures that assess the core elements of early-stage partnerships include:

  • The Full Frame Initative’s Centering Community Self-Assessment is a 30-item organizational survey and 22-item community member survey. It is a holistic assessment that includes reflection questions, and measures each of the priority areas for early stage partnerships. The tool is designed for reflection and to identify areas of improvement; a methodology for aggregation is not provided.

  • The Research Engagement Survey Tool (REST) is a 32-item survey completed by community partners (with 9- and 48-item versions also available) that measures community perspectives on each of the priority areas for early-stage partnerships. The tool was developed to assess community members’ involvement in research studies, but could be adapted for use with anchor institutions (rather than research organizations).

  • The Internal Coalition Effectiveness (ICE) Instrument is a 30-item survey that measures how well members work together to achieve common goals and whether coalition leaders are effective in facilitating the work., Coalition members and leaders complete the tool, which includes assessment of each of the priority areas for early stage partnerships.

Southwest Partnership, Baltimore, Maryland

The Southwest Partnership (SWP) centers the local community, focusing on housing, workforce development, commercial development, and other projects. The partnership is governed by a board where neighborhood associations and community representatives hold the majority. Public board meetings allow for transparency and accountability. Additionally, all projects are community-driven, with SWP playing a pivotal role in securing grants and fundraising for projects. SWP will not support or work on a project in a neighborhood without first having the approval of the relevant neighborhood association. New projects and programs are typically developed and spun out of subcommittees and workgroups of community members supported by staff. For example, the Vibrant Streets Committee sets the priorities, application requirements, and review procedures for neighborhood grants each year, and the group forms a subcommittee of reviewers who work with staff to make awards. The co-ownership/partnership model has increased trust and accountability as community members have seen that SWP is committed to allowing the community to take the lead in determining projects and priorities.

Anchor collaboratives have the potential to drive transformative change through authentic community engagement in the process of activating assets. Collaborating with local community stakeholders is crucial to the long-term sustainability and success of anchor collaboratives, ultimately helping to build economic security, improved health and well-being, and stable, thriving communities.

[52] Charter: Healthcare Anchor Network Partnership Measures. Developed for The Healthcare Anchor Network, by Ellen Schultz, based on input and feedback from the National Community Advisory Committee convened between November 2023 and February 2024. Submitted February 27, 2024.

[53] Melody Goodman, V. Thompson, and N. Ackermann, “Creating a Survey of Community Engagement in Research,” Patient-Centered Outcomes Research Institute (2021), accessed February 1, 2024,

[54] Mary Cramer, J. Atwood, and J. Stoner, “Measuring Community Coalition Effectiveness Using the ICE Instrument,” Public Health Nursing 23 (2006): 74-87, accessed February 1, 2024,

[55] “Community coalitions using the Internal Coalition Effectiveness (ICE) Instrument,” National Collaborating Centre for Methods and Tools, accessed February 1, 2024,

Continuum of Progress: Collaboration with Community

This continuum of progress was adapted from the Spectrum of Community Engagement. The Building (inform) stage of the continuum is not considered a best practice for community partnerships. Every anchor collaborative starts somewhere, and some may find that the building stage most reflects where they are in their efforts to collaborate with community. The Building (inform) stage was included here as a point from which the collaborative can grow. As the collaborative builds and strengthens relationships with community groups, an aim should be to ensure that a diverse array of community stakeholders have the power to influence the direction, approach, and outcomes of the anchor collaborative.
While the collaborative may have a shared understanding of the value of collaborating with community, residents and community groups are largely absent from the decision-making bodies of the collaborative, and they may be unaware of, or even skeptical of the collaborative’s intentions. Members of the collaborative may state they are not yet ready for collaboration with community.
The collaborative considers community needs in its strategy and activities. Members are open to shifting their approach based on new knowledge provided by community leaders.
The collaborative is a partnership with community groups and anchor institutions. Anchor institutions recognize that collaborating with community brings together unique strengths, assets, and capacities that are essential for meeting goals.
Engagement with the community is limited to one-way information sharing—the collaborative may keep community members informed of its activities, but community members or groups do not have a say in setting goals or implementing strategies.

The collaborative publishes frequent updates on its progress. Information exchange is bi-directional—the collaborative has established some mechanisms for gathering, integrating, and responding to feedback. Community members feel their perspectives are valued by the collaborative.

The collaborative’s strategy, priorities, and activities are co-designed with community members and in alignment with community priorities. Practices are democratic, transparent, and rooted in accountability, trust, co-ownership, and the equitable distribution of resources among the collaborative. 
The collaborative’s strategy, priorities, and activities are largely informed and driven by the needs and expertise of the anchor institution members. While the collaborative understands the limitations of not having community at the table, meetings generally remain closed-door, with progress sometimes published on a website, flier, or other publicly visible resource.
The collaborative’s strategy, priorities, and activities are driven by the priorities of the anchor institutions and aligned with community needs and feedback, which may have been identified through existing community improvement plans (e.g., CHNAs).
The collaborative has established open lines of communication with community groups and residents, who serve in a formal capacity on committees or advisory boards with power to make decisions at every stage of the process. Community members are compensated for their time and expertise.
Community members consistently participate in public and private forums, workshops, surveys, etc. Power dynamics are named and processes are adapted for equitable engagement across groups.
Anchor Institution Mindset
We keep the community informed of our plans and activities. We know that collaborating with community will be an important part of this collaborative’s work, but for now feel our strategy is best informed by members of the collaborative.
We value community insight, which helps us think differently about equitable economic development and wealth building. We are committed to building stronger relationships and lines of communication with community partners.
We cannot do this work effectively without leadership and expertise of community members and groups. We are committed to democratic processes, active listening, accountability, and co-ownership with the communities most impacted by systemic issues.
Backbone Mindset
I am working with anchor institutions to identify community partners and provide opportunities for residents and community leaders to engage more deeply in the work.
I have helped anchor institutions engage some initial community partners, expand their understanding of community priorities, and am working to build trust with key community groups.
I embrace the opportunity to form deep partnerships in the community and am confident in my ability to recognize and address complex power dynamics within the collaborative.
Community Member Mindset
While I am aware of the collaborative and its stated intentions, I am skeptical of its motivations and intentions. I do not see how my priorities and values are reflected in the goals of this group. It is unclear how this collaborative will benefit my community.
I am cautiously optimistic about the potential for partnership. I am learning about the priorities of anchor institutions in my community and am beginning to see the anchor collaborative efforts to build or restore trust within our communities. I feel my experiences and perspectives are valued.
I understand the limits of what’s possible and I am part of designing and implementing solutions while actively imagining more. I am an equal partner in this collaborative and feel the community’s collective interests are represented.
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