Collaborating Across Cultures for Health Networks

September 2018

Collaborating Across Cultures for Health Networks

Author: Esther Hammerschlag, MA, East Chewuch Consulting

One of the most challenging forms of collaboration for health networks is collaborating across cultures.  While some cross-cultural collaborations may be obvious, such as between Native and non-Native groups (i.e. Native American or Alaska Native tribes and non-Native entities), others are much more subtle, such as between groups or healthcare systems with regional differences.  So why are these cross-cultural collaborations so challenging?  Shouldn’t it be easy if we’ve already mutually decided to come together, or formalized a network and secured funding to facilitate this collaboration?

The answer lies in differing worldviews. A worldview is our own model of reality, including our system of beliefs, values, and attitudes which form our perception of the world and how we interact with it.  Within each of our health networks, each member has their own worldview.  While typically the worldviews of network members have more similarities than differences, in some cases even minor differences in worldviews - when not understood – can create wide chasms which interfere with successful collaboration or keep it from becoming anything beyond superficial.

To successfully collaborate across cultures and create meaningful results, we must take time to build a foundation which honors these differing worldviews. This is what moves collaboration beyond a state of doing (simply checking off the list), to a state of being (actually changing how we do things and work together).  When collaboration focuses solely on doing, tasks become one more thing to get done which interferes with individual agendas.  However, when we change how we work together, those tasks not only naturally occur, they occur in a way that creates increased value and meaning for everyone.

Numerous principles and strategies can help facilitate collaboration across differing worldviews that bring us together in how we work together, moving beyond superficial forms of collaboration which partners quickly tire of, or simply end when funding disappears. However, there are two overarching principles or strategies I have found to be the most useful in my own work facilitating collaboration across cultures.

1. Eliminate ‘but’ from your Network’s vocabulary.

I can attest this is much easier said than done.  It’s a strategy I’ve learned from many mentors, and still forget at times.  Think about it – how many times in a given day might you write an email or have a discussion that ends with “that’s a good idea, but how are we going to….?”  Imagine yourself at a Network Board meeting, and one Board member – let’s call him Joe – suggests a new service needed by your members which will cost more money to implement than is in the budget.  Now imagine the Board Chair says “that’s a nice idea Joe, but there’s no way we can afford to do that.”  Then one of two things can happen.  Either a debate starts about whether the network can afford it (someone is going to lose), or Joe backs down feeling his ideas aren’t valued.  How would it feel different if the Chair instead said, “That’s an interesting idea, Joe.  Do you, or does anyone else have suggestions how we could pay for that?” This provides an opportunity for discussion and problem solving to occur.  The outcome may be the same – partners may decide the budget won’t allow for it. However, it opens opportunities for solutions to emerge, helping to build trusting and supportive relationships.  In this way, decisions and solutions come out of respectful discussion, rather than debate meant to prove one person right or wrong. 

This is an example of how we can constructively build knowledge.  Picture your board members sitting around a table.  One makes a suggestion (think about the earlier example) and the group goes around the table, each person adding on with an ‘and’ statement (no buts allowed!)  These ‘and’ statements could be concerns (“…and I wonder who will manage it”), they could be simple acknowledgements (“…and I think this has potential to provide what we need), or they could add additional information (“…and I think our organization might be willing to contribute some additional resources through a similar project we are already working on”).  Try this exercise the next time your network is brainstorming ideas – you might be surprised at the inertia and enthusiasm that builds as each individual’s perceptions, ideas, concerns, and values are added to the conversation, demonstrating the collective knowledge, skills, and resources that exist at your table. 

2. My experience is not your experience, and yours is not mine.

This is about context – context of the problem we are trying to solve, and context of the individual partners.  Knowledge is more than simply knowing facts, knowledge is context dependent.  This means that each person’s knowledge is rooted in their own set of relationships and experiences, such as their personal and professional experiences, their relationships with family, friends, and colleagues, their relationships with the community, and their relationships with ideas --- their worldview.  This context is a major component of each individual’s contributions and provides the richness in collaboration.  It is why you and I may attend the same meeting, yet hear different outcomes, or view the same network partner with completely different perceptions.  It is in fact what makes collaboration such a vibrant and organic (and often extremely challenging!) process.  When we can embrace these contextual differences, rather than make assumptions that we share the same experiences, collaboration can really take off and become exciting. 

Have you ever had a colleague decide to tell you all their dirt on one or several of your partners? I have.  One experience in particular caught me off guard, as it was one of those collaborations which on the surface didn’t appear to cross cultural boundaries, but in fact did. In this example, a partner became deeply offended when I offered that I would like to develop my own relationships and experiences with the other partners rather than begin relationships based on her personal opinions.  What I realize now is that while I understood that I was developing my own set of contexts to help me facilitate this challenging group of diverse individuals, she had experiences that had rubbed so hard against her own values she simply couldn’t fathom the possibility of developing a constructive relationship with a certain individual.  She shut down because she simply couldn’t believe that any other context could exist.  Neither person was right or wrong - we simply had very different contexts even though we lived in the same community and worked on the same project. We faltered by not developing a mutual acceptance of these differing contexts. 

Mutual acceptance doesn’t mean we have to agree with one another, it just means that we respect the other’s experience.  It is not fair to judge another’s perception – after all, they have their own set of experiences, attitudes, and beliefs we can’t ever fully understand.  What we can do is acknowledge differing opinions and be curious.  We can seek to understand and learn more. This begins the process of building upon our differences rather than allowing them to divide us. And, this becomes how we build knowledge together, cementing the relationships and trust that will make our collaboration meaningful and long-lasting.

This article was written by Esther Hammerschlag, MA, owner of East Chewuch Consulting, for the September 2017 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.