Balancing Collaboration and Competition: The Kingsport, Tennessee Experience

Abstract

In 1988, business, health care, and community leaders in Kingsport, Tennessee, initiated the Kingsport Area Health Improvement Project (KAHIP) to improve the health status of local citizens. The community has good conditions for collaboration: (1) a large employer that was a 1993 winner of the Malcolm Baldrige National Quality Award, (2) community structures for the implementation of collaborative efforts, (3) relative stability in community employment and income, (4) adequate medical resources, (5) outside support from foundations and national organization, and (6) the confidence and commitment of its leaders to make quality efforts work. Barriers to improvement have included 1) two large acute care hospitals competing for many of the same physicians and patients, 2) the uncertainties introduced by the restructuring of the community's largest employer, and 3) ongoing moves in the managed care arena by some key players, which have left a degree of anger and mistrust. Realizing that the approach taken in the late 1980s and early 1990s was no longer working in the new competitive environment, KAHIP reconstituted itself in 1994. Providers now have a greater leadership role in community improvement efforts. As a result, improvement efforts in Kingsport include the institution of interventions to reduce injuries to children/adolescents resulting from motor vehicular accidents, the establishment of a primary care health center for the uninsured/underserved, and development of a smoking-cessation program. The keys to continued leadership are 1) explicit faith in the continuous quality improvement approach, 2) commitment to communitywide change, 3) willingness to continue to engage in dialogue, 4) willingness to try new organizational alliances and structures to revitalize the effort, and 5) willingness to address those issues that individuals and institutions can agree to work on and set aside those they cannot agree on.