This case focuses on the challenges of keeping a collective impact program—the Tackling Youth Substance Abuse (TYSA) program on Staten Island—focused and effective over time, a problem faced by many collaborative community-based efforts. The TYSA program was founded in 2012 as a cross-sector collaborative response to the alarming rates of substance abuse on Staten Island, using a collective impact framework.

In the four years since its founding, TYSA had accomplished a great deal. But by October 2016, when the case opens, many of the original members of TYSA’s steering committee—most of whom had been high-level decision-makers in their organizations—were delegating their spots to mid-level staff who were not empowered to make organizational decisions. In addition, TYSA’s early successes against prescription drug abuse were increasingly overshadowed by a growing opioid problem on the Island and by a continuing culture of alcohol abuse by underage teens. A subtler challenge was that, in the Staten Island community, TYSA was over-identified with Adrienne Abbate, TYSA’s Project Director, herself; how could TYSA shift the community’s perception to demonstrate the program’s value beyond its leader?

Project Director Adrienne Abbate decided to pull TYSA’s executive leadership and staff together to discuss strategies to reinvigorate the program and to sustain the momentum they had fought so hard to create.

This case describes the challenges facing Jon Moussally, the CEO of TraumaLink, a four-year-old social venture that provided trauma first aid to victims of traffic injuries in Bangladesh, a country that had some of the most dangerous highways in the world but no formal emergency response system. Jon, a practicing emergency room physician and public health student, had been shocked by the chaotic traffic that he observed during a trip to Dhaka, Bangladesh, for a course on global health issues. Over the next 18 months, Jon and three partners—two fellow students and the Bangladeshi head of a local social venture organization—decided on a three-pronged approach: they would train community-based volunteers who lived or worked close to the highway to provide free basic trauma first aid; they would develop an easy-to-use 911-type software system to deploy volunteers quickly to a crash scene; and they planned to raise operating funds by selling advertising or subscriptions to companies in Bangladesh whose workers travelled the dangerous highways daily. 

By the fall of 2017, TraumaLink had been successfully launched along two sections of particularly dangerous highways. Their trained volunteers had been able to quickly and effectively provide first aid to victims of traffic injuries. The software had worked well to notify and deploy volunteers and collect data. However, Jon and his partners had not yet found sustainable, long-term sources of revenue, despite almost four years of trying. After an initial pilot phase in November 2014, the organization had been awarded $142,500 by the US Agency for International Development, but these funds would run out by the end of 2018, with little chance of another round.  

TraumaLink had proven that they could deliver emergency services and save lives, but could Jon and his partners figure out how to become financially sustainable so that they could continue to support and expand their services within Bangladesh and possibly beyond?

Southcoast Health System consists of three hospitals in southeastern Massachusetts: St. Luke’s in New Bedford, Charlton Memorial in Fall River, and Tobey in Wareham, as well as numerous affiliated entities. But how did the merger that created the Southcoast system came about?

“Basically, we merged because we wanted to, not because we needed to,” said John Day, President and CEO of Southcoast Health System (formerly the CEO of St. Luke’s Hospital). “We wanted to avoid a divide and conquer situation. As community hospitals, we needed to be able to serve the long-term interests of our communities.”

“We decided it was ridiculous to be competing with each other,” added Ron Goodspeed, MD, President of Southcoast Hospitals Group and Executive Vice President of Southcoast Health System (formerly the CEO of Charlton Memorial). A mix of events and environmental conditions set the stage for the three hospitals to consider merging. One of the most critical of these was a turnover in Charlton’s CEO position. Meanwhile, the health care environment was becoming increasingly volatile and competitive, and the focus in the business community was shifting away from city-specific planning and toward developing the larger southeastern area of the state. 

The predominant goal of the management and boards at all three hospitals was to find a way to best serve the interests of their communities. They decided on a full asset merger: building a single executive management team and board of trustees to oversee the organization.