Rebuilding community and regional collaboration: the Kingsport, Tennessee experience

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. KAHIP's efforts continued to move, albeit slowly, until late 1993, when managed care organizations began to deselect hospitals and physicians and competition began to overcome hopes for collaboration. In 1994 KAHIP and other community leaders reaffirmed seven principles, including the need for continued dialogue and collaboration. By early 1998 ten community improvement teams were functioning, six chartered by KAHIP.

Four established projects have continued to expand either in scope or through institutionalization in the community or both, including Drive Smart, a collaborative learning project concerned with reducing preventable injuries and death among youth from motor vehicle crashes, and the Network of Employers for Traffic Safety, a public-private partnership dedicated to reducing the number of deaths and injuries in the workforce.

Four other teams are operating in Kingsport. One, the Kingsport Community Alliance Linking Enforcement, Responsibility and Treatment (ALERT), is dedicated to reducing the impact of substance abuse. Another, the Community Database Team, works on developing a database focused on community health status information.

In a community with widespread knowledge of continuous improvement philosophy and techniques, it makes sense to encourage other agencies to take the initiative and the credit and not worry about whether a specific process is adopted. The role of the public health system in health assessment, policy assessment, and quality improvement in an era of managed care and reduced government should be encouraged.