Frontiers in Health Services · 6 authors, 6 centres
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This study examines four long-term business-nonprofit partnerships in Boston and finds that acknowledging differences between partners—rather than emphasizing similarities—is key to resilience. Managers who built internal capacity to be responsive to, rather than control, their partners were better able to sustain collaborations through uncertainty. The findings suggest that cross-sector partnerships that learn are more resilient than those that rigidly plan.
**Background:** Businesses increasingly partner with nonprofit organizations to address social determinants of health, but differences in culture, structure, and values between sectors create persistent challenges. Prior literature identifies two approaches: one emphasizing advanced planning and shared goals, the other emphasizing continual learning and leveraging differences. This study investigates the intra-organizational capacities that enable sustainable business-nonprofit partnerships over time.
**Methods:** The authors conducted a retrospective, multiple-case study of four strategic business-nonprofit partnerships in the Boston area, each lasting 6–10 years. Cases were selected based on locale (Boston-based), composition (at least one business and one nonprofit), minimum engagement (beyond financial transfers), duration (several years), and novelty (not previously studied). The four cases represented varying levels of organizational integration: an arm's length model (financial services business with grantee partners), an operational partnership model (retail nonprofit), an incubator model (industrials business that spun out a nonprofit), and an adoption model (apparel company with an embedded nonprofit initiative). Data included 113 semi-structured interviews with leaders and employees from 42 organizations, 9 focus groups with 40 youth/young adult program participants and 1 focus group with retail nonprofit employees, and 29.5 hours of direct observations. Data were analyzed using reflexive thematic analysis with an abductive approach.
**Key Results:** Four central challenges were identified: (1) managing shared work while respecting structural, cultural, and values differences; (2) conducting joint work without clarity on roles or expectations at the outset; (3) managing relationships with organizations embedded in broader public, for-profit, and nonprofit networks; and (4) managing partnerships with open-ended trajectories (partnerships could become less integrated over time and still be considered successful). In response, the authors identified four practices for building 'capacity for responsiveness': (1) developing a set of minimum viable conditions for the partnership while otherwise tolerating ambiguity; (2) creating two-way dialogue structures up and down and within and between organizations; (3) recruiting and developing leaders with experience in both business and nonprofit sectors to act as cultural brokers; and (4) mobilizing non-financial commitments (e.g., staff hours, IT support, flash consulting days) in support of the partnership. The study found that partnerships that learned were more resilient than those that planned, and that striving to erase differences between partners could undermine the value of partnering.
**Clinical Implications:** While this study focuses on organizational partnerships rather than clinical interventions, its findings are relevant to population health and health equity initiatives that depend on cross-sector collaboration. The insights suggest that health-focused partnerships between businesses and nonprofits should invest in internal capacities for responsiveness—including tolerance for uncertainty, multi-level communication, cross-sector leadership development, and non-financial resource commitments—to build resilience and sustain long-term collaboration aimed at addressing social determinants of health.