title: Collaborative leadership and the implementation of community-based fall prevention initiatives: a multiple case study of public health practice within community groups.
abstract: Falls among community-dwelling older adults are a serious public health concern. While evidence-based fall prevention strategies are available, their effective implementation requires broad cross-sector coordination that is beyond the capacity of any single institution or organization. Community groups comprised of diverse stakeholders that include public health, care providers from the public and private sectors and citizen volunteers are working to deliver locally-based fall prevention. These groups are examples of collective impact and are important venues for public health professionals (PHPs) to deliver their mandate to work collaboratively towards achieving improved health outcomes. This study explores the process of community-based group work directed towards fall prevention, and it focuses particular attention on the collaborative leadership practices of PHPs, in order to advance understanding of the competencies required for collective impact.
  
  
  
  Four community groups, located in Ontario, Canada, were studied using an exploratory, retrospective, multiple case study design. The criteria for inclusion were presence of a PHP, a diverse membership and the completion of an initiative that fit within the scope of the World Health Organization Fall Prevention Model. Data were collected using interviews (n = 26), focus groups (n = 4), and documents. Cross-case synthesis was conducted by a collaborative team of researchers.
  
  
  
  The community groups differed by membership, the role of the PHP and the type of fall prevention initiatives. Seven practice themes emerged: (1) tailoring to address context; (2) making connections; (3) enabling communication; (4) shaping a vision; (5) skill-building to mobilize and take action; (6) orchestrating people and projects; and (7) contributing information and experience. The value of recognized leadership competencies was underscored and the vital role of institutional supports was highlighted.
  
  
  
  To align stakeholders working towards fall prevention for community-dwelling older adults and establish a foundation for collective impact, public health professionals employed practices that reflected a collaborative leadership style. Looking ahead, public health professionals will want to shift their focus to evaluating the effectiveness of their group work within communities. They will also need to assess outcomes and evaluate whether the anticipated reductions in fall rates among community-dwelling older adults is being achieved.
authors.affiliation: School of Nursing, McMaster University, Hamilton, ON, L8S 4K1, Canada. mreid@mcmaster.ca.
authors.forename: Maureen
authors.initials: M
authors.lastname: Markle-Reid
authors.affiliation: Halton Region Health Department, Oakville, ON, L6M 3L1, Canada.
authors.forename: Cathy
authors.initials: C
authors.lastname: Dykeman
authors.affiliation: School of Nursing, McMaster University, Hamilton, ON, L8S 4K1, Canada.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ploeg
authors.affiliation: School of Nursing, McMaster University, Hamilton, ON, L8S 4K1, Canada.
authors.forename: Caralyn
authors.initials: C
authors.lastname: Kelly Stradiotto
authors.affiliation: Haliburton, Kawartha, Pine Ridge District Health Unit, Haliburton, ON, K0M 1S0, Canada.
authors.forename: Angela
authors.initials: A
authors.lastname: Andrews
authors.affiliation: York Region Public Health, Vaughan, ON, L4K 0G5, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Bonomo
authors.affiliation: Simcoe Muskoka District Health Unit, Barrie, ON, L4M 6K9, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Orr-Shaw
authors.affiliation: Brant County Health Unit, Brantford, ON, N3R 1G7, Canada.
authors.forename: Niyati
authors.initials: N
authors.lastname: Salker
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000328:Adult; D002983:Clinical Competence / Q000592:standards; D003153:Community Health Services / Q000458:organization & administration*; D003299:Cooperative Behavior; D017144:Focus Groups; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D009864:Ontario; D017149:Private Sector; D011634:Public Health; D015980:Public Health Practice; D017150:Public Sector; D012107:Research Design; D012189:Retrospective Studies
keywords: Case study; Collaborative leadership; Collective impact; Fall prevention; Older adults; Public health; Qualitative