This is the second in a 4-part series based on an Expert Webinar held Aug 13, 2026 called “Building a Community Safety Net: Connecting People, Processes, and Tools to Coordinate Resources That Matter”. Speakers were Randi Harms and Loretta Severin from the University of Kansas Center for Public Partnerships and Research. Sign up to see the full video and get future Expert Webinar announcements.
Pulse Check Points
Public Health Nurses Can Build Better Referral Processes
Public health nurses work with people who care deeply about their communities.
They know the local resources. They build trusted relationships with families. They pick up the phone, make connections, track down answers, and find creative ways to help when a family needs support.
Those relationships are essential to a strong community safety net.
But good intentions alone don’t create a coordinated system.
A public health nurse may know exactly who to call when a family needs housing assistance. A community health worker may have a trusted contact at a local food program. A social service agency may know which clinic can help a family with a specific need.
That informal network can work remarkably well.
Until someone leaves. Or changes roles. Or takes a vacation. Or simply isn’t available.
Then what happens? The referral may stall. The family may have to start over. A provider may spend time searching for an answer that someone else already knows.
That’s why communities need more than strong relationships. They need shared processes that turn those relationships into consistent action.
A referral isn’t complete just because someone made it
Consider an example from the expert webinar.
- A community had created a shared expectation that organizations would acknowledge a referral within five days. On paper, that sounded like a clear process.
But once the community began looking at what actually happened, they noticed something concerning. Some referrals were being acknowledged and closed very quickly.
A provider might receive the referral, try to contact the family, fail to reach them, and close the referral. The community had met its five-day standard. But had the family actually received meaningful help?
Not necessarily.
The experience prompted an important realization: having a process isn’t the same as having an effective process.
The partners returned to the table and asked better questions.
- How many outreach attempts should a provider make?
- How should those attempts happen?
- How much time should a family have to respond?
- What does meaningful follow-up look like?
The community then refined its shared expectations.
That’s what effective process improvement looks like. Communities don’t create a workflow once and assume it will work forever. They test, learn, measure, and improve.
Turn relationships into a system
Strong relationships provide the foundation for resource coordination.
But organizations also need to agree on how they will work together.
For public health nurses, that can start with some surprisingly basic questions.
What does “referral” mean?
- Does a referral mean giving someone a phone number?
- Does it mean sending information to another organization?
- Does it mean the receiving organization agrees to contact the family?
- Does it remain open until the family successfully connects with the service?
Different organizations may use the word referral differently.
These distinctions matter.
If partners use the same word to describe different actions, they can believe they have agreed on a process when they actually haven’t.
Who is a partner?
- A community may use the word partner to describe anyone who attends a coalition meeting.
Another organization may define a partner as someone who shares responsibility for serving a particular population.
Clarifying the term can help communities determine who needs to participate in designing and carrying out the referral process.
What do we mean by “community”?
- Is the community a county?
- A group of neighborhoods?
- Several counties?
- A specific population?
Defining the community helps partners understand the scope of the work and identify which organizations need to be involved.
These conversations may seem like administrative details.
They aren’t. Shared language creates the foundation for shared action.
Co-design the workflow with the people who use it
A referral process may look simple on paper. In practice, it can involve nurses, community health workers, administrative staff, program managers, service providers, and families.
Each person sees the process differently.
That’s why communities should involve the people who will actually use a workflow in designing it.
This approach, often called co-design, helps partners identify what already works, uncover barriers, and create processes that fit real-world conditions. It also creates ownership.
When organizations help design a process, they’re more likely to understand why it exists and take responsibility for making it work.
That matters because resource coordination rarely stays exactly the same.
Staff change. Programs change. Funding changes. Community needs change.
A process that only one person understands isn’t a sustainable process.
A shared “why” keeps the process moving
Even well-designed processes can create disagreements.
One organization may want faster referrals. Another may struggle with staffing capacity. One partner may want more information included in a referral. Another may have concerns about what information its staff can access or manage.
These are real challenges. A shared purpose can help partners work through them.
The Aug 13th Expert Webinar describes this as finding a shared “why.”
What would families experience if resource coordination worked as well as it possibly could?
- Would they spend less time searching for help?
- Would they have to repeat their story fewer times?
- Would providers know what happened after a referral?
- Would families have more confidence that the person helping them could connect them to the next resource?
Keeping that shared vision in view can help partners move beyond organizational priorities and return to the reason they’re coordinating in the first place: Helping people connect meaningfully with the services they need.
Measure the process—not just the activity
It’s easy to measure how many referrals an organization makes. But volume doesn’t tell the whole story.
A community can make thousands of referrals and still leave families struggling to connect with services.
Better questions include:
- How many referrals receive a response?
- How quickly do organizations respond?
- How many referrals result in a successful connection?
- Where do referrals get stuck?
- Which services receive more referrals than they can handle?
- Where do providers struggle to find appropriate resources?
- Are families experiencing fewer barriers?
This kind of information can help communities distinguish between activity and impact.
It can also reveal problems that aren’t obvious from individual experiences.
A nurse might feel that referrals to a particular service are working well because she has a strong relationship with someone there. Referral data might show that other providers can’t get the same results. That isn’t a reason to assign blame. It’s a reason to ask a better question:
What can we change to make the process work more consistently for everyone?
Build processes that outlast individuals
The strongest community safety nets don’t depend on one exceptional nurse, one well-connected community health worker, or one person who knows everyone in town.
They build systems that allow those relationships and expertise to benefit the entire community.
For public health nurses, that can mean helping partners move from:
“I know who to call.” to “We have a shared process for making sure families get connected.”
That shift doesn’t eliminate the importance of relationships. It makes those relationships more sustainable.
And it creates a better experience for families, regardless of which public health professional opens the door.
Start small: turn one good intention into a shared process
You don’t have to redesign your community’s entire referral system at once.
Start with one common referral.
Bring the people involved in that referral together and ask:
- What are we trying to accomplish for the family?
- What exactly do we mean by “referral”?
- Who is responsible for each step?
- What information needs to be shared?
- How quickly should someone respond?
- How will we document and track what happens?
- How will new staff learn the process?
- What will tell us that the process is working?
- When will we come back together to review and improve it?
Then test it, learn from what happens and improve it. Because the goal isn’t to create a perfect process.
The goal is to turn good intentions into consistent action—and make it easier for every door to be the right door.
Watch for parts 3 and 4 in this series over the next few weeks:
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The graphics used for this article were generated with a series of AI-prompts. The article was written by a human after getting an AI-generated outline of keypoints from the webinar transcript.