What’s an organization to do in this world of ours, except prepare for change? Only, what if the services a community needs rely not on a single organization but a collection of them? How do you help a whole group respond, especially in rapidly-changing circumstances? At the Primary Care Coalition, we’re confident the answer lies in a strong backbone. Consider the role your spine plays in your body. It is the core structure for both stability and motion, as well as the central pathway for messages to and from different sectors. A healthy backbone, in other words, is an instrument of both communication and alignment. At PCC, we are structured for support. That is the core of what we do. We help patients, we support providers, we build systems. The actual services we provide are often hidden behind the language of program administration and leveraged resources, but what they really mean is that we excel at making things work better, together. Crucially, in this extended backbone metaphor, there is no requirement for all parts of the body to have the same motion or strategy. An elbow and a femur move differently by design, but an aligned body helps keep their actions balanced. That backbone balancing can even amplify impact: learning to coordinate hip drive with arm motion can deliver a more powerful swing. None of the impact reflected in our recent FY24 Annual Report would be possible from a single organization. It’s the blending of expertise across professional and cultural and funding lanes that creates an extra-strength, super-powered, Montgomery County model of a safety net. As times get increasingly chaotic and finances increasingly tight, we will all have to think harder about the best way to leverage strengths toward a greater whole. As our Chief Operating Officer Hillery Tsumba says, “When resources are constrained, people tend to consolidate power and meet fewer needs. But that is when it is more important than ever to give up power for a shared goal and try to go further by stretching resources to do more.” We will have to be not just boldly creative but bravely collaborative to turn a do-more-with-less atmosphere into a climate of innovation. But it can be done. Here are some key considerations on our minds for making collaboration work in challenging times: | 
