Key Points

· In a time of scarce resources and significant needs, funders may seek to maximize the impact of their grantmaking through collaboration. While many foundations move well from identifying a problem to building broader awareness and forging key partnerships, they typically flounder in trying to move beyond collaboration to a sense of mutual responsibility or collective accountability for the greater good, which is a precondition for sustainable systems change.

· This article discusses three complex initiatives that made sustainable changes in integrated behavioral health and primary care. Using a conceptual framework based on the Building Blocks of Systems Change model, this article focuses on achieving collective accountability and sustainable systems change, highlights common challenges, and presents guidelines for funders.

· While the article details how various policy approaches and tools drove cultural transformation in these three funding regions, the conceptual framework and lessons learned apply to a broad range of environments and intended outcomes. These lessons can be used to move initiatives to collective accountability and systems change, so that the change becomes the new “normal,” independent of external funding or expectations.

Open Access