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Doing Business Differently, Together: The Story of ReThink Health Ventures

Jane Erickson, Project Director | 05/23/2019

The Rippel Foundation launched our ReThink Health initiative’s Ventures project over three years ago to better understand: What does it take to do business differently, together? Specifically, we sought to explore what could accelerate the progress of ambitious multisector partnerships and organizations working to transform health and well-being in their regions, and what often derails their progress. Along the way, we’ve shared our discoveries here on The ReThinkers’ Blog. The Ventures project recently came to a close, so we’ve been taking time to reflect on the process and findings with our learning partners—the multisector partnerships we worked with in six regions across the country; our evaluators, Mt. Auburn Associates; our program team at ReThink Health; and our co-funder, the Robert Wood Johnson Foundation (Rippel and RWJF funded the project together).

Exploring what it takes to really do the messy work of transforming regional health ecosystems has always been at the center of ReThink Health’s purpose, and Ventures was no exception. When we began Ventures, we had already been teaming up with multisector partnerships across the country for over a decade, and we knew that even the most advanced groups faced giant challenges when trying to fundamentally shift conditions in their communities to significantly improve the health and well-being of all residents.

Groups often had similar ambitions, which were both primordial and grand: to help their communities achieve radically better and more equitable health outcomes, to encourage a vibrant and inclusive economy, and to build a shared sense of belonging and authentic civic engagement—all while ensuring that residents have access to quality urgent services that are an important part of maintaining health and well-being. The more we understood what it would take to advance regional change on this level of magnitude, the more we affirmed our focus in Ventures: help bring about health transformation by making it more possible for all of the people and sectors with a footprint on a region’s health and well-being to do business in profoundly different ways, together.

With Ventures, we sought out some of the most mature regional multisector partnerships in the country so that we could support and learn alongside efforts that were especially well positioned for progress. In the selection process, we looked for multisector partnerships with leaders from health care, public health, and other sectors, with a track record of solving problems together and an established forum for doing so. We looked for groups working at a cross-county, county, and city level. And because Ventures was focused on comprehensively transforming regional systems that produce health and well-being, we looked for groups that not only focused on how health care is delivered, but also on “upstream” efforts that promote healthy behaviors, expand economic opportunity, and ensure that other important conditions to improve health and well-being equitably are in balance.

After looking at over 145 places and partnerships with a reputation for being mature, we convened a learning cohort of six multisector partnerships from around the country. The cohort included groups from: Sonoma County, California; Bernalillo County, New Mexico; Trenton, New Jersey; Finger Lakes, New York; King County, Washington; and the Central Oregon region. (We published a study in Health Affairs about what we learned through the participant selection process—you can read more about our key findings here).

Supporting these ambitious groups in their efforts to rethink how they approached the work of transforming regional health systems was no small task, and certainly one that couldn’t be fully realized during a short-term project. Our shared work would eventually cover lots of uncharted territory: How do leaders from across organizations and sectors need to work together differently? What might it look like to build a comprehensive regional strategy for transforming their health ecosystems? How could they sustainably finance that work, and build shared values to keep the group aligned around long-term goals? We decided early on that it would be critical to set-up the Ventures project so we could evolve the design based on our learning with the partnerships in real-time. If we got too far out ahead and became married to any one “plan,” we’d miss the most important opportunities for mutual discovery. (To hear what leaders participating in Ventures took from their experience, take a look at this video).

Ventures focused on helping the partnerships grow their already big ambitions and take their current work farther, faster, rather than launch a new project or initiative. Ventures became about working with each regional partnership as they built a set of routine essential practices that would help the members of each group and their broader organizations and networks focus on crucial ongoing actions intended to strengthen the conditions that support the transformation of regional health ecosystems .

In addition to taking responsibility for framing (and reframing) these practices as we went along, ReThink Health’s part was to tailor 1:1 coaching, offer small grants (through The Rippel Foundation) that each group could use in a flexible way to advance their work during the project, and regularly convene the cohort virtually and in-person for in-depth experiential learning and networking around the practices. Throughout, we continuously evolved the project’s approach and resources to best meet the needs and goals of each group, using what eventually became known as the Essential Practices for Transforming Health and Well-Being Through Regional Stewardship—and a suite of catalytic tools that regional partners could use to hone the practices (you can find them all inside that same link).

At the end of the project we came together with the Ventures partnerships, our own staff, our evaluators, and colleagues at the Robert Wood Johnson Foundation to reflect on lessons learned. A handful of insights from those conversations stand out as especially significant for stewards who are looking for help on their journey to work across sectors and organizations to equitably transform regional health and well-being.

Five Lessons for Stewards Transforming Regional Health and Well-Being

1. Maintain enthusiasm and ambition for transforming regional health and well-being. Throughout Ventures, the partnerships with the biggest ambitions made the most notable strides. The magnitude and difficulty of this work requires that stewards, as a first step, have a deep commitment and drive to create a new reality. Stewards’ ambition matters for their region to achieve dramatically different results in its health and well-being, to work together in new ways to achieve those results, and to continually learn and incorporate new practices. Ideally those ambitions are shared by a group of well-positioned leaders from many organizations and sectors, including residents.

Of course, there are other critical factors that impact the trajectory of a collaborative effort, many of which can be—at least in part—supported by shared ambition and enthusiasm for change. The environment within which a partnership operates plays a huge role—the policy environment, culture of collaboration across a region, competitiveness of healthcare systems and insurance providers, and state of the regional economy can all serve as a bolster or barrier to their work. A strong desire to do business differently can help to mobilize and sustain an effort to improve a weak environment. And where an environment is particularly strong, “wanting it” can fuel new ways of working together that can produce unprecedented results.

2. Build practices, not only plans. Planning is an important part of any change effort. When we started Ventures, we envisioned that each participating partnership would develop a sweeping plan for health system transformation in their region. We quickly realized that when finished, a plan would rapidly become outdated, or would sit on top of a filing cabinet collecting dust. The Ventures partnerships didn’t want to plan to do business differently, they wanted to learn how to do business differently. So we focused on working with the groups to identify and build critical, routine practices that all leaders engaged in multisector work must hone—their Essential Practices. Zeroing in on the Essential Practices quickly helped stewards begin to strategize, prototype, and course-correct more effectively. By the end of Ventures, we had collectively identified ten Essential Practices, falling under four practice areas:

  • Articulating a Shared Vision for regional transformation
  • Building a comprehensive and aligned Sound Strategy for the region
  • Identifying a broad range of Sustainable Financing to fulfill overall goals
  • Ensuring there is Broad Stewardship to successfully govern the effort over time

3. Distribute leadership among many groups and individuals in a region. What does it look like to govern and manage a regional endeavor that is incredibly broad, constantly changing, and influenced at every turn by diverse leaders from across many organizations and sectors? Especially in places with a larger geographic scope and bigger populations, it can be most effective to build a network where leadership for health system transformation can be distributed across a wide range of actors, rather than owned by a single partnership.

As my colleagues noted in their recent blog post, distributed leadership is both a governance structure and a practice—a way that leaders can think and act to achieve a common purpose. This was a transformative idea for many of the Ventures partnerships, one that has encouraged them to rethink their role in leading regional change. Instead of growing a single collaborative or organizational approach, many are now seeking to build a network of which they are one integral part of a bigger whole. You can read more about how to develop a network of organizations conducting the integrative activities that support governance and management of transformation efforts here.

4. Build a shared vision for regional transformation. It is common—and expected—for initiatives and organizations to develop a vision for their work. It is less common for collaborative efforts to have a shared, compelling vision for health system transformation in their region—a clearly articulated desired future for their community in which their organizational vision is nested. Together with our learning partners, we found that building a widely shared vision for regional transformation enables important new thinking and can invite a broader range of stakeholders into dialogue. A “north star” vision for regional change is one that benefits all residents, encompasses all of the dynamics that produce health and well-being, and operates on a decades-long time horizon. Done well, a shared vision drives greater alignment across stakeholders because it provides a way to base their decisions and actions on widely shared values, and they’ve already taken the time to understand how their own organizations and interests will benefit as that vision is realized.

This isn’t something regional partnerships and their broader networks do once, but iteratively as progress is made and regional needs evolve. Through their work to build a shared vision, many of the Ventures groups expanded their strategies for transforming health and well-being, considered new approaches, expanded the time horizons for their strategy and planning work from two to five years out to 30+ years, and invited a broader network of stakeholders into action with them. While it may sound basic and intuitive, we learned that building a shared vision for regional transformation is the gift that keeps on giving.

5. Understand the dimensions of your region’s health ecosystem. Answering Ventures’ central questions about “what it takes” requires understanding how stewards can overcome the “tyranny of the urgent”—the tendency to address priorities that are important, but that tend to take precedence over longer-term solutions that will support transforming regional health and well-being. We also know that it’s really challenging to understand and map out the dynamics of a regional health system. Throughout Ventures, we worked with each participating group to help them build a cohesive picture of their health ecosystem. This helped them to “see all of the pieces of their pie,” and understand how to best develop an effective strategy that would help them focus on key leverage points—areas they could focus on that would have big, generative ripple effects throughout their ecosystem to realize their vision for regional transformation.

And for many regional partnerships, having this knowledge caused them to make significant shifts to their strategy. Those that were historically focused on providing urgent services expanded to focus more on supporting vital conditions that underpin regional health and well-being—like education, housing, and early childhood development—and those already focused on supporting vital conditions began to prioritize developing an interdependent regional portfolio that represented interests of stakeholders that were more aligned.

These five lessons represent just a handful of the insights and outcomes from Ventures. If you’d like to learn more, browse through the Ventures webpage, take a look at the evaluation report authored by our learning and evaluation partners Mt. Auburn Associates, or dive into the experiences of each Ventures region in these six case studies. As always, we invite you to share your own questions and insights with us by commenting below, using the hashtag #ThinkWithUs on social media, or through email at ThinkWithUs@www.rethinkhealth.org.