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What is ReThink Health?

At ReThink Health, a Rippel initiative, we work with national and regional stewards to discover what it takes to design and execute transformative change and produce better health and well-being for all.

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Who are Stewards?

Stewards are leaders (people and organizations) who take responsibility for forming working relationships with others to drive transformative change in regions. Stewards have (or are interested in developing) an equity orientation in regard to purpose, power, and wealth.

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They understand

  • Purpose must be larger than oneself and one’s organization.
  • Power must be built and distributed with others, not consolidated.
  • Wealth must be invested, not withheld, to create long-term value as well as address short-term urgent needs. [Citation][Block, Peter. Stewardship: Choosing Service Over Self-Interest. Second Edition. San Francisco: Berrett-Koehler Publishers, Inc., 2013.]

As a Rippel initiative, we are interested in working with a particular kind of steward—those who are positioned to influence how regional decisions are made, and how resources are spent—to equitably shift the system in ways that better produce health and well-being.

How do stewards shift the system that produces health and well-being?

Rippel’s best hypothesis is that as stewards mature in their ability to facilitate cross-sector collaboration and alignment, they are able to create a new ecosystem for health and well-being in their regions; an ecosystem known for producing equitable outcomes. This hypothesis is backed by both empirical and anecdotal evidence. Like Rippel, you might be wondering: how do stewards mature? Working together with stewards to discover “how” is the reason for Rippel’s ReThink Health initiative and its multiple projects.

One of the major contributions of the ReThink Health Frontiers and Ventures projects was to develop A Pathway for Transforming Health and Well-Being Through Regional Stewardship. This Pathway clarifies Rippel’s hypothesis about the essential practices stewards should commit to and develop as part of their quest. It also describes what stewards can expect to experience when they work together in these ways, across five phases of development.

As our team works with stewards, we all get more and more knowledgeable about what the Pathway ought to include. With the passing of time we have refined our hypothesis, making it stronger and better for stewards who want to use it as a framework for transforming the regions they serve. Refinement will continue as we take on each new initiative and project.

Dive into the Pathway and learn about

  1. The essential practices stewards should commit to and develop as part of their quest to create equitable opportunities for everyone to reach their full potential for health and well-being
  2. What stewards can expect to experience when they work together in these ways, across five phases of development

What happens when stewards work with Rippel’s ReThink Health team?

ReThink Health’s team works together with stewards as learning partners. As stewards mature, they conquer challenge after challenge, and then encounter new ones. Rippel works hard with stewards who are at the forefront of discovering what it takes to overcome these challenges, including:

We work with our steward partners to carefully consider the six conditions of systems change, and ask: what conditions are holding the problem in place and how can stewards shift them to produce better health and well-being for all? Then, we prototype, make sense of, and refine strategies that best help stewards move along the Pathway and nudge their systems forward. We share the most promising strategies widely, so many more stewards can benefit.

Shifting the Conditions That Hold the Problem in Place

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Stewardship is an already-established practice

In 2000, the World Health Organization broadly defined stewardship as “the careful and responsible management of the well-being of the population”, and in the most general terms as “the very essence of good government.” [citation]Kapoor N, Kumar D, Nivedita Thakur N. Core attributes of stewardship; foundation of sound health system. Int J Health Policy Manag 2014; 3: 5–6. doi: 10.15171/ijhpm.2014.52https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4075105/ 

Highly respected leaders from around the world have also identified stewardship as a means to health and well-being. Here is a sample of their works:

External Resource

Stewardship and Public Service: A Discussion Paper

This discussion paper prepared for the Public Service Commission of Canada presents stewardship as a bridge between purely market-based approaches and broader public sector responsibilities. While market-based reforms have shown many possible outcomes, they are not robust enough to embrace the full range of public sector activities, such as governance and guarding the public interest.

External Resource

Health Stewardship: The Responsible Path to a Healthier Nation

The Aspen Institute published this paper explaining the value of health stewardship and making a case for its importance for successfully navigating the challenges facing the system that produces health and well-being.

External Resource

What Help is a Steward? Stewardship, Political Theory, and Public Health Law and Ethics

As part of The Northern Ireland Legal Quarterly journal’s special issue on ‘super-stewardship’ and the related work of Roger Brownsword, this paper critically examines stewardship in public health.

External Resource

Achieving Accountability for Health and Health Care Minneapolis, MN

This article in Minnesota Medicine proposes Accountable Health Communities (AHCs) as a way to establish health system stewardship. They would to review local data against the Triple Aim, create shared goals and investments, and involve citizens in reform and stewardship.

External Resource

Stewardship: Choosing Service Over Self-Interest

In this book, Peter Block asserts that a fundamental shift in how we distribute power, privilege, and the control of money—away from self-interest and toward stewardship—can transform every part of an organization for the better, and he examines the nitty-gritty of implementing these reforms.

External Resource

Core Attributes of Stewardship; Foundation of Sound Health System

This International Journal of Health Policy and Management Perspective offers one way to look at stewardship, positing that it has five core attributes: responsible management, political will, a “normative dimension” (equity), balanced interventions, and components of good governance.

External Resource

Public Involvement and Health Research System Governance: a Qualitative Study

This article in Health Research Policy and Systems describes an exploratory, qualitative study of specific active stewardship efforts in two countries: England and Canada. It illustrates some of the benefits of stewardship while identifying three sets of common issues across both locations.

External Resource

World Health Organization: Stewardship Resources

The World Health Organization has collected resources related to stewardship, with an emphasis on the health care sector.

Team

The Rippel Foundation, home of ReThink Health, is made up a team of dynamic individuals who share a passion for partnering with stewards as they design and execute the strategies they need to guide transformative change and produce better health and well-being for all. We think big, strive for excellence, take risks, and push boundaries. 

Get to know the Rippel team below.

Administration Board of Trustees Strategy & Management Organizational Learning & Evaluation Communications Programs
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Lindsey Alexander

Project Director
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Ella D. Auchincloss

Project Director
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Stacy Becker

Vice President, Programs
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Molly Belsky

Program Coordinator
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Nina Burke

Senior Program Associate
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Chicken

Unconventional Thinker
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Maggie Cooke

Strategic Partnerships Associate
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Anna Creegan

Project Director
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Jane Erickson

Project Director
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Katy Evans Pritchard

Project Manager
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Bethlihem Gebremedhin

Administrative Associate
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Bobby Milstein

Director of System Strategy
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Krishna Patel

Program Associate
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Sarah Rial

Program Coordinator
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Iueh Soh

Project Manager
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Pedja Stojicic, MD

Project Director
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Katherine Wright

Senior Program Associate 
Project Teams
To see who is involved with ReThink Health’s current project teams, click on the icons below
Organizational Learning and Evaluation
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Stacy Becker

Vice President, Programs
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Nina Burke

Senior Program Associate
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Jane Erickson

Project Director
Administration
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Bethlihem Gebremedhin

Administrative Associate
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Kimberly Hines Hart

Corporate Counsel
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Jane Novak

Finance Associate
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Farida O’Neill

Executive Associate
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Ed Rosen

IT Contractor
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Audrey Wells

Director of Finance and Administration
Board of Trustees
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Edward W. Ahart

Chair
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Elliott S. Fisher

Trustee
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Michael W. Harris

Trustee
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Laura Landy

President and CEO; Trustee
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James R. Sonneborn

Trustee
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David S. Surrenda

Trustee
Strategy and Management
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Stacy Becker

Vice President, Programs
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Kim Farris-Berg

Director, Communications
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Laura Landy

President and CEO; Trustee
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Bobby Milstein

Director of System Strategy
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Audrey Wells

Director of Finance and Administration
Communications
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Kim Farris-Berg

Director, Communications
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Bradley Girard

Senior Creative
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Amanda McIntosh

Senior Communications Associate

ReThink Health’s History

ReThink Health is the brainchild of a group of visionary leaders from multiple sectors. It’s grounded in the earliest thinking of The Rippel Foundation’s first President, Julius A. Rippel, who as far back as 1959 raised concerns about our unsustainable health care system and the need for new ways of thinking and acting to keep people healthy and health care affordable. After decades of grantmaking, it became apparent in 2007 that to achieve Rippel’s mission, a tectonic structural shift to the system that produces health and well-being would be necessary.

To figure out how to spark that change, Rippel convened a group of extraordinary leaders—those who would become ReThink Health’s pioneering founders. The group included some of the nation’s most respected health care leaders, as well as a diverse group of experts and change agents from economics, politics, business, community organizing, and energy. Putting their heads together between 2008 and 2010, they realized everyone would need to rethink their approach to improving health and well-being—and an entirely new kind initiative would be needed to help leaders across regions and sectors to see a new way forward. That initiative is ReThink Health. They based the initiative on the guiding principles that, to make lasting change to the health ecosystem, efforts must be:

  • Systemic Approach challenges from a system level and design a new system that fosters health and well-being.
  • Transformative Incremental change is not enough. Business-as-usual is not working, so we must upend the status quo and transform the system, all the way down to how people think about health and well-being.
  • Stewarded Leaders must be stewards—they must take responsibility for forming working relationships with others to transform health and well-being across their region.
  • Multisector Stewards must form relationships across sectors. Every part of a regional system contributes to health and well-being, so they must all be at the table, whether they are health care providers or payers, or they are focused on education, business, justice, and so on.
  • Regional Health and well-being are largely local, so system-wide national impact will build from local action. There is no one-size-fits-all solution.
  • Equitable The transformed system that produces health and well-being must be equitably designed and address systemic inequities in the current system, as those inequities are a major barrier to health and well-being for all.

Based on these pillars, the pioneers founded ReThink Health with the goal of gaining greater understanding of these ideas and spreading what is being learned about what it will take to transform the system that produces health and well-being. Some of ReThink Health’s most exciting discoveries since its founding include:

This “health system in a computer” is an interactive tool that allows stewards to explore how various strategies might impact their region’s health and well-being. Thousands of people and organizations have used the model to test different combinations of investments and interventions, informing their real-life strategies.

This Pathway is ReThink Health’s best hypothesis of what it takes to become stewards and transform together.

The Ventures project explored what could accelerate the progress of ambitious multisector partnerships working to transform health in their regions, and what often stands in the way of that progress. We worked with multisector partnerships in six regions across the country as they built practices that are essential for transforming a regional health ecosystem.

ReThink Health worked with multisector partnerships in Minnesota and Michigan to create maps of their regions’ health ecosystems, as part of their collaborative exploration of effective ways to intervene.

This workbook, divided into easy-to-digest modules, uses colorful examples, engaging exercises, and plain, everyday language to help stewards do what it takes to expand their financing horizons beyond the grant to more sustainable options.

Community Activation for Health System Transformation was a 5-year project focused on developing a set of skills stewards can use to train themselves and others to build coalitions, distribute stewardship mindsets across those coalitions, and build stewardship capacities among themselves and others. We forged and tested a curriculum for teaching these skills that had a major impact on a national workforce in the health care sector.

We developed a toolkit with exercises, meeting guides, videos, and more to help stewards plan resident engagement efforts. Among other things, the toolkit can help stewards accurately assess their resident engagement efforts, get on the same page about their goals, and figure out how to close the gap between the two. As part of this, we laid out a typology of the three outcomes (resident awareness and participation, feedback and input from residents, and active resident leadership) that stewards engaging in regional resident engagement practices seek to pursue, and the common practices they use to achieve those outcomes. Transforming a region’s system for health requires a balance between practices across all three outcomes.

With the National Academy of Medicine, we published a widely-read paper and designed a national meeting exploring how stewards might use tax credits as a means to fund population health efforts.
 The paper includes two detailed prototypes we developed to show how such a tax credit could work.

Our national survey, conducted in 2014 and 2016, sheds light on how stewards approach the work of transforming health and well-being in their regions, including how they advance and finance their efforts.

ReThink Health’s Pioneers
See some key accomplishments that led to each pioneer’s role in founding ReThink Health. These tremendously talented people continued to make marks in their respective fields, but the list below only features highlights from before they founded the initiative.
  • Donald Berwick
    Health care quality improvement
    Former head of the Centers for Medicare & Medicaid Services and the Institute for Healthcare Improvement. One of the country’s foremost advocates for advancing quality improvement and value-driven health care.
  • Elliott Fisher
    Health policy and research
    At the time, was director of The Dartmouth Institute for Health Policy & Clinical Practice. His research has shown how variations in health care spending have little to do with health status or price or outcomes, but rather on greater use of services.
  • Marshall Ganz
    Community organizing
    Harvard professor and community organizing luminary. Helped organize the United Farm Workers and supported development of President Obama’s winning campaign strategy.
  • Laura Landy
    Philanthropy and entrepreneurship
    Rippel president and CEO. An entrepreneur and foundation leader whose work has focused on bridging sound market and business practices with social goals to create sustainable solutions to our nation’s most challenging problems.
  • Amory Lovins
    Energy research
    A renowned scientist and founder of the Rocky Mountain Institute, whose critical thinking about alternative approaches to energy policy has driven world leaders and the public to think differently about climate change and sustainable energy.
  • James (Jay) Ogilvy
    Business (strategic planning)
    A cofounder of Global Business Network, who helped pioneer scenario planning, which has become an integral part of strategic thinking in business and government and has revolutionized both public and private planning.
  • Elinor Ostrom
    Economics
    A Nobel Laureate in Economic Sciences, whose research has been at the forefront of promoting policies for fostering democratic governance and sustainable stewardship of common resources shared among populations. Elinor passed away in 2012.
  • Peter Senge
    Organizational design and systems thinking
    A pioneer and influential leader in economic and organizational design, systems thinking, and leadership development, who founded the Society for Organizational Learning. His book The Fifth Discipline has been hailed as one of the most important management books ever by publications like Harvard Business Review and Financial Times.
  • John Sterman
    Environment and system dynamics
    An MIT professor and a leader in system dynamics, who has focused on addressing climate change and helping corporations see opportunities and consequences of their investments.
  • David Surrenda
    Organizational psychology
    A psychologist and founder of the Graduate School of Holistic Studies at John F. Kennedy University. David developed The Leadership Edge which helps leaders advance creative-change strategies and sustainable solutions for their organizations.

Work at Rippel

Discover how working with The Rippel Foundation, home of ReThink Health, will help you realize your full potential while helping national and regional stewards guide transformative change and produce better health and well-being for all.


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