Annotated Bibliography

This list of readings and presentations presents the foundational research and practice upon which ReThink Health’s Stewardship Guide is built. Each of these sources provides additional in-depth treatment of the challenges and practices of stewarding health system transformation.

Emerson, Kirk; Nabatchi, Tina; and Balogh, Stephen. (2012). An Integrative Framework for Collaborative Governance. Journal of Public Administration Research and Theory, 22, pp. 1-29. This article synthesizes and extends a suite of conceptual frameworks, research findings, and practice-based knowledge into an integrative framework for describing how collaborative governance structures operate. The framework specifies a set of nested dimensions that encompass a larger system context, a collaborative governance regime, and its internal collaborative dynamics and actions that can generate impacts and adaptations across systems. The article also offers 10 propositions about the dynamic interactions among components within the framework and concludes with a discussion about the implications of the framework for theory, research, evaluation, and practice.

Erickson, Jane; Branscomb, Jane; and Milstein, Bobby. (2015). Multi-sector Partnerships Building Health and Resilience: Findings from the 2014 Pulse Check. ReThink Health: Cambridge, MA. In 2014 ReThink Health. This report synthesizes the findings of ReThink Health’s 2014 Pulse Check which they conducted to sketch the national landscape of multi-sector, regional partnerships that are working to create healthier and more resilient communities. Using data from 133 multi-sector partnerships across the United States, they share insights into the scope, makeup, challenges, and accomplishments of these groups.

Ganz, Marshall. (2010). Leading change: Leadership, organization, and social movements. In N. Nohria & R. Khurana (Eds.), Advancing Leadership, Harvard Business School Press, Boston: MA. This chapter provides a theoretical and practical treatment of the core methods of organizing and community engagement. Rooted in 28 years of organizing experience, and informed by insights of social science and teaching at Harvard’s Kennedy School of Government, Leading Change explores the practices necessary for strengthening the effectiveness of civic associations, community organizing, and social movement responses to the critical challenges of our time through continual learning, capacity building, and leadership development.

Hackman, J.Richard (2002). Leading Teams: Setting the Stage for Great Performances. Boston, MA: Harvard Business School Press. This book, written for leaders and team members, provides a comprehensive treatment of how to design and lead teams. It draws on five decades of teams research to illustrate the handful of conditions, which, when present, increase the chances of having great teamwork—and how to get those conditions in place for any kind of team.

Hirsch, Gary; Isaacs, Kathryn; and Wageman, Ruth. (2015). A Dynamic Model of Collaborative Capacity in Health Transformation efforts. Working paper. This study of 20 health transformation collaboratives around the U.S. explores what conditions, created by leaders, most enable these efforts to create collaborative capacity—the ability to enact more and greater changes over time. It identifies the key positive conditions that can create growth loops and strong upward trajectories, and the unintended ways that such efforts can get off course and hit reversals. The research offers more than just a checklist of conditions for success: it shows how collaborative capacity is a dynamic process and how leaders can act to prevent pitfalls and build momentum over time.

Hilton, Kate and Wageman, Ruth. (2015). Leadership in volunteer multistakeholder groups tackling complex problems. Emerald Monographs in Leadership and Management Series: Leadership Lessons from Compelling Contexts. S. Braun, C. Peus, and B. Schyns, Editors. London: Emerald Group. This chapter explores distributed leadership in volunteer multi-stakeholder groups tackling complex problems, focusing on community organizing practices to transform health and health care in Columbia, South Carolina. It brings to life many of the special challenges common to multi-stakeholder groups, including indistinct articulation of shared purposes, limited engagement and motivation, conflicting interests, lack of trust, limited authority, and decision-making dominated by institutional elites. It shows how the learning of organizing practices cross stakeholders—including public narrative, collective decision-making, and building team structure—can serve as shared leadership practice to systematically overcome those challenges.

Homer, Jack; Hirsch, Gary; Fisher, Elliott; and Milstein, Bobby. (2015).   How the Right Combination of Local System Changes Could Substantially Improve Health and Lower Cost and Be Financially Self-Sustaining. Working paper, ReThink Health. Health reform in the U.S. is a national priority that requires concerted action in every region across the country. Knowing that health and health care are shaped strongly by local conditions, researchers examine several strategy choices that local planners may pursue to influence health system performance over time. This report concentrates on five strategies in particular: (1) delivering high-value preventive and chronic care; (2) reinvesting savings from lower health care costs; (3) shifting provider payment from fee-for-service to contingent global payments; (4) enabling healthier behaviors and safer environments; and (5) expanding socioeconomic pathways to advantage for families. Authors estimate the relative and combined effects of these strategies using simulated scenarios from the ReThink Health Dynamics Model, configured with national data to represent a prototypical mid-sized American city. Results show the likely influence on cumulative measures of deaths, health care costs, inequity, workforce productivity, and program spending from 2012-2040. These scenarios suggest that a carefully crafted mix of clinical and social change initiatives, together with value-based payment and sustainable financing could significantly transform local health system performance.

McGinnis, Michael D. (2013). Caring for the health commons: What is it and who’s responsible for it. Working Paper. This research paper explores Elinor Ostrom’s core concepts of the commons and their application to the idea of a health commons, stewardship, and common property. Examples from the case of Grand Junction, Colorado, are used to illustrate the relevance of these principles to shared stewardship of a regional health commons. The paper concludes with a set of questions that can help assess a community’s ability to more effectively manage their own system of healthcare delivery.

Milstein, Bobby; Homer, Jack; Briss, Peter; Burton, Deron; and Pechacek, Terry. (2011). Why Behavioral And Environmental Interventions Are Needed To Improve Health At Lower Cost. Health Affairs, 30, 823-832. A dynamic simulation model of the US health system is used to test three proposed strategies to reduce deaths and improve the cost-effectiveness of interventions: expanding health insurance coverage, delivering better preventive and chronic care, and protecting health by enabling healthier behavior and improving environmental conditions. We found that each alone could save lives and provide good economic value, but they are likely to be more effective in combination. Although coverage and care save lives quickly, they tend to increase costs. The impact of protection grows more gradually, but it is a critical ingredient over time for lowering both the number of deaths and reducing costs. Only protection slows the growth in the prevalence of disease and injury and thereby alleviates rather than exacerbates demand on limited primary care capacity. When added to a simulated scenario with coverage and care, protection could save 90 percent more lives and reduce costs by 30 percent in year 10; by year 25, that same investment in protection could save about 140 percent more lives and reduce costs by 62 percent.

Ostrom, Elinor. (2010). Beyond markets and states: Polycentric governance of complex economic systems. The American Economic Review, 100(3), 641–672. 2009 Nobel Prize lecture. The research of Elinor Ostrom, professor of political science at Indiana University and Nobel Laureate in Economics, inspires much of our thinking about stewardship of health systems. Her work vividly underscores the power of leaders coming together across organizations to steward local resources on behalf of their communities. Ostrom found that communities, left to themselves, can sort out their own ways of stewarding their resources to sustain them over time. Through cooperation, trust, and collective action, the users of those resources create sensible rules for themselves to avoid over-fishing, over-farming, and cutting down their forests. We see many parallels in her work for our efforts to transform our health systems to promote and sustain the health of our residents and to steward and invest our financial resources in health and care.

Senge, Peter. (2006). The Fifth Discipline. New York: Doubleday. The tools and writing in ReThink Health’s Stewardship Guides that are focused on developing a learning practice and sharpening systems thinking are based in this work. This book teaches the core mindsets and practices of collective problem solving and using systems thinking to develop enterprises into learning organizations. The five disciplines represent approaches for developing three core learning capabilities: fostering aspiration, developing reflective conversation, and understanding complexity.

Siriani, Carmen. (2009). Investing in Democracy: Engaging Citizens in Collaborative Governance. Washington, D.C.: The Brookings Institution. The health of American democracy ultimately depends on our willingness and ability to work together as citizens and stakeholders in our republic. Growing numbers of policymakers across the country are figuring out how government can serve as a partner and catalyst for collaborative problem solving. This book details three such success stories: neighborhood planning in Seattle; youth civic engagement programs in Hampton, Virginia; and efforts to develop civic environmentalism at the U.S. Environmental Protection Agency. The book explains what measures were taken and why they succeeded. It distills eight core design principles that characterize effective collaborative governance and concludes with concrete recommendations for federal policy.

Wageman, Ruth. (2013). Building great leadership teams for complex problems. Chapter 4 in Developing and Enhancing High-Performance Teams in Organizations. E. Salas, Editor. Malden, MA: Wiley. This chapter draws on a decade of research to identify the most common design problems of leadership teams that form across organizations to lead a complex change effort. It explains why those challenges—such as unclear purposes, the wrong people convening, and time-wasting or wheel-spinning—occur, and offers hands-on strategies for leadership team members, facilitator, and leaders to redesign their teams for momentum and excellence.

Meeting Summary: ReThink Health Roundtable on Leveraging Investments. (2014). ReThink Health: Cambridge, MA. In September 2014, ReThink Health convened 25 leaders of regional health collaboratives for an innovative roundtable in Chicago on leveraging investments to advance their health and health care. Together these leaders meaningfully explored barriers to their stewardship activities and approaches to sustainable investment and financing. Learn more about how ReThink Health catalyzed actionable dialogue and creative problem-solving with these change-makers.