Stewarding Shared Resources Elinor Ostrom’s Research and ReThink Health’s Approach 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 studied many communities whose residents depended on critical public resources for their livelihoods: fishing grounds, forests, arable land, and water supplies. All of these resources are vulnerable to being overused, even used up, as people make independent decisions to harvest more and more to support their own families, groups, or organizations. That destructive pattern is typically called the “tragedy of the commons.” We see many parallels in Ostrom’s 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. She 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. She saw that: Some communities do fall prey to the “tragedy of the commons” – as families, companies, or groups each harvest as much as they can for their own gain. Some communities do not. Instead, they form local groups of leaders representing users of the resources. These self-governing groups act on behalf of a bounded group of residents. They form shared aspirations for sustaining the resource. They formulate rules and monitor each others’ behavior. They create mechanisms to resolve inevitable disputes. This kind of stewardship is neither a free-for-all nor does it rely on outsiders creating rules and governing local resources. It is a sometimes-fragile but ultimately powerful and flexible process of shared leadership and the balancing of individual, group, and community interests.