Stewards are people or organizations who take responsibility for working with others to create conditions that all people need to thrive, beginning with those who are struggling and suffering. Stewards may be affiliated with organizations or may act on their own agency, such as a resident. Stewards have (or are interested in developing) an equity orientation in regard to purpose, power, and wealth.
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.
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.
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.
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/
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.
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.
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.
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.
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.
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.
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.
The World Health Organization has collected resources related to stewardship, with an emphasis on the health care sector.