Ella Auchincloss

Senior Project Consultant

ReThink Health supports leaders who are steering their regions toward an integrated, sustainable, and equitable health ecosystem. Our Pathway for Transforming Regional Health serves as a reference for those embarking on the complex task of transformation. It offers a sense of the steps along the process, and helps leaders pinpoint where they are now and get on the same page about where they are going—both the the immediate future and in the long term.

In our Ventures project, ReThink Health is working with communities that have already done the hard work of getting to the point where transformation is actually within sight. In these regions, the “low-hanging” fruit of easy collaborations have been harvested, many hard decisions have been made—though there will be more—and entrenched power structures are beginning to be disrupted. These communities have made it to this stage of the Pathway by walking it. The work of getting to this point is not easy and is not for the faint-hearted. For those at the beginning of the journey, the road ahead may look daunting—and it’s not always obvious how to proceed.

Over the past five years, the ReThink Health engagement team has been experimenting and adapting the framework of community organizing—with its long history of empowering neighborhoods and building leaders to advance change—to help communities coalesce and take action on a common health-related agenda. We have coached leaders, from inner-city Baltimore to the Mississippi Delta and rural Appalachia, on tactics understood to be essential by community organizers but often lacking in health system transformation.

In all of this work, we have observed how the practices of  community organizing transcend geography and context to help leaders progress through the early stages of regional health transformation. Our observations are the basis for these 5 tips for ensuring early success:

Tip 1:  Get C-Suite Support for Building Relationships in the Field

For a nascent regional effort, a good leader is more like a field organizer than an office worker. The most successful efforts have leaders who are deeply committed to building strong relationships beyond their organizational boundaries. If these leaders can usually be found in the office, they probably aren’t doing their jobs.

And yet, many leaders are just beginning in a new role and at the same time trying to earn the respect of colleagues and peers. Being perceived as an absentee leader by people who think a leader’s most important work happens at a desk can be a challenge. Support from senior executives at the leading organization can help a lot by creating institutional cover for this kind of worker. The C-suite should be clear and candid in its support for how much time leaders will be spending in the field developing relationships.

Leaders’ performance should be specifically measured by new commitments made to the nascent initiative, turnout to key meetings, new partners signed on to the effort, and other relevant metrics. Practically speaking, if your “organizers” aren’t submitting a lot of coffee shop receipts for reimbursement, they probably aren’t spending enough time in their communities. Relationships are the key to finding an “on-ramp” and advancing along the Pathway.

Tip 2:  Use Storytelling to Frame a Hopeful Vision

Renowned community organizer Marshall Ganz defines leadership as “accepting responsibility for enabling others to achieve purpose under conditions of uncertainty.” Enabling others to achieve shared purpose is the critical function of leaders. A willingness to take action is often dependent upon people feeling confident that the leaders deeply believe that this vision is actually possible.

In our experience, many leaders in the health field  need coaching to move beyond conveying their community’s health solely in terms of depressing statistics. Yes, the work is urgent, but people will not be moved to join you unless you can present a compelling vision of the future that also lays out clear, specific, next steps for achieving milestones. This is long-haul work that plays out in a series of wins and lessons (not losses) over a series of time. The most successful leaders frame their story with a vision of hope. The practice connects them to their own sources of hope and motivation, and it sustains the work of the entire group.

Tip 3:  Regularly Map the Community’s Actors and Resources

The most successful leaders routinely scan their environments. Once leaders begin to attract a growing number of new stakeholders to the effort, it’s important to undertake a regular practice of mapping key actors. After all, after each action taken and each milestone reached, the landscape shifts. New leaders can emerge, new resources can emerge, you may learn a lot about where power lies, who leaders are, and the way things really work in neighborhoods. After every big action, as part of their debrief, teams should initiate an intentional process of learning by asking:

  • Who are our people? (That is, who are the people we really need to recruit for this endeavor to be successful?)
  • What are their interests?
  • What are their resources?
  • Who is missing and who should reach out to them?

This regular analysis of stakeholders offers a way of assessing progress for building more community driven support for your effort.

Tip 4:  Set Expectations: There is Value in the “Ground Game”

One of the most common challenges faced by leaders is managing the gap between the short-term effort of developing critical new relationships and the longer-term impact on a community’s health. We recommend that leadership teams develop an evaluation framework that helps funders see how this infrastructure develops over time. Funders and key stakeholders should be encouraged to accept measures such as these to track progress against short-term aims (the aims, of course, being set in the context of a strategy):

  • Number of new stakeholders engaged
  • Number of new volunteers and teams recruited
  • Number of new coalitions formed
  • Number of joint grants applied for
  • Number of leadership team meetings
  • Number of public charters, town hall meetings

While these types of measures are often seen as outputs (numbers) rather than outcomes (changes that result from the numbers), funders and stakeholders can learn that, in the early stages of transformation efforts, what might seem like baby steps are essential. Without a short-term ground game, there is no game. Without outputs, you can’t get outcomes.

Tip 5:  Extend Radical Welcome to Bring in Residents

We worked with an urban community health collaborative that expressed an interest in engaging elementary school parents in a pediatric asthma initiative. They held their planning meetings in the middle of the workday, in a location that was out of the way, and where it was impossible to find parking. Everyone who attended the meeting did so because it was their job to be there. Initiative leaders also tried showing up to the schools, but it was during time when parents were dropping their children off to school and then going to work. They were unsuccessful and eventually gave up engaging with parents at all, favoring a provider-based approach to addressing a health literacy challenge.

Our lesson: If your collaboration would benefit from the participation of local residents, it’s your job to make it easy for residents to participate. Think about the people you are targeting and consider their barriers. You might consider holding your meetings after work hours; offering stipends for active participation; offering childcare, transit passes, and meals; and/or holding meetings in an area that is familiar to them, such as a local church or residential community center. Engage a local partner who has gained the trust of the residents to help you meet the key community leaders.

Don’t presume that trust will come early. Many residents have had too many experiences with well-intended changemakers who come and then leave when the money runs out. Expect to try a number of different approaches.

These are only a handful of the critical lessons we have learned to help groups get started along the Pathway. We know that there are many, many regional efforts currently underway, laying important track and harvesting important lessons toward these goals. We welcome your stories of success and, more importantly, your wisdom gained from your efforts engaging residents. Tell us what you’ve learned by commenting below or emailing us at ThinkWithUs@ReThinkHealth.org.

 

The personal views and opinions expressed in this blog (and in any comments) are those of the original authors only, and do not reflect the opinions of The Rippel Foundation or ReThink Health. Neither The Rippel Foundation nor ReThink Health is responsible for the accuracy or validity of any of the information contained in the blog or any comments. All information is provided on an “as-is” basis.

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