Tiffany Manuel

Vice President, Enterprise Community Partners, Inc.

Over the last 20 years, we’ve seen an explosion in the availability and accessibility of population-level health data. These data are strong evidence, helping us to identify the population health programs, policies, and initiatives that are cost-effective, improve population health outcomes, and engage communities as co-producers of their own health. We’ve also learned that investments in population health have residual impacts that go well beyond improved health outcomes. This wealth of data and empirical evidence was unimaginable 25 years ago when I started my career as a social scientist, trying to advance the case for increased investment in community-led health interventions. 

Unfortunately, access to more data and evidence has not been the total game-changer that many of us thought it would be. While we have made progress, it can still be hard for many stakeholders to grasp how some proposed solutions—such as focusing upstream or scaling proven models of success—can make meaningful and demonstrable improvements in our communities. This prompts the question: What can we do that will effectively increase public support for scaling upstream solutions that will fundamentally transform our health systems for the better?

Simply put, we need to get better at using data strategically to make a stronger case for the systems change. Recent examples of increased investment in health care systems have shown us that effective casemaking can create a much-needed tipping point. It can broaden the public’s understanding and help them shift their attention from small-scale programs and service delivery improvements to multi-sector collaboration focused on more wide-reaching, transformational approaches to health. 

What is Casemaking?

In legal parlance, lawyers try to “make a case” to convince judges or juries to side with them. In the corporate world, making the “business case” means answering the question: What will be the costs and benefits if we take this action?

When applying this same concept to regional efforts to transform health systems (or, bring about “systems change”), casemaking becomes the ability to weave together good storytelling, empirical evidence about what works, and a solid value proposition for the purpose of convincing people that a particular approach is the right way to go. More formally defined, casemaking is the act of explaining to stakeholders why some course of action should be taken, and the relative benefits of that action. As my colleague, Sherry Immediato, wrote in her recent blog on this topic, effective casemaking “depends on our heads, our hearts, and our hands, [because] the best cases for change are analytically compelling, emotionally engaging, and specific about what to do next.”  

Making the case for systems change in health and the other social sectors is, frankly, a tall order. Changing the typical patterns of engagement and overcoming inherent barriers requires us to go beyond the usual mechanics of crafting a case and use every element of that case to drive home and reinforce systems-level thinking and approaches. One of the most important and powerful casemaking strategies is a persuasive technique called anchoring. Attorneys, mediators, salespeople, and other skilled communicators often use this strategy to intentionally direct a conversation and enlist greater support for specific outcomes. Anchoring responds to the human tendency to give the most weight to the first piece of information or idea provided to us when making decisions. Given this cognitive bias, it is essential that, when making a case for change, we choose the first piece of information—or anchor—strategically.

At the most basic level, then, anchoring a case for systems change means presenting systems-level solutions first and then consistently reinforcing and directing attention back to those solutions. The more firmly you anchor data in systems-level solutions, the more likely it is that the resulting conversation among stakeholders will stay focused and that those stakeholders will actually have the conversation you need them to have.

Five Strategies You Can Use to Anchor Your Case

1. Anchor Your Case by Using Data Strategically. We often use data primarily to demonstrate the size, magnitude, and intensity of the problems we hope to solve. But, when we use data on the “front end” in this way, we essentially credential the problem and verify the need. Why not, instead, reinforce our case for systems-level change by using the data to anchor the systems-level solutions or approach that we are proposing?

Health advocates working to reduce childhood obesity, for example, might anchor a systems-level solution by pointing to the number of new parks or open spaces that would need to be created or rehabilitated to provide children with an outlet for physical activity, rather than starting with the number of obese adolescents in a community. The magnitude of the challenge may be embedded later in the case, but by focusing attention on a systems-level solution first, the emphasis remains on the systems-level solution. 

2. Anchor Your Case in Optimism about Solutions, Rather than Dwelling on the Problem. Just as using data to anchor the problem rather than the solution is problematic (as discussed above), so too is anchoring the problem rather than the solution. Focusing on our communities’ many and enormous social ills can be demoralizing. It can sometimes be difficult for people to imagine how to solve them, and few Americans have faith that institutions will be able to change the status quo. Our anchors ought to be placed in the parts of the case that help people feel excited about contributing to our work.

Anchor your case in concrete examples where systems-change efforts have netted improvements in population health and/or reduced costs. This means being especially selective in providing examples and case studies that show systems change in action. Focus on the uniqueness of your approach and how your solution will help bring about change.  I am surprised by how often I see advocates making a case for systems change by anchoring the conversation in the problems they hope to tackle. While the severity and urgency of the problems may have brought you and your partners to the table, talking about problems typically does not get people excited about joining an effort. In fact, a good body of research in the cognitive sciences consistently finds that our brains are wired for optimism—which means anchoring your case in problems makes it likely that your potential stakeholders will disengage.

3. Anchor Your Case in Specific Aspirations, not the Esoteric Idea of “Systems Change.” The term “systems change,” and the idea of changing whole systems at all, can feel bureaucratic, abstract, and wonky—even for those who work in the social sector already. Anchoring your case using this vague language will likely leave your stakeholders lacking the ability to see a stake in your success—a critical feature of effective casemaking. As you make your case, be sure to connect your efforts to concrete aspirational outcomes you know your stakeholders long to see—feeling safe in their homes or having improved health outcomes, for example. 

I recommend starting your case in a way that lifts those aspirations as direct or indirect outcomes of your work and reminds your potential allies of your shared goals. This builds on the idea above—working toward aspirations fosters optimism and will rally support. A listening session with key stakeholders about their aspirations for the community is good preparation for the case you ultimately want to make. ReThink Health Ventures will soon release a Public Narrative Toolkit that describes how to use what you learn to inspire community members to take action.

4. Anchor Your Case in the Future, not the PastThe future is something we can create together and intentionally. So one of the most important things you can do to build support for your systems-change effort is ensure that it has a strong future orientation at the front end. People tend to romanticize past successes, recalling their own personal sacrifice more than the systems that supported them. For example, someone who worked very hard and lost weight might look back years later and recall hours at the gym and snacking on carrot sticks but not acknowledging the new bike lanes that encouraged biking to work or the healthy food markets that opened nearby. . As a result, when people look backward, their willingness to support systems-change efforts decreases. Instead, invite stakeholders to imagine the future they can help create—something social psychologists call future pacing

5. Anchor Your Case in a Value Proposition that Lifts up Stakeholders’ Shared ValuesYour value proposition must express values that stakeholders share. This recommendation is sometimes a tough one for systems-change advocates. The value advocates bring to the work may be social justice, but the value that is most compelling to the wide range of stakeholders at the table may be prosperity. While you should not lift up values that are out of sync with our your authentic reasons for being at the table, you want to lead stakeholders to think more expansively about the values that are shared among everyone at the table. When people see their own values reflected powerfully in the casemaking, they can see why they have a stake in the effort’s success and feel a greater sense of urgency and excitement around solving the problem in the way proposed by the group.  

How Do You Know if You’ve Effectively Anchored Your Case?

Those who are most effective in anchoring their cases know how to take advantage of the very human cognitive bias that causes us to respond to incoming information in the way that it is initially offered. As explained earlier, we tend to give the most weight to the first idea or piece of information we hear so it is important to choose that first piece of information carefully. While it may seem to be a simple construct, advocates for transforming the health system must practice the skill frequently to be disciplined in the anchoring approach. 

For those just starting out with this skill, look for two signs that will tell you if you are effectively anchoring your case for systems change. First, well-anchored cases change the conversation. Stakeholders start to ask questions that demonstrate they are interested in solving the problem, invested in solutions that have scale, and willing to rethink the structure of the existing health ecosystem—including the many interdependent elements not always considered part of the “health system.” Second, well-anchored cases influence action, prompting broader support for changing direction, policy, approaches, and/or programs. 

Anchoring is an important skill for everyone engaged in making the case for systems change. Many of us working in this arena need to practice using it effectively, but it often falls too far down our list of priorities. Have you tried or will you try anchoring in your presentations? Share your thoughts with us by commenting below.

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.

Join the Conversation

  • Susan Hagen

    We’re preparing in the next year to issue a “disparities report”, but we don’t want to fall into the trap of thoroughly documenting disparities, only to leave our partners and the community feeling discouraged

    by the nature of this data. Your approach provides a thoughtful way of framing our findings to promote a sense of possibility, instead of despair.

    • Tiffany A Manuel

      Fantastic! Can’t wait to see how you issue the report – tweaking the anchor to focus on the “sense of possibility”. How EXCITING!

  • Kitty Bailey

    Great post! Any suggestions for when you have diverse stakeholders in the audience for whom different “anchors” would be best. Who to satisfy with that important “first piece of infomation?” For example, I’m thinking of a meeting where we have health care and community members.

    • Tiffany A Manuel

      Great question! Generally, you want to anchor a common or shared value and examples of systems-level solutions. You could (and should) have multiple examples of systems-level solutions because your task with anchoring is to open up the conversation to shared problem-solving and solutions. Once you do that, you can tweak your specific “ask” to each stakeholder audience that you want at the table.