Overview: Stewardship and the Pathway

What is Stewardship?

Stewardship occurs when regional stakeholders–leaders, community members, organizations from all sectors–align around priorities, strategies, and a shared vision for fostering healthy people and thriving communities. Stewardship teams are groups of well-positioned leaders who are willing and able to take responsibility for leading the transformation across their regions, not just within their own organizations. These teams look different in every community. Participants often include leaders from health care, public health, business, insurers, philanthropy and nonprofits, social services, transportation, housing, and education.

Some of the key functions stewardship teams fulfill over time are:

  • Establishing opportunities to empower community voices and surface their priorities;
  • Creating conditions to identify and sustain a shared vision for the future;
  • Building critical relationships across sectors;
  • Setting priorities for action;
  • Identifying and pursuing strategies that will have significant impact; and
  • Guiding resources into smarter more sustained investments.

Learn more about the role of stewardship and how the work of Elinor Ostrom has influenced ReThink’s approach.

Pathway for Transforming Regional Health

The Pathway for Transforming Regional Health begins when leaders step outside the boundaries of their own organizations and work in collaboration with others to improve health and health care. Using the Pathway, leaders working to transform health at a regional level can assess where their effort is on the journey, what pitfalls to avoid, and what steps they should be considering to accelerate progress. The Pathway is represented as a curvy line rather than a linear roadmap because we know that regional efforts may cycle between phases for a while, move back into prior phases as they address pitfalls, or make occasional exponential progress.

Through ReThink Health’s partnerships with leaders in regions across the country, and drawing on research from many sectors beyond health and health care, we have found that ambitious transformation efforts require three key ingredients. These are the three core pillars of the Pathway:

  • Broad-based Stewardship: Leadership teams that work across boundaries
  • Sound Strategy: A plan for focused action on high-leverage opportunities
  • Sustainable Financing: New kinds of investment approaches to alter long-term trends

Significant improvements may be achieved in each domain of stewardship, strategy, and financing, but there are limits to each alone and they promise to be far stronger together. This Guide focuses on bolstering the stewardship function of regional change efforts. With active and broad-based stewardship, collaborative groups will be better equipped to advance along the Pathway by developing sound strategies and successfully tackling ways to finance their ambitious visions.

You can learn more about the imperative of sustainable financing in our companion resource ReThink Health Financing Primer, and explore how leaders in regions can create sound strategy with the ReThink Health Dynamics Model.

Pitfalls along the Pathway

Often, successes in earlier stages of transformation create predictable pitfalls in later stages. For example, collaboratives that succeed in solving the key problem they came together to address can wind up stopping there—precisely because the results were satisfying and participants feel no need to do more. Pitfalls can derail progress, lead to missed opportunities for greater accomplishment, and keep a collaborative effort from achieving a bigger vision. These pitfalls can occur in communities of any size and demographic composition and with any array of health resources.

Momentum Builders

Momentum builders help leaders of stewardship teams avoid or move past common pitfalls. These are critical actions that help an effort to continue on an upward trajectory, protect against further reversals, and enable the transition to the next phase.