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Multi-Sector Collaboration: Internal and External Leadership Approaches and Capacities
P O P U L AT I O N H E A LT H I N N O VAT I O N L A B
September 22, 2017
Agenda
P O P U L AT I O N H E A LT H I N N O VAT I O N L A B
• Agenda, Objectives, Where are we in the Learning Lab Process?
• Speaker Introductions
• External Leadership Key Concepts Kevin Barnett
• External Leadership Personal Experiences Peter Roberts
• Q and A
Objectives
• Learn about strategies to align stakeholder resources where health inequities are
concentrated
• Applying a system approach to heath care governance, leadership, and operations
• Share examples of exemplary practices and emerging lessons from the field
• Uncover blind spots, power dynamics and other “invisible” influences in current structures
• Understand personal and collective actions needed for success
• Sharing personal stories and how they influenced leadership practices and decisions
•
P O P U L AT I O N H E A LT H I N N O VAT I O N L A B
SHARED INTENT SYSTEMS PERSPECTIVE MAKE MEANING PROTOTYPE SCALE
SHARED INTENTSYSTEMS PERSPECTIVE
MAKE MEANING PROTOTYPE SCALE
• Discover the need + shared purpose you are addressing
• Create a preliminary vision of the future you want to enact
• Build a strong core team to address the need
• Observe + engage the greater system - impacts, challenges, opportunities, leverage points, gaps and blind spots
• Engage stakeholders in the system to increase your understanding
• Map out the system and ask stakeholders "what's missing from my map"
• Reflect, individually and collectively
• Make meaning of what you are learning with your team + co-create
• Uncover blind spots, test your preliminary vision
• Integrate your current level of understanding
• Brainstorm or ideate potential solutions (services, products, processes)
• Build a prototype
• Test -> Feedback -> Test
• Go back to the drawing board if a prototype fails and repeat until you reach a scalable prototype
• Scale what is working
• Plan
• Implement
• Test
DEF
INIT
ION
AL
ELEM
ENT
KEY
STE
PS
Shared Vision and Goals Partnership and Leadership Backbone Organization and Data Analytics
Wellness Fund and Portfolio of Interventions
All
Learning Lab Process
Welcome and Introductions
P O P U L AT I O N H E A LT H I N N O VAT I O N L A B
Peter Roberts Kevin Barnett
Building External Partnerships that SupportHealthcare Transformation
ACH Webinar Series
September 22, 2017
Kevin Barnett, DrPH, MCP
Senior Investigator
Public Health Institute
Hospital as“Total Health”
Anchor InstitutionWith shared ownership for
the health ofthe community
Shared RiskCommunityInfrastructure To Manage Shared ROI
Shared Savings
Bundled Payments
PCMHAlign
Resources With Diverse
Stakeholders
ID andAnalyze Common
Diagnoses
ID andAnalyze Factors
Influencing Panel
Pay forPerformance
PCCM
ReadmissionPenalty
Hospital asAcute Care
“Body Shop”Fee for Service
Improve
Health ofCommunity
Episodic
PatientCare
Global Payment Totally AccountableCare Organization
Health Care Transformation ContinuumEvolution of payment models and analytic capacity
ID and AnalyzeGeographic
ConcentrationsOf Inequities
Coming to Terms with Health InequitiesMeaningful partnerships are needed to address these drivers of poor health, all of which are outside of clinical service delivery.
• Unhealthy housing
• Exposure to array of environmental hazards
• Limited access to healthy food & basic services
• Unsafe neighborhoods
• Lack of public space, sites for exercise
• Limited public transportation options
• Inflexible and/or poor working conditions
• Impact of chronic stress
Coming to Terms with Our HistoryHealth inequities are a product of many decades of discriminatory practices, starting with federal policies and associated business decisions that devastated the potential for accumulation of capital by people of color.
How do we come together? Patients, Populations, People and Places
Hospital A
Hospital B
Hospital A Patients
Hospital B Patients
U/Uninsured People
Low Income Census Tract
County Jurisdiction
FQHC
Community Engagement - Lessons from HistoryImportance of moving beyond tokenism to meaningful engagement for optimal mobilization of community assets
Arnstein, Sherry R. "A Ladder of Citizen Participation," JAIP, Vol. 35, No. 4, July 1969, pp. 216-224.
Citizens Advisory GroupsNeighborhood Advisory Councils
Focus GroupsAttitude SurveysPublic Hearings
Ongoing engagement from the outsetNegotiate roles and relationshipsAccommodate practical realitiesVeto power
From Insularity to EngagementPatterns of community engagement in community health assessments and beyond
Problem Analysis Addressing the high costs of chronic illnesses requires a thoughtful
approach to causes and associated impacts
Root Causes
NTCauses
NTImpacts
LTImpacts
Diabetes
Poverty
Epigenetic triggers
UnsafeNeighborhoods
High morbidityLimited healthy food access
Limited transport options
Toxic stress/helplessness
Limited physicalactivity
Low self esteem
Limited access to preventive servicesHigh service utilization
Increased societalHC costs
Bullying, isolation in school
Reduced productivity
Reduced career options
Food mktg influence
Poverty/dependency
Poor medical mgmt
Food Insecurity
Opportunities for Alignment
Issue-Specific Assessments
(Health Impact Assessment)
Local Health Departments(CHAs/CHIPs)
Tax-exempt Hospitals(CHNAs/ISs)
Community Health Centers
(Section 330 Application)
United Ways(CHAs)
Community Action Agencies
(Community Services Block Grant Application)
Financial Institutions(CRA Performance Context
Review)
When available, HIAs provide an additional layer of information, most often relating to broader environmental impacts, in the design of strategies to improve health.
Given reduced public funding,, ongoing collaboration with diverse stakeholders provides an opportunity to leverage expertise and secure political support for LHD leadership in monitoring and advancement of policies that reinforce and sustain improvements in health status and quality of life.
IRS allows hospitals to develop ISs in collaboration with other hospitals and State and local agencies, such as public health departments.
Expanded enrollment and movement towards global budgeting will require work with others who can help address the determinants of health and reduce health disparities.
CHCS are encouraged to link with other providers such as LHDs and hospitals to provide better-coordinated, higher quality, and more cost-effective services.
UWs have an established history of collaborating with other stakeholders in conducting assessments and addressing unmet health needs.
Standard 2.1 emphasizes partnerships across the community, CAAs can often “serve as a backbone organization of community efforts to address poverty and community revitalization: leveraging funds, convening key partners…””
Targeted CRA investments in housing, retail, education, and job creation in targeted low- income census tracts that are aligned with parallel interventions and investments of health care and public health stakeholders provide an opportunity to address social determinants of health and help reduce health care costs.
Potential Partners – Roles Strategic alignment of resources (and shared ownership) involves alignment that makes optimal use of complementary skills.
• Public health agencies
• Social service agencies
• Service-based CBOs
• Community Action As
• Faith Community
• Advocacy CBOs
• United Way
• Local Philanthropy
• City agencies
• Associations
Assessment, community outreach, evaluation, policy development
Service coordination/integration, enhancement, leveraging
Community engagement, mobilization, facilitation, policy advocacy
Core operating infrastructure development, sustainability
Alignment with planning priorities, secure political support
Domains of Activity, Geography, and Primary Focus of Interventions
Domains of Activity
PhysicalEnvironment
Social Determinants
Behaviors Clinical
Geography of Interventions
Individual and Family
Regional – countyMunicipal – neighborhood
PrimaryStakeholders
Chambers of commerceMetropolitan planningCDFIs / CDCsRegional employers
State agencies
Physicians groupsRetail providers
CorrectionsHospitals
Health PlansCommunity Clinics
Public health agenciesSocial service agencies
Community Action AgenciesHomeless Shelters
Focus on Diabetes and its Antecedents:Stakeholders and Areas of Focus
Public Sector Public Health
Parks and Recreation
Community Development
Community
Backbone Entity
Care Management
Affordable HSGwith support services
Shared Metrics↓ Diabetes PQI
↑ Food Access↑ + Options in schools
↑ Awareness/knowledge↑ Physical activity
Health Education
Community Mobilization
Policy Development
Grocery/cornerstore development
Child care/development
After school programs
Façade Renovation
CBOs/Coalitions
Local Philanthropy
TOD/Walkability
NeighborhoodWalking
Hospital Community Benefit
Compliance Orientation
Annual ReportingPrograms and Services
Process MeasuresProprietary BiasLimit exposure
IntersectoralPlace-Based
CHI
TransformationalOrientation
IntersectoralShared Ownership
Data SharingQuality Improvement
Measurable OutcomesSustainability
Community Development
Transactional Orientation
Reduce Risks Close the Deal
Build Track RecordStimulate Replication
Convergence at the Center
External Leadership:The Servant Leader Role
Peter Roberts, President, Roberts Health SolutionsSeptember 22, 2017
External Leadership: The Servant Leader Role
“Meeting the Neighbors” – With whom am I collaborating?
• Listen, Listen, Listen – no judgment
• Good old fashioned relationship building – invest the time
• Systems perspective – how does it all fit together, or not?
• Don’t leave out the uncommon partners
External Leadership: The Servant Leader Role
Experiential Learning – Who am I serving?
• Put yourself in someone else’s shoes
• What does life feel like?
• What are the challenges and opportunities?
• Find the success stories
External Leadership: The Servant Leader Role
Shared Leadership – Giving away the power
• Well-intentioned individual leaders lack critical mass
• Think in terms of the Abundance of resources in the community
• Have patience with yourself and others – relationship and trust building start small and take time
External Leadership: The Servant Leader Role
Collective Impact – Finding a structured process for social change
• Forming the Backbone - Support
• Developing the Common Agenda - Focus
• Organizing the Working Groups – Shared leadership
• Defining the Measures – Progress
• Aligning and Implementing Initiatives – No silver bullet
• Celebrate, Celebrate, Celebrate – Give away all credit
External Leadership: The Servant Leader Role
Community Integrator Role – Uncommon partners
• Individual level
• Organizational level
• Policy level
External Leadership: The Servant Leader Role
QUESTIONS?
Contact Information:Peter Roberts
peter@robertshealthsolutions.com
214-771-1208