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