Having come from a field where collaboration and stakeholder engagement is just starting to catch on, I am astounded by the level of cooperation underway in the health field here in Colorado and throughout the country. I joined Spark in February after helping lead Colorado’s largest “open source” policy development process in the form of Colorado’s Water Plan. After a decade of engagement across eight regional groups and a statewide group involving 400 stakeholders, we were able to bring in over 30,000 more voices and complete Colorado’s first water plan by Coloradans and for Coloradans. This collaborative approach was not easily adopted; the natural resource word has traditionally been litigious due to competing objectives. The competing needs of the environment, industry, recreational enthusiasts, cities, and agriculture led to deep fissures that took leadership, money, time, and a careful planning process to close. In the end, however, we reached consensus across the stakeholders in Colorado, but without engaging stakeholders to develop the content and keep a balanced process, Colorado’s Water Plan would just be another document gathering dust.
While working on the water plan, bringing people together to form and believe in a common vision was difficult. In contrast, in the field of health it is often on the path to accomplish the work where the challenges truly begin. For instance, Spark is engaged in two projects with the Colorado Department of Health Care Policy and Finance. The purpose of the first project is to improve the quality of care for people with long-term disabilities and the elderly through the newly formed Community Living Quality Improvement Committee (CLQIC), which includes individuals who are disabled, the elderly, and parents of disabled young adults in addition to advocates, service providers, and experts. These voices, the “consumers” of health services, keep these conversations grounded in reality and bring a sense of urgency to solving the real and long standing issues facing these communities. Despite the myriad perspectives brought to the table by these voices, the vision for the project was unanimously adopted: With person and family centeredness as a foundation, the CLQIC envisions a Colorado where consumers and families have the necessary information, access to services, and quality of care needed to remove barriers that prohibit individuals from being able to embrace the life they choose. However, coming to consensus on how to achieve that vision is more difficult.
The second project seeks to build an action strategy to implement telehealth across Colorado. Spark is reaching out to professionals (e.g., doctors, nurse practitioners, insurers, academics), as well as patients to determine how telehealth should be implemented. We will interview those currently receiving telehealth services, and those who are not, but are in great need. As with the CLQIC, everyone agrees on the need to expand telehealth, but not exactly how to do it.
In both examples, it is clear that the hard work starts not with finding a common purpose, but with exposing the differences that lie beneath the surface. As professionals, we each bring our own perspectives of what is possible and who should be doing the work. We each worry about the staffing and funding needed to support our respective organizations. We each hope to justify the hard work we’ve done throughout the years by continuing to keep that work going. We are vested in the current system, and the changes we would like to make are often incremental and safe. Consensus in this context can lead to the lowest common denominator, which results in little change. If we keep doing what we’ve been doing, then we will get the same results!
In both of these projects, it is clear that the vested interests of professionals can only bring the dialogue so far. Oftentimes we struggle to bring the disabled, or elderly, or youth, or busy parents, or people who speak a different language, or so many other groups of people that can be hard to reach. However, it is the voice of those who receive or will receive services that can ensure that the work is patient centered and is truly aimed at making a positive difference in people’s lives. This is the binding agent that pulls the subsurface fissures back together. The outcomes that result from involving those on the ground are worth the effort it takes to bring them to the table. That is why when Spark takes on a project – whether it’s health, natural resources, education, nuclear security, or some other topic, we try to make sure this simple lesson is forefront in the design of the work. We developed an equity toolkit for us to turn to and have made it public so that everyone can have the practical tools to implement this simple lesson: If the people whose lives an initiative could truly effect are involved in developing solutions for a project, and those voices are wielded to help the professionals FEEL the potential and get re-connected to why they got involved in a particular field in the first place, then you will develop actions that will make a meaningful difference.