All of the rapid change in the health landscape allows for exciting opportunities to engage stakeholders and, therefore, create solutions that are as equitable as they are innovative. However, engaging these voices effectively requires a commitment to the process to ensure they aren’t just token representation, and that their perspectives and lived experiences truly inform the process. This level of engagement can be challenging, to be sure, but the effort is well worth it in improved outcomes.
This month, we are highlighting some of the work we’re doing with two health-related projects actively involving the stakeholder voice:
Both projects seek to improve health outcomes. To do this, these projects rely heavily on meaningfully engaging stakeholders in the process to inform the work, identify needed shifts, and ensure the work is driving toward high-impact outcomes.
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.
One of the things that has become clear in our work with systems change broadly and collective impact specifically is that no one program or organization can address large-scale issues on its own. Put another way, our impact goes further when we work together toward a common agenda.
Over the past nine months, Spark has been serving as the backbone for the Healthy Schools Collective Impact (HSCI) initiative. HSCI’s bold goal is for all Colorado K-12 public schools to provide an environment and culture that integrates health and wellness equitably for all students and staff by 2025.
Talk about creating meaningful change!
School systems work hard to address needs of all students; however, many do not have the capacity or resources to address student health and wellness consistently. This go-it-alone approach can often result in inequitable, duplicative, and siloed approaches and resources.
This is where collective impact comes in.
Healthy Schools Collective Impact is changing how schools in Colorado approach school-based health and wellness by bringing stakeholders together in a structured way to support schools and get them the health and wellness resources they need to engage the whole child and, in turn, bolster academic achievement.
With the support of Spark as the backbone, HSCI members have been working hard to lay the foundation for change, including:
Engaging stakeholders from statewide systems that impact health and wellness in schools and districts, including policy, professional development, research, and marketing/communications/engagement.
Working with diverse stakeholders, including work groups (focused on nutrition, physical activity, behavioral health, and student health services), to create the HSCI Theory of Change, a living document that serves as a plan for the work.
Informing The Colorado Health Foundation’s Creating Healthy Schools funding opportunities, to address equity and align funding with the Theory of Change.
Establishing a new structure for HSCI that emphasizes the inclusion of voices of a diverse set of key stakeholders, with a specific focus on ensuring end-users (students, educators and families) have a seat at the table.
Moving from planning to action
With this solid foundation, our next step is to take the group from planning to doing by instilling a sense of trust and urgency, and providing the tools, data, and space for innovation that HSCI needs to achieve their bold goal. For many groups, even those that aren’t working in a collaborative context, this can be the hardest step. However, from our work with other collaborative initiatives we have found it can be helpful to keep the following in mind:
Remember that “partnerships move at the speed of trust”: Building a truly collaborative effort takes trust and building trust can take time. That said, groups can take steps to build authentic partnerships by developing mutual respect, fostering active and inclusive participation as well as equity, sharing power, and finding mutual benefits.
Evaluate, learn, adjust, repeat: Leveraging real-time data, making the time for learning from that data, and then collectively interpreting the learning can help organizations steadily shift their strategies in response to changes in their environment, thereby improving outcomes.
Systems change can be daunting – but achievable – particularly when stakeholders come together around a common agenda, and then trust, experiment, learn, and adjust as they move forward.
Do you have any tips for moving collaborative work forward? What are your experiences with finding small wins in a collective impact setting? Share with us in the comments or click here to share a case study, tip, trick, or tool!
What happens when 14 community organizations, two foundations and several communications experts come together to change how the public thinks about access to health care? You build a movement.
Project Health Colorado (PHC) was a groundbreaking three-year Colorado Trust initiative to build public will for access to health. PHC involved 14 community organizations that used multiple innovative strategies, along with a paid media and mobilization campaign, to engage the public around access to health. A few of the innovative strategies used by the grantees included:
Building the capacity of other nonprofits to talk about access to health.
PHC also included a paid media campaign that targeted key groups throughout the state. In addition to traditional and social media strategies, the campaign deployed street teams at fairs and festivals. The street teams helped spread the message of the importance of access to health for all, engaging the public with an interactive website where they could ask questions, get answers and get involved.
What happened as a result of the forums, storytelling, training and mobilizing? Over 25,000 Coloradans were reached through in-person conversations and more than half a million people were reached through electronic and digital communications. People reached by grantees went on to talk to others, creating a ripple effect, carrying the message of PHC that people should be able to get the health care they need, when they need it. Volunteers from all walks of life became ambassadors for the message, particularly community members with no professional reason to be involved.
Want to learn more? The final evaluation report for PHC explores the impact of the many intersecting strategies, walking through key findings and their implications through a mix of infographics and narratives. We’ve also created a separate evaluation report intended for foundations that are undertaking complex grant strategies like PHC.
Let’s learn together about what happens when organizations come together around an innovative idea, and work to make a meaningful difference building public will for access to health.