Community Health Assessment ConferenceNew Paradigm for Planning and the Data That Supports Planning Efforts

February 11th and 18th

Kevin “Doc” KleinUncharted Territories Inc.

1:15 Introduction (who am I, what is my work)1:20 Telling a story about your work with communities1:35 Exploring an alternative story2:00 Paired conversations (thinking through stakeholders strategic questions)2:20 Sampling of questions2:40 Creating a framework for grounding data conversations using system

thinking tools3:15 Summary

Keynote Outcomes and Agenda

√ Understanding for how CHA can be integrated into an action planning process√ Whet your whistles about the discipline of systems thinking√ Transfer the learning to some concrete next steps (what will we do on Monday?)

3:45 Problem in a hat (what problems might arise under this new approach)turning problems into outcomes that lead to success

4:30 Summary of insights and next steps4:45 Depart

Breakout Session Agenda

√ Discussion about how to turn your problems into outcomes√ Acknowledge the “yes buts” and develop a curiosity for the possibilities√ Understanding for some of the common themes or challenges everyone shares

Action Planning and Data

Systems Thinking Tools

Concrete Next Steps

is our work making a difference?

Action Planning and Data

helping stakeholders make the best decisions possible

Why do we gather data?

Framing our mental models about the planning process

What data is most helpful for making decisions and taking action?

Understanding our Mental Models About Planning

Question: Why do we gather data?

Answer: To help community partners improveperformance with health outcomes

Data Priorities PartnerPlanning Actions

What data is most

important?

How do we determine priorities?

Who is at the table? What’s in it for them?

What strategies are best and how

do we mobilize partners?

Strategic Planning Implementation

Mental Model or Mental Picture of Our Work

Mental Model

QuestionsTo be Answered

Data Evidence/Insights

CatalyzingPartners

Priorities/Commitments/

ActionsEvaluation

What questions do stakeholders need answers

to?

What data do we have? What data

to we need?

Who are the right people to work

together on what?Organizing for Action

What leadership is needed to turn

theories into actions?

What do we know about what works? Where do we need

innovation?

Exploring a Different Mental Model for How Data Can Support Planning

What Questions Need to Be Answered?

What are the most important questions for improving health?

Figuring out what stakeholders care about?

The right question is better than a thousand wrong answers

Chinese Proverb

Population Level Questions

Stakeholder Level Questions

Where are the opportunities for improving health from a systems level?

What are we doing well? What could we do better? Who do we need to help?

Where are the opportunities for improving health from an organizational level?

Important Questions That Define our Data Needs

Population Health ImpactsRace/Ethnicity, Gender, Economic, Age

related to Place and Time

Organizational ResultsContributions, ROI, and Sustainability

types of questions

types of questionsWhat population has the lowest life expectancy in our county and why?

Why are my employees or students absent and what combination of health improvements would lead to more productivity? What do we know about their risk factors?

Strategic Questions That Drive Performance Improvement

ACTION ZONE

What Data Do We Need?

Obtaining data that helps stakeholders make decisionsand move forward

Data: What is working well and why? What are areas we would like to improve? Where are the assets?

What is working well?

Where would we like to improve and who is best suited to help?

Where are the assets that exist in the community/state?

This is more than just an best practices question, but taps into experience as well

It is also a question of where people who are struggling with challenges are overcoming those challenges (i.e. why are some people living longer lives than others)

Scanning or assessing the whole system is impossible, although overtime there are patterns that begin to develop in the system as you capture their stories and ground them in the system maps?

Who are the shakers/movers, the connectors, and decision-makers in the community, state, or region?

Creating maps of where gifts and assets exist to address the opportunities for creating more healthcan be time consuming, but highly rewarding

Some of this work has already been done or exists…Scanning for what we know is the critical first step; having conversations with the connectors is the next.

What do we know about the health status in populations?How do people move through the system? What areas should be disaggregated?

What Works? What Innovations Do We Need?

Learning from past experience, experimenting withnew ideas

Drawing on Both Knowledge and Imagination

Political Will Leadership/ Passion

Innovations Needed What’s Working Interventions/Strategies

Best Practices

Learning HistoriesCollective Wisdom From Community

Theories/Insights

Catalyzing Partners

Once the data and insights are readily available, whatprocesses, tools, and support are necessary to help stakeholders make informed decisions and turn those decisions into action?

The Work of Design Teams/Steering Committees

X

X

X

X

Learn to better see the whole system

Help define the desired future

Determine focus areas (combination of system-wide strategy areas)

Help to form action teams (collaboratives)

Priorities, Commitments, Actions

How do stakeholders choose priorities and make commitments to action?

Choosing Priorities

Data: What do we know about health status of populations? What is working well and why? What areas in the systems would we like to improve? Where are the assets?

High Impact Leverage: What interventions do we know have the greatest impact

Evidence (Best Practices): What has worked in the past and why?

Experience: What does our past experience point to as successful and why?

Determining what combination of interventions will have the most impact involves five key elements:

Decision Filters (Criteria): Guiding principles that provide direction and focus

High Impact Leverage: What interventions do we know have the greatest impact

1

2

3

4

5

6

7

Paradigms=the deep underlying story or beliefs that drive our actions

Vision/Goals=the story of the future we aspire to create and the measurable outcomes that define whether we have arrived

Wisdom (education)=the knowledge, experience, skills, and dispositions to bring about a desired future

Leadership=those who inspire, sets examples through their actions, and organize for action

Polices=the rules, rewards, and punishments that are enforced by asociety or community

Framing/Language=the ways we organize our thoughts to speak toour values and how we choose to describe the system

Data/Information Flows=the relevant information and relationships of that information that influence decision-making

Examples of Leverage in Order of Importance

Decision Filters (Criteria): Guiding principles that provide direction and focus

1

2

3

4

We will choose to invest in places that impact quality of life as defined bylife expectancy, educational attainment, and livable wage for all populations, including the most vulnerable.

We will seek a balanced approach between primary prevention and disease management

We will seek maximum impact for each dollar invested

We will build on the assets and strengths of communities, not just develop programs

5We will develop and support networks of action collaboratives/teams wherecooperation and coordination show the most promise of results

Listed below are five sample criteria designed to help decision-makers make informed thoughtful choices about their investments of time and resources

Systems thinking tools

helping stakeholders make the best decisions possible

Learning to Better See the Whole System

Clarifying the Desired Future

Determining What Combination of Strategies Will Lead to Results

Who Needs to Do What By When?

WARNING!!!

The discipline of systems thinking, like anything new takes some time to learn. It requires us to think differently about how we approach complex systems, moving beyond reductionism to understanding how complex relationships interact.

“I wouldn’t give a fig for the simplicity on this side of complexity, but for the simplicity on the other side of complexity, I would give my life.”

Oliver Wendell Holmes

Time toParticipate

Access toFacilities/

Healthy Food

Support

Incentives

Worksite WellnessPrograms

ActionsLong-TermOutcomes

Short-TermOutcomes

Profitable,SustainableCompany

ProgramObjectives

ProgramComponents

Mental Model Regarding Worksite Wellness and ROI

Level of Employee

ParticipationOver Time

Level of EmployerInvestment in

Worksite Wellness

Worksite Wellness

ActionsLong-TermOutcomes

What is our story about health impact?

Actions Long-TermOutcomes

Short-TermOutcomes

Worksite Wellness

Level of Employee

ParticipationOver Time

Time toParticipate

Access toFacilities/

Healthy Food

Support

Incentives

Equal Opportunity For All Employees

No. of EmployersSeeing Results

Level of EmployerInvestment in

Worksite Wellness

Telling a More Explicit Story About Health Impact

Diabetes Systems Thinking Framework(Learning to Better See the Whole System)

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Diabetes Systems Thinking Framework(Learning to Better See the Whole System)

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Diabetes Systems Thinking Framework(Learning to Better See the Whole System)

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Poin

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Overall Cost of Care w/oDiabetes

Quality of Life w/o

Diabetes

Level of Health Equity

Overall Cost of Care with Diabetes

Prevalence of Diabetes Longevity

Quality of Life with Diabetes

Maintain or Lower Costs For Being

Healthy

Maintain or Improve Number of Healthy

Days

Income Stability/Levels,

Educational Attainment/ Access To Care, Other???

Lower Costs of Care Through Improved

Clinical/Self Management

Slow Down Rise of Prevalence and

Eventually Level Off

Increase Life Expectancy and Quality of Life

Increase Number of Healthy Days,

Improve Health Indicators (BP, A1C, etc)

Desired Future of Diabetes

Question 1: Where are we starting? What is our history?

Question 2: Where would we like to be (scope and scale)

Setting Goals by Understanding Bathtub Dynamics

Getting the Best Results for Your Investment of Time and Resources

Data: What do we know about health status of populations? What is working well and why? What areas in the systems would we like to improve? Where are the assets?

High Impact Leverage: What interventions do we know have the greatest impact

Evidence: What has worked in the past and why?

Experience: What does our past experience point to as successful and why?

Determining what combination of interventions will have the most impact involves five key elements:

Decision Filters (Criteria): Guiding principles that provide direction and focus

Concrete Next Steps

what will you do on Monday in the office?

Step by step approach to action planning

Little things you can do

Step by Step Process for Action Planning

List out your key funders and community leaders and do key informant interviews with them:

Ask these three questions (1) what is our community doing well? (2) What would you like to see improved and why? (3) Who needs to be involved to make it happen?

Imagine what each key stakeholder cares about most and assess whether you have data to answer their questions about these outcomes

Make of map of the key assets of the county and overlay that with your health status/population data (i.e. diabetes, income, race/ethnicity etc)

Look at your obesity or other disease data over time and make a listOf the key drivers (root causes) that make that graph go up or down. Sketch out the relationships between the drivers on your list. Lastly figure out who needs to be involved to influence each driver.

concrete next steps across and action planning process

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