The Stew BLOG

Lessons from the Frontlines: Coaching for Health Transformation

Sherry Immediato | 03/27/2018

ReThink Health Ventures launched at the end of 2016 to help regional multisector partnerships accelerate momentum and break through barriers to transform health. The Finger Lakes region of New York was one of six communities selected to participate. At the invitation of regional health planning organization Common Ground Health, and with encouragement from the Ventures staff, many organizations across the region formed an ad hoc group to explore how they could use the Ventures opportunity.

After months of working together and reflecting on the full scope and gravity of the work to be done, this group concluded that it would be wise to work through existing networks rather than build a new organizational structure. Common Ground Health took on an operational and strategic coordination role.

The Ventures project emphasizes a learning orientation, and as always ReThink Health’s aim is to share insights widely. Last week, we invited Trilby de Jung, CEO of Common Ground Health, to offer her perspective about how the stakeholders’ decision to work with an established multisector partnership to accomplish their goals has been playing out in the Finger Lakes. This week, Sherry Immediato, the ReThink Health Ventures coach for the team, offers lessons that other multisector transformation efforts might learn from the experience in the Finger Lakes.

Having worked with ReThink Health for nearly a decade, I’ve had the opportunity to observe leaders in many communities. The most successful leaders artfully blend persistence and flexibility in their pursuit of new forms of collaboration to achieve dramatically different results. From my point of view, the biggest lesson multisector partnerships can take from the experience in the Finger Lakes is the importance of approaching this work with an orientation toward continuous learning.

It helps to remember we are boldly going where few have gone before. Sometimes our experiments will achieve what we intend and sometimes they won’t, but we can always learn from them to become more effective. In her blog last week, Trilby described this practically, recognizing the need to pivot. My responsibility as a coach is to both support the design of these experiments and help evoke the wisdom of the team to know when to persist and when to be flexible and make changes.

The Finger Lakes region provides a specific learning challenge faced by other large, ambitious regions: How can many well-established, cross-organizational efforts be better aligned to achieve more in their community? In the Finger Lakes, these efforts are already loosely linked through overlapping board membership. Many of the the initiatives, while addressing different issues, involve two or more of the same organizations working together closely. On the one hand, creating a new group, which some have called a “table of tables,” might produce clearer shared goals and improve coordination. On the other, this can add to “table fatigue,” where members feel a disproportionate amount of their time is spent figuring out what to do rather than actually doing something.

As Trilby noted in her post, the initial ad hoc group of executive directors in the Finger Lakes determined there is a clear value proposition for improving health in the region, and a new table is not needed right now. There is support for Common Ground Health, which has been catalyzing innovation in health care for the region since the 1960s and has an established network, to lead the planning needed to reduce health disparities. Many new conversations are taking place about how the organizations can all work together differently to support what ReThink Health calls “vital conditions”—that is, the circumstances that enable health and well-being, such as stable housing and jobs, wages, and wealth.

As for my own learnings, I’ve taken away four key lessons that can benefit new multisector efforts hoping to get off to a good start. These may be of particular importance when a region already has a history of multisector collaboration.

1. Focus on bold goals that demand a fresh approach. The initial motivation of the executive directors that formed the ad hoc group in the Finger Lakes was fueled as much by the desire to address matters of operational coordination as it was to address larger strategic questions. The group asked: How do we continue to work together effectively on matters that none of us can address alone to improve health? In retrospect, we ended up spending more time on “working together effectively” because we were focusing on incremental operational issues within the group’s control. A more effective approach might have been to develop more specific goals in support of the value proposition, which reflected the strategic vision the group had agreed on, and build a case for why and how the various players should work together differently as a means to achieving their goals. This way, the operational conversations could be focused within the context of a clear strategic direction.

2. Model collaboration when forming the initial group. Convening a new group that spans organizations, and in which collaboration is a goal, is best done by multiple organizational champions in concert. When one organization spearheads the effort, it can raise concerns that that organization is looking for advice and retaining decision-making authority, or worse, making a power move. If multiple organizations had formally launched this exploration in Finger Lakes, rather than Common Ground Health alone, the group’s authority and accountability would have more clearly been in service to the larger whole.

3. Prepare to pass the baton from the start. As Trilby noted, the ad hoc group got off to a strong start and crafted a value proposition for improving health in the region, but it was unclear about its authority to do more. This is completely understandable in hindsight. It might be helpful to always charter new groups like this as “initial,” with the expectation that the form, function, and members will likely change as the work becomes clearer and progresses. This would help ensure that all parties have opportunities to influence the process while empowering a smaller group to get things started.

4. Use learning practices to enhance candor and insight. Some of my colleagues recently reminded us to welcome the discomfort of uncomfortable conversations in service to our greater goals. I think it helped the ad hoc group to reflect on lessons learned from their past efforts and to share their challenges, rather than only touting successes while sweeping the problems under the rug. Their practice of regularly assessing where the group is, relative to its intent, is the single biggest factor in helping that group pivot as needed. Because there are few opportunities for external feedback—unlike the experiences we’ve all had in sports, the arts, or school—groups engaged in this kind of work need to adopt some reflective practices so they can step back, assess, and make any adjustments and refinements to ensure they’re staying true to their purpose.

Where to from here? It’s inspiring to see Common Ground Health expand its vision to include reducing health disparities in the region. Moving forward, Common Ground Health has established a new working group that is focused on what it would mean to deliver on the value proposition. This work seems to have energized the board and staff to consider new initiatives, roles, and partnerships, recognizing that some of their efforts are less relevant in a changing world.

We’ve shared our encouragement for Common Ground Health’s board to actively engage and hold itself accountable to its peers as it proceeds. I encourage the multisector initiatives in the Finger Lakes region to continue experimenting with actions that answer the question that started our efforts together: How can our many well-established cross-organizational efforts be even better aligned to achieve more in our community? The answer—in fact, the many answers—to this question will inform not only the transformation strategy for the Finger Lakes but that of many other regions around the country grappling with these same challenges.