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Communities of Solution: A Working Model Based on Scale and Community Bright Spots Developed by 100 Million Healthier Lives¹

Provided By Soma Stout, 100 Million Healthier Lives, Institute for Healthcare Improvement, December 8, 2016

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¹ For more information, see http://www.100mlives.org (accessed May 1, 2017).

INDIVIDUAL PARTICIPANT QUESTIONS AND COMMENTS ABOUT THE 100 MILLION HEALTHIER LIVES COMMUNITIES OF SOLUTION FRAMEWORK

Many workshop participants discussed the Communities of Solution handout at their tables and generated written questions and comments that were collected by staff at the end of the panel session.

Individual participants had the following questions and comments about how the framework characterizes how individual people and communities relate to each other: How is community defined? Who is in the community? Are leaders part of the community or separate from the community? If people work in the place but do not live there, are their commitments to the community? How do we bring different groups together in a way that builds trust? How do we ensure that we aren’t simply responding to the group with the loudest voice? How do you address privilege in relationships and at the community level? How do you elevate the understanding of privilege? How do we change our language to move beyond “us” and “them”? How does a heterogeneous community relate in terms of a critical mass of people who see themselves as the stewards of the community’s well-being? How small do you get in order to make change? How are you/your community acknowledging how the system became inequitable, the history? What are we trying to change in the community? How do we ensure that we’re not simply changing who the dominant group is in a community? At the outset, are some people inhibited from fully open conversation because they feel (a) dehumanized, or (b) blamed for bad behavior? Does productive conversation require “naming” of systemic barriers like systemic racism or root causes at the structural level? Do you value acknowledging past inequities, -isms, etc., to promote healing?

Some individual participants commented that there were elements missing from the framework, such as a vision of a healthy community that accounts for communities with significant multi-dimensional challenges. One element is defining success at the earliest stages (e.g., simply having a young person walk through the door of a community center can be a success but is missing from this framework). Also missing is how to create abundance as you work with the community, ensure opportunities for not just sector leaders at the table, but look for opportunities for community members—for example, employee wellness programs that benefit the community of employees (but if employees do not live in the geographical area, look at impact for the geographical community).

Individual workshop participants also had a few questions about the nature of institutions in this framework. For example, the important decisions about resource allocation and policy are made by our democratic institutions in our representative democracy, so how far can we go without them? How do we engage them if they aren’t already engaged? How

do you develop the will and ability of institutions to shift the way they do business so that they are more interconnected with others and more likely to exchange resources beyond their narrow lines of work?

Individual participants also asked about challenges to the change process, such as what is the resistance, which should be named so we can address barriers. How do you gauge the level of resistance or pitfalls that might stand in the way or otherwise defeat a proposed process? What is the ignition? Leadership? What are the rules of evidence that we are actually changing? Could you create a succession plan to develop residents as the future leaders? Is it necessary to think about a longer time horizon when doing this work? How do you overcome the temptation for short-termism to eclipse long-term investments? How do you plan from the start for spread and scale? How do you sustain this work over time? What have we learned about sufficient activation energy to sustain improvement? What are the feedback processes or input processes to learn from previous work? How does the health care delivery system engage—hospitals, doctors, clinics, others? What kinds of metrics are used?

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