Community Health Assessment Conference

1. Community Health Assessment Conference New Paradigm for Planning and the Data That Supports Planning Efforts February 11th and 18th Kevin “Doc” Klein Uncharted Territories Inc.

2. 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?) 1:15 Introduction (who am I, what is my work) 1:20 Telling a story about your work with communities 1:35 Exploring an alternative story 2:00 Paired conversations (thinking through stakeholders strategic questions) 2:20 Sampling of questions 2:40 Creating a framework for grounding data conversations using system thinking tools 3:15 Summary

3. 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 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 steps 4:45 Depart

4. is our work making a difference? Action Planning and Data Systems Thinking Tools Concrete Next Steps

5. helping stakeholders make the best decisions possible Action Planning and Data Why do we gather data? Framing our mental models about the planning process What data is most helpful for making decisions and taking action?

6. Understandingour Mental Models About Planning

7. Question: Why do we gather data? Answer: To help community partners improve performance with health outcomes Mental Model or Mental Picture of Our Work Who is at the table? What’s in it for them? What strategies are best and how do we mobilize partners? How do we determine priorities? What data is most important? Partner Planning Data Priorities Actions Strategic Planning Implementation

8. Exploring a Different Mental Model for How Data Can Support Planning What data do we have? What data to we need? Who are the right people to work together on what? Organizing for Action Mental Model Priorities/ Commitments/ Actions Evidence/ Insights Catalyzing Partners Questions To be Answered Data Evaluation What questions do stakeholders need answers to? What do we know about what works? Where do we need innovation? What leadership is needed to turn theories into actions?

9. 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

10. Important Questions That Define our Data Needs Population 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? Stakeholder Level Questions

11. Strategic Questions That Drive Performance Improvement Population Health Impacts Race/Ethnicity, Gender, Economic, Age related to Place and Time types of questions What population has the lowest life expectancy in our county and why? ACTION ZONE Organizational Results Contributions, ROI, and Sustainability types of questions 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?

12. What Data Do We Need? Obtaining data that helps stakeholders make decisions and move forward

13. Data: What is working well and why? What are areas we would like to improve? Where are the assets? What do we know about the health status in populations? How do people move through the system? What areas should be disaggregated? What is working well? 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) Where would we like to improve and who is best suited to help? 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? Where are the assets that exist in the community/state? Creating maps of where gifts and assets exist to address the opportunities for creating more health can 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.

14. What Works? What Innovations Do We Need? Learning from past experience, experimenting with new ideas

15. Drawing on Both Knowledge and Imagination Interventions/Strategies Political Will Leadership/ Passion Innovations Needed What’s Working Best Practices Theories/Insights Collective Wisdom From Community Learning Histories

16. Catalyzing Partners Once the data and insights are readily available, what processes, tools, and support are necessary to help stakeholders make informed decisions and turn those decisions into action?

17. The Work of Design Teams/Steering Committees X Learn to better see the whole system X Help define the desired future Determine focus areas (combination of system- wide strategy areas) X X Help to form action teams (collaboratives)

18. Priorities, Commitments, Actions How do stakeholders choose priorities and make commitments to action?

19. Choosing Priorities Determining what combination of interventions will have the most impact involves five key elements: 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? Decision Filters (Criteria): Guiding principles that provide direction and focus

20. High Impact Leverage: What interventions do we know have the greatest impact Examples of Leverage in Order of Importance Paradigms=the deep underlying story or beliefs that drive our actions 1 Vision/Goals=the story of the future we aspire to create and the measurable outcomes that define whether we have arrived 2 Framing/Language=the ways we organize our thoughts to speak to our values and how we choose to describe the system 3 Wisdom (education)=the knowledge, experience, skills, and dispositions to bring about a desired future 4 Leadership=those who inspire, sets examples through their actions, and organize for action 5 Polices=the rules, rewards, and punishments that are enforced by a society or community 6 Data/Information Flows=the relevant information and relationships of that information that influence decision-making 7

21. Decision Filters (Criteria): Guiding principles that provide direction and focus Listed below are five sample criteria designed to help decision-makers make informed thoughtful choices about their investments of time and resources We will choose to invest in places that impact quality of life as defined by life expectancy, educational attainment, and livable wage for all populations, including the most vulnerable. 1 We will seek a balanced approach between primary prevention and disease management 2 3 We will seek maximum impact for each dollar invested We will build on the assets and strengths of communities, not just develop programs 4 We will develop and support networks of action collaboratives/teams where cooperation and coordination show the most promise of results 5

22. helping stakeholders make the best decisions possible Systems thinking tools 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?

23. 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

24. Mental Model Regarding Worksite Wellness and ROI Short-Term Outcomes Long-Term Outcomes Program Objectives Program Components Actions Level of Employer Investment in Worksite Wellness Time to Participate Access to Facilities/ Healthy Food Support Incentives Worksite Wellness Programs Profitable, Sustainable Company Level of Employee Participation Over Time

25. What is our story about health impact? Long-Term Outcomes Actions Worksite Wellness

26. Telling a More Explicit Story About Health Impact Long-Term Outcomes Short-Term Outcomes Actions Level of Employer Investment in Worksite Wellness Equal Opportunity For All Employees Time to Participate Access to Facilities/ Healthy Food Support Incentives No. of Employers Seeing Results Worksite Wellness Level of Employee Participation Over Time

27. Diabetes Systems Thinking Framework (Learning to Better See the Whole System) Vision Big Picture Outcomes Population Flow Structure System Categories Potential System Level Intervention Points

28. Diabetes Systems Thinking Framework (Learning to Better See the Whole System) Vision Big Picture Outcomes Population Flow Structure System Categories Potential System Level Intervention Points

29. Diabetes Systems Thinking Framework (Learning to Better See the Whole System) Vision Big Picture Outcomes Population Flow Structure System Categories Potential System Level Intervention Points

30. Desired Future of Diabetes Increase Number of Healthy Days, Improve Health Indicators (BP, A1C, etc) Income Stability/Levels, Educational Attainment/ Access To Care, Other??? Slow Down Rise of Prevalence and Eventually Level Off Maintain or Lower Costs For Being Healthy Overall Cost of Care w/o Diabetes Quality of Life w/o Diabetes Level of Health Equity Overall Cost of Care with Diabetes Prevalence of Diabetes Quality of Life with Diabetes Longevity Maintain or Improve Number of Healthy Days Lower Costs of Care Through Improved Clinical/Self Management Increase Life Expectancy and Quality of Life Question 1: Where are we starting? What is our history? Question 2: Where would we like to be (scope and scale)

31. Setting Goals by Understanding Bathtub Dynamics

32. Getting the Best Results for Your Investment of Time and Resources what will you do on Monday in the office? Concrete Next Steps Step by step approach to action planning Determining what combination of interventions will have the most impact involves five key elements: Little things you can do 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? Decision Filters (Criteria): Guiding principles that provide direction and focus

33. Step by Step Process for Action Planning

34. concrete next steps across and action planning process 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 list Of 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.

35. Materials and Extras

36. Principal of a High School Outcomes that matter: Challenges they face: Important questions that want answers to: Data needed to make better decisions: Hospital Administrator Outcomes that matter: Challenges they face: Important questions that want answers to: Data needed to make better decisions: Primary Care Physician Outcomes that matter: Challenges they face: Important questions that want answers to: Data needed to make better decisions:

37. Child and Family Services Administrator Outcomes that matter: Challenges they face: Important questions that want answers to: Data needed to make better decisions: Fire and Rescue Services Director Outcomes that matter: Challenges they face: Important questions that want answers to: Data needed to make better decisions: Minister of a Church Outcomes that matter: Challenges they face: Important questions that want answers to: Data needed to make better decisions:

38. County Commissioner Outcomes that matter: Challenges they face: Important questions that want answers to: Data needed to make better decisions: Small Business Owner Outcomes that matter: Challenges they face: Important questions that want answers to: Data needed to make better decisions: Legal Services Director Outcomes that matter: Challenges they face: Important questions that want answers to: Data needed to make better decisions: