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Lessons for Cross-Sector Improvement. APAC Forum September 27, 2013. The Triple Aim. Better Health for the Population. Better Care for Individuals. Lower Cost Through Improvement. The Problem.

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lessons for cross sector improvement

Lessons for Cross-Sector Improvement

APAC Forum

September 27, 2013

the triple aim
The Triple Aim

Better Health for

the Population

Better Care

for Individuals

Lower Cost



the problem
The Problem

When we seek to bring different sectors together to solve shared problems, it’s very difficult and it very rarely happens.


barriers to cross sector collaboration
Barriers to Cross-Sector Collaboration
  • The fact of separate organizations
  • Different aims
  • Different philosophies/cultures (mistrust)
  • Different (sometimes competitive) funding streams
  • Different networks
  • The sheer complexity of meaningful collaboration
if this is the rule are there exceptions
If This is the Rule, Are There Exceptions?
  • The Early Years Collaborative
  • Alcohol and Other Drug Treatment Courts
  • 100,000 Homes Campaign
session objectives
Session Objectives
  • Share stories of cross-sector improvement
  • Identify “clues” (early insights on what seems to work)
  • See if we can apply them to one or two your current challenges
lessons for cross sector improvement1

Brandon Bennett

Faculty Improvement Advisor

Lessons for Cross Sector Improvement

Scotland’s Early Years Collaborative

the glasgow effect
The Glasgow Effect

“The deprivation profiles of Glasgow, Liverpool an Manchester are almost identical. Despite this, premature deaths in Glasgow are more than 30% higher, with all deaths approximately 15% higher. This ‘excess’ mortality is seen across virtually the entire population”

Dr Harry Burns (Chief Medical Officerof Scotland) suggests stress in early childhood can lead to long term chronic ill health

Sir Harry Burns

Walsh D, Bendel N, Jones R, Hanlon P. It’s not ‘just deprivation’: Why do equally deprived UK cities experience different health outcomes? Public Health


To make Scotland the best place in the world to grow up in by improving outcomes, and reducing inequalities, for all babies, children, mothers, fathers and families across Scotland to ensure that all children have the best start in life and are ready to succeed

work stream aims
Work Stream Aims

Stretch Aims:

To ensure that women experience positive pregnancies which result in the birth of more healthy babies as evidenced by a reduction of 15% in the rates of stillbirths (from 4.9 per 1,000 births in 2010 to 4.3 per 1,000 births in 2015) and infant mortality (from 3.7 per 1,000 live births in 2010 to 3.1 per 1,000 live births in 2015).

To ensure that 85% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time of the child’s 27-30 month child health review, by end-2016.

To ensure that 90% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time the child starts primary school, by end-2017.

Source: The Scottish Government

a cross sector approach
A cross sector approach

An implicit recognition of the unique

drivers that will exist and persist

across localities and which are

linked to geography

True collaboration between Civil Service

(Health, Education, Social Welfare, Judicial), Private Enterprise, and the Third Sector (non-profits and charitable organizations)

Community Planning Partnerships as a key leverage point for local intervention

lessons learned thus far
Lessons Learned (thus far)

Build of Previous Success

Choose Something Meaningful

Leverage Existing Structures

Focus on Asset Based Development

Equip Communities with a Mechanism for Introducing

Change (Model for Improvement)

challenge questions
Challenge Questions

What local assets exist in your community to bring together dispirit leaders?

What issue can be framed across sectors that most would be excited about?)

the alcohol and other drug treatment aodt court te whare whakapiki wairua

The Alcohol and Other Drug Treatment (AODT) CourtTe Whare WhakapikiWairua

A Community Collaborative

Judge Ema Aitken

APAC Conference

September 2013

the what the how the why
The What, the How, the Why

AIM: to stop the cycle of crime – imprisonment – release – crime – imprisonment for AOD dependent offenders.

HOW: by using the coercive power of the Court to get offenders into treatment, and the collaborative effort of the community to change and maintain behaviours.

OUTCOME: to reduce reoffending, save money and restore our people to their families and communities as healthy productive citizens.

getting started the problem and the realities
Getting Started: The problem and the Realities
  • Clearly identified the problem: that current system is not effective in reducing reoffending for AOD dependent offender.
  • And the realities: that addiction is an illness that requires individual-specific treatment, and that offending thoughts and behaviours need also to be addressed.
  • To reduce reoffending we need to understand what long term recovery looks like and walk with our participants on that journey.
the model chosen
The Model Chosen
  • USA 10 Key Component model: proven to be more effective than any other intervention in their criminal justice history when dealing with ‘high risk/ high needs’ offender.
  • Proven to significantly reduce reoffending rates if 10 Key Components applied.
  • In NZ: a post-guilty plea pre-sentence intervention available for AOD dependent offenders who would otherwise be facing up to 3 yrs imprisonment .
the underlying principles
The Underlying Principles
  • Judge-led team approach
  • Abstinence-based court
  • Customised treatment, habilitation and rehabilitation
  • Intensive monitoring through regular court appearances and regular and random AOD testing
  • Proximal and distal goals identified and set, incentivesand sanctions used to achieve those goals
  • Honesty is permanent proximal goal
the pilot
The Pilot
  • 5 year pilot – formative and substantive evalutions at 12 months and 4 years
  • 62 participants across both courts (max. 100)
  • 8 different ethnic groups
  • 8 women 54 men
  • 20 recidivist drink drivers; 42 recidivist criminal offenders
getting started
Getting Started
  • Know your problem and develop a well-informed sense of the possible solutions
  • Consult widely and throughout the set-up and implementation phase
  • Evaluate processes early and respond
  • Stay optimistic, focused and energetic – it will take longer than you think!
100 000 homes campaign
100,000 Homes Campaign
  • Aim: House 100,000 of America’s most vulnerable homeless by mid-2014.
  • The math:
    • 2-3 megacities to house 40% of their unsheltered population;
    • 50 high-burden communities to house 300 per year;
    • 75 middle-burden communities to house 100 per year;
    • 125 lower-burden communities to house 100 each.
    • 10,000 families
  • Current status as of Sept 2013 (over three years in): 66,000 housed
field plan
Field Plan

Big City & County:

25% of resource and effort

assume house 25% of c&v

or 12,000, total


Special populations & mid/small cities:

25% of resource and effort

assume 75 mid-sized cities house 250 ea

and 125 small cities house 100 ea

or 31,000 individuals

+ 10,000 families

+ 5,000 Hospital to Home

5,000 pre-launch

25,000 by 18 months

50 core cities (>1,000 unsheltered):

50% of resource and effort

assume 25 house all c&v and

25 house 50% of their c&v

or 43,000, total (average of 300/city/yr)

100,000 by 3 years

100 000 homes approach
100,000 Homes Approach
  • Know the problem (vulnerability index)
  • Employ housing first (wraparound services)
  • Create easy-to-track, shared metrics
  • Continuously improve core housing process
100 000 homes approach1
100,000 Homes Approach
  • Know the problem (vulnerability index)
  • Employ housing first (wraparound services)
  • Create easy-to-track, shared metrics
  • Continuously improve core housing process
100 000 homes approach2
100,000 Homes Approach
  • Know the problem (vulnerability index)
  • Employ housing first (wraparound services)
  • Create easy-to-track, shared metrics
  • Continuously improve core housing process
the real secret
The Real Secret?

Tenacity (Rhythm) and Leadership (“Team 42”)

kansas city kansas a possible next step
Kansas City, Kansas (A Possible Next Step?)


take home lessons
Take-Home Lessons
  • Shared aims matter
  • Leadership “maturity” matters
  • Common systems matter
  • Common data/visualization matters
  • Management system matters (rhythm and style of meeting)
  • Policy environment matters

Do you face similar challenges in your work?

Where are you stuck?