Integrate Community Efforts to Improve Community Health
Evidence-based initiatives, dedicated people, hard work and even better funding will never be enough to turn the tide on community health. At the core of our social problems is the fact that our fragmented approach to the health and well-being of our communities is out of date.
A more systematic approach is needed, one grounded in current system science and better aligned to how the complex adaptive network we call community works. Such an innovative approach is being implemented in Salem and our goal is to make it available to deliver sustainable outcomes in other communities as well.
A system-based approach to a system-wide problem.
In Salem, as in many communities, treatment of individuals and projects intended to improve overall community health lack comprehensive integration of non-medical resources and services. Collaborations are often little more than loose networks within which each organization works with only a small part of a much bigger and deeply interconnected reality. Without reliable integration – including shared infrastructure, decision-making processes, operational policies, procedures and real-time information sharing – the likelihood of sustainable improvement is low.
Why? Because fixing just one part of the problem at a time only works in stable systems. I can replace the brake pads on my car without worrying about how doing so might affect the battery because it is a system that remains stable even when manipulating its individual parts.
The same is not true of natural systems like communities, which are extraordinarily complex self-organizing networks of people, ideas, things and other organisms. Within complex systems, all the individual parts change and respond to the information and events flowing through the whole system.
Communities are therefore constantly changing. And by rewiring themselves in real-time, community health problems easily adapt and outmaneuver interventions developed by traditional management processes for static social systems that don’t exist.
Our “problems” are therefore just systems that are failing to produce the outcomes we want. To create desired change, we must be able to see and manage the whole system using its own rules and processes. And this is only possible if we can effectively integrate all disciplines and providers.
Real collaboration, real results.
Today’s system science can move us from a disorganized array of programs working in operational and funding silos to a more systematic approach emphasizing continuous growth and learning. An integrated, system-wide approach would:
Focus on desired outcomes.
The most powerful point of leverage in any system is purpose, which we express as a desired outcome. Whether the subject is a patient, a student or a neighborhood, integration works by aligning a set of desired outcomes toward an overall purpose. Except where necessary, we work to decouple process as that creates rigidity and cost.
Encapsulate all aspects of specific problems.
A whole-system response to community health depends on the creation of a network of providers, each with specific expertise and responsibility for contributing defined results. The idea is to fix all the parts simultaneously to ensure the best opportunity for success.
The network of providers is selected based on prior performance (clinical and cost). Progress is tracked and the problem monitored so that the specific provider network can adapt to new information or in response to changes.
Evolve through continuous learning.
A variety of internal measures follow the behavior of the community and the treatment networks. Instead of starting over with each new program or grant, the system maintains a rich and ever-growing knowledge base that informs existing and future projects. This creates a research environment that supports accountability and future innovation, allowing us to move beyond population-based methods to those informed by relational science.
Valuing what matters.
Community is both the foundation of human society and its primary source of social and economic value. Human and all other forms of capital depend on the existence and quality of community, and community is therefore a core driver of a nation’s ability to remain globally competitive. A 2018 report from the “Institute for Evaluation and Metrics” showed the United States fell from 6th to 27th place in human capital production from 1990 to 2016.
Changing this trend requires that we start understanding the importance of community as a creator of real value in the economic cycle. An integrated approach to community health accomplishes this by focusing on desired outcomes, and as a result, it creates a more sane and sustainable funding model at the same time.
As a results-based system, it requires less technology and process to function, reducing up-front costs while encouraging continual improvement. This business model is supported by the system’s evolutionary learning protocols, which track circumstances and results. As communities work together more efficiently, the goal is to migrate funding to an outcome-driven marketplace, enabling true value-based payment.
It’s no longer a question of “if.”
Our current approach to community health is failing to produce sustainable results, and therefore will not last. Community service providers without the ability to evolve will similarly fall by the wayside, as donors and funding agencies increasingly demand to see real improvement and progress.
To make real, lasting improvements in community health, an integrated, community-level systematic approach is needed. Curandi is envisioning just such an approach; a system that matches the problem and learns and evolves in order to continually build on the gains already achieved.
By partnering with Catholic Community Services on its Fostering Hope Initiative, our intention is to provide the tools the project needs to succeed in building community-focused solutions through a strong, multidisciplinary network driven by outcomes. We have begun by installing an integration platform from ACT.md that enables greater accountability and coordination among project partners. All partner organizations will be able to access this platform free of charge and will benefit from the ease of case management and interdisciplinary communication it makes possible.
In future, phased implementations, we will build upon the integration platform, developing relational analytics and feedback tools to aggregate knowledge and enable continuous improvement, real-time care plan tracking and rapid intervention, as well as a more sustainable and outcome-focused business model.
If we want better outcomes from our efforts to improve community health, we need to do things differently. Recent advances in system science research and powerful new digital tools make this possible.