Why It Matters
As part of the SCALE initiative, people around the US are demonstrating how to lead culture change and sustainable improvement in health, wellbeing, and equity.
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Building Thriving Communities of Solutions

By Soma Stout | Wednesday, July 26, 2017

Privoso Partners for Health

Proviso East High School Garden Collaborative Project (Photo: Susanne Fairfax Media)

Four years ago, Mercedes Hernandez was facing enormous challenges. An immigrant woman who had escaped a violent relationship, she did not speak English and did not have a job. Today, she is a businesswoman supporting the development of a healthy catering business with 35 cooperative members. As a community improvement adviser, she serves as a catalyst for healthy change.

This would have been unimaginable to Mercedes four years ago.

Mercedes’s personal transformation paralleled the transformation in her community. Despite its unfavorable statistics — high crime, unemployment, and poor health outcomes — the people of Maywood, IL, like Mercedes, had a vision for their community.

As Lena Hatchett, Executive Lead of the Proviso Partners for Health, put it: “Despite very little evidence that crime, unemployment, education, and food access were getting better, somewhere inside me was a vision that the community could be beautiful, and the Black and Brown people that lived in it could love themselves and each other.”

The SCALE Approach

Maywood, Illinois, was one of 24 communities across the country that began a process of deep transformation to become a community of solutions to achieve a Culture of Health, as part of the 100 Million Healthier Lives Scaling Community Accelerators through Learning & Evaluation (SCALE) initiative with the generous funding of the Robert Wood Johnson Foundation. By building on the strengths of 100 Million Healthier Lives and four partner organizations — the Institute for Healthcare Improvement, Communities Joined in Action, Community Solutions, and the Network for Regional Healthcare Improvement, SCALE created a pathway and support system for deep community transformation that focused on:

  • Developing the skills of hundreds of leaders across these communities to create meaningful, measurable improvement, working together across sectors and in partnership with people with lived experience on inequity.
  • Supporting these leaders to take on complex community transformation in a way that grew resources, people, and joy in the change process and created a culture of learning, sharing, and failing forward.
  • Helping leaders tangibly improve equity and health outcomes through the application of co-design and improvement methods paired with advanced leadership skills — the ability to have difficult conversations, to hold tension, to understand equity from a systems perspective, and to adopt a mindset of abundance.

Putting the Approach into Practice

Proviso Partners for Health embraced these principles and began looking at the people within their community as potential leaders, calling on hundreds of youth and community members, like Mercedes, to become active agents of community transformation.

They collectively developed a theory of change about what would improve their community, and from a perspective of assets and abundance in a community of concentrated poverty. They formed three social enterprise businesses and combined leadership development with healthy eating and job creation.

Mercedes was one of the community members who became community leaders through this process — and her idea to replace the food bank with a healthy catering business run by a cooperative of women in the community is just one element of how food systems are being transformed. The tools of improvement science were deeply integrated — Mercedes uses run charts to track her sales of healthy foods, youth used Plan-Do-Study-Act (PDSA) cycles to taste-test healthy salad bar options in schools, and community members with lived experience created driver diagrams to describe the change they wanted to see in their lives.

The coalition even passed a successful soda tax together with partners across Cook County and began working with hospitals across the county, in partnership with the Illinois Public Health Institute, to transform their community benefits to achieve health equity.

Mercedes wrote a poem to describe the work:

Breeze of satisfaction in the eyes
Embrace of power of the soul
Hope and effort by union
Holding hands we reach for the sun
Full of excitement celebrating the best of us
In triumph and success
For the good of all.

Taking the Approach to Scale

Across the country, the communities in SCALE have flourished and developed deeply meaningful relationships within their communities and with one another. An incredibly diverse array of people — of different backgrounds, professions, race, class, and political persuasion — came together in every community to advance the health and well-being of their communities and found innovative ways to partner with those aren’t thriving to create meaningful improvement. These are some examples of what SCALE communities accomplished:

  • Helping children at risk for exposure to trauma in the Tenderloin neighborhood in San Francisco
  • Helping homeless youth graduate in Cheyenne, Wyoming
  • Helping homeless women and populations experiencing inequity manage their chronic disease in Los Angeles, California, or Maricopa County, Arizona, or Cattaraugus County, New York
  • Promoting youth empowerment, healthy living, and pathways to economic development in Algoma, Wisconsin, and Waterville, Maine
  • Addressing the needs of refugee communities in Minnesota and Utah
  • Addressing racism, trauma, and community resilience in Boston, Massachusetts, and Kershaw County, South Carolina

In the process, these communities found they had much more in common with one another than differences, and that real change was possible. As Lena Hatchett wrote, “At the end of the SCALE 1.0 journey, I hardly recognize this community. We ignited a community revolution with SCALE and it is spreading naturally.”

Together, these communities are blazing a trail to becoming a community of solutions on the journey to a Culture of Health.

The experience of the SCALE communities has been captured in a series of synthesis papers and stories told by the communities about their journey, which can be found at www.100mlives.org/initiatives. These papers offer rich and textured insights into how any community could get started, from an overview of the Community of Solutions approach, to partnership with people with lived experience, to integrating design, improvement, and sustainability methods in communities.

For more information on SCALE, or how your community or organization can become part of a Community of Solutions in 100 Million Healthier Lives, go to www.100mlives.org/initiatives or the Map of the Movement at www.100mlives.org/map.

Population Health is a featured track at the 2017 IHI National Forum on Quality Improvement in Health Care (December 10-13 | Orlando, FL)

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