How Communities Became Partners in Improving Health Outcomes

Improving health outcomes at scale often begins with building the capability and relationships needed to turn shared aims into local action. The Bedfordshire, Luton and Milton Keynes Integrated Care Board partnered with IHI to build improvement capability, strengthen collaboration, and reduce inequities through a Learning and Action Network. Two local efforts show what that work made possible in practice, demonstrating how community partnership can move beyond consultation to rebuild trust, share power, and design care around people’s lived experience.

In Central Bedfordshire and Bedford Place, teams focused on improving outcomes related to hypertension (high blood pressure) among communities experiencing significant health inequities. In Central Bedfordshire, the work centered on engaging Gypsy, Roma, and Traveller communities. In Bedford Place, the team worked with Black African and Black Caribbean residents registered with three local practices where hypertension prevalence and health inequities were especially significant.

Although the communities and local contexts differed, the teams arrived at a shared lesson: sustainable improvement begins with trust.

Trust Starts with Existing Community Strengths

In Central Bedfordshire, the team quickly recognized that traditional health care communication methods — letters, posters, digital messages, and standard invitations to services — were not effective for engaging Gypsy, Roma, and Traveller communities. Literacy barriers, cultural norms, stigma related to discussing health conditions, and a lack of trust in formal systems all shaped how residents experienced health care.

Rather than expecting residents to engage with the system on the system’s terms, the team shifted its approach. They brought care closer to the community and built on relationships that already existed. Trusted local residents played an important role in helping the team understand cultural norms, barriers to care, and ways to communicate that would feel relevant and acceptable.

The team also used existing community assets rather than creating new structures. A trusted community podcast helped raise awareness about hypertension, while locally produced videos featuring familiar faces — including a community member and a clinician — supported education and ongoing engagement. Health visitors, nurses, and primary care network staff who already had relationships with residents served as important bridges between services and the community.

Outreach activities, including blood pressure checks and advice through the “Know Your Numbers” campaign, were delivered directly on site, making support available in familiar environments. Community pharmacies and local organizations such as Healthwatch also helped extend access and offer residents different ways to engage.

This work challenged a common assumption in health care improvement: that some communities are “hard to reach.” The Central Bedfordshire experience suggested something different. Communities are often reachable when services are designed around trust, familiarity, and the realities of people’s lives.

Creating Space for Residents to Lead

The Bedford Place team applied similar principles while focusing on shared leadership between residents and clinicians. From the beginning, the team worked with clinicians to identify residents with lived experience relevant to the project’s goals. This helped ensure the work was grounded in the barriers residents were actually encountering in local practices.

One of the team’s most important early insights was that engagement cannot happen without psychological safety. Residents were initially reluctant to speak openly when large numbers of system partners or professionals were present. In response, the team adapted its approach and created a closed-group model, where participation remained consistent and any new attendees joined only with the agreement of the group.

This structure created familiarity, trust, and space for honest conversation. Over time, residents became more confident sharing their experiences, challenging assumptions, and contributing directly to design decisions.

The team also addressed another common barrier: professional language. Residents shared that acronyms and clinical terminology often made them feel excluded. The group established a simple agreement: residents could stop the conversation at any point and ask for an explanation. This shifted the dynamic. Instead of expecting residents to adapt to health care language, clinicians and system partners adapted their communication so that discussions were more inclusive and accessible.

Community leadership was also central to the work. The team appointed community deputy leads from Black African and Black Caribbean communities to help build credibility, support engagement, and encourage participation through trusted networks.

One example of co-design came through the project’s community survey. When residents reviewed an initial survey draft, they pushed back on the format and asked for more meaningful questions, clearer response options, and space to provide written feedback. The team listened and redesigned the survey. The revised version received 122 resident responses, demonstrating the value of involving residents not merely as participants, but as partners shaping the work.

The Bedford team also used culturally meaningful engagement activities to build connection across Black African and Black Caribbean communities. A discussion centered on hibiscus tea — including what it is called in different cultures, how it is prepared, and its connection to health — helped open conversations about shared traditions, culture, and blood pressure management.

Over time, residents began to take greater ownership of the work. They shared health information within their networks, participated in awareness sessions, supported conversations in churches and community spaces, and maintained community communication channels. A community-managed messaging group helped relationships continue beyond formal meetings. Eventually, residents formed their own independent network, BEACON (Bedford Empowerment African and Caribbean Outcomes Network), to continue conversations about health, community empowerment, and civic participation.

Lessons for Health Systems

Together, the Central Bedfordshire and Bedford Place examples offer several practical lessons for health systems seeking to improve outcomes and reduce inequities.

First, trust is built through consistency, not campaigns. One-time events or generic communications are unlikely to overcome long-standing barriers. Regular presence, familiar faces, and follow-through matter.

Second, community members are experts in their own experiences. In both places, residents helped identify what the system had missed — whether that meant communication barriers, cultural norms, stigma, or the conditions needed for people to speak honestly.

Third, existing community assets are often more powerful than new programs. Podcasts, local leaders, faith communities, community pharmacies, resident networks, and informal communication channels all helped extend the reach and relevance of the work.

Fourth, shared ownership supports sustainability. In Bedford Place, the emergence of an independent resident-led network showed that the work had moved beyond engagement and toward community mobilization. In Central Bedfordshire, the team’s commitment to maintaining regular outreach reflected the importance of continuity.

Finally, meaningful engagement requires health systems to adapt. Too often, systems ask communities to change how they access care, communicate, or participate. These examples show the value of reversing that expectation: health systems can change how they listen, communicate, and design support.

These projects began with a clinical goal: improving hypertension outcomes. But they ultimately revealed a broader lesson about what it takes to improve health equitably.

Sustainable improvement is rarely the result of a single intervention. It emerges when health systems invest in relationships, build capability for improvement, learn alongside communities, and adapt based on what they discover. Together, these efforts demonstrate how a system can move from intention to action — and from isolated initiatives to lasting change.

Lourena Mendes, MPH, is a Program Manager at IHI. Brenda Carson, RN, is an IHI Improvement Advisor. Susan Hannah, RN, is Regional Director, Europe, at IHI.

Photo by Carlos Magno on Unsplash

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