The Stew BLOG

Insight Spotlight Series: What are We Learning Alongside Stewards of Equitable Health and Well-Being?

Jane Erickson, Project Director | 11/09/2020

At ReThink Health, we work with nationwide and regional stewards to discover what it takes to guide the transformative change needed to produce equitable health and well-being for all. Stewards are people and organizations who take responsibility for working with each other to create conditions that each of us needs to participate, prosper, and reach our full potential. Our team works with stewards as action-learning partners; we are committed to sharing real-time insights as we prototype, make sense of, and refine transformative strategies on the frontiers of a rapidly changing world.

Over the next month, through this Insight Spotlight blog series, we’ll be sharing highlights from what we’re learning across three ongoing projects, each funded by the Robert Wood Johnson Foundation: Portfolio Design for Healthier Regions, Hospital Systems in Transition, and Amplifying Stewardship Together. In this first blog in the series, we share a bit about what guides our learning across each project along with key themes that are beginning to emerge.

Take a look at our recently published Amplifying Stewardship Together report to learn more about stewardship for equitable health and well-being.

What guides learning across ReThink Health’s projects?

Across our projects, we are learning how the partners we support take up the practice of stewardship, how their mindsets and actions shift as their stewardship journeys progress, and how they influence the mindsets and actions of others with whom they work. As we’ve shared in previous blog posts, whether stewards foster change locally or nationally, from within a single organization or across many, they always work in complex adaptive systems. Complex adaptive systems have many players, many interacting parts, multiple (and massively entangled) boundaries, no start or end point, and are constantly adapting. (If this sounds like the messy world we live in, you are right—our organizations, communities, and country can all be seen as complex adaptive systems.)

So how can we make sense of what matters through all this complexity? At ReThink Health, we focus on surfacing patterns. By looking at patterns across multiple, intertwined scales—specifically at the individual human level, the organizational level, and the network level (whether that network is local or nationwide)—we can start to paint a picture that shows what works, for whom, how, and under what conditions.

Here is a snapshot of some strong patterns that we’re seeing across projects right now. In the forthcoming Insight Spotlight blogs, we’ll be sharing more about how these patterns are playing out in different contexts, along with other lessons that are emerging in each project.

What patterns are emerging across ReThink Health projects?

  • Stewards have diverse orientations to current and future systems. All individuals and organizations that participate in ReThink Health projects share a strong commitment to equitable system change and a desire to embrace new mindsets and actions. At the same time, we are observing that stewards can have different orientations to the kind of systems change they seek. Some begin their stewardship journeys with greater acceptance of the status quo and enthusiasm for specific improvement opportunities. Others reject business as usual and apply pressure for change either from within existing institutions or from outside to accelerate innovation. Still others are passionate about realizing a new vision for the future and tend to work outside mainstream structures as they create alternatives and nurture a new system into being. This differences highlight that stewardship is a broad endeavor encompassing many complementary styles of practice and theories of systems change.
  • 2020 systemic crises surface opportunities and challenges. The multiple, layered systemic crises of 2020—especially the pandemic and protests against police brutality and racial injustice—are simultaneously creating significant challenges and opening opportunities for stewards to think and work in new ways. For many, shared experiences within a failing system have made it easier to articulate and spread a convincing case for large-scale systems change. This has helped to drive greater alignment and action within and across many organizations. On the other hand, times of crisis can cause some—even those who identify as stewards—to retreat into short-sighted behaviors that may not support common interests. Especially for large, established institutions, we have observed that in the face of great uncertainty it can be especially challenging to emphasize stewardship practices that support equitable systems change, such as relationship-building, agility, and transparency.
  • Individual stewards are influencing large-scale change through their organizations. Individual stewards often look for better ways to expand equitable health and well-being through their organizations. They are quick to critique systems that are inhumane; and they easily spot flaws in policies, practices, and priorities that cause harm or lead to unfair adversity. They also routinely offer alternatives, some of which take hold as new organizational norms. Along these lines, we see stewards showing up as a different kind of professional—one who is both connected to the strategy of their organization and to the lives and well-being of people in their community. They see themselves as citizen-professionals: valuing both identities as complementary, not incompatible. They acknowledge the important role that must be played to help their institution advance an agenda that reflects a purpose beyond the organization’s goals alone—one that builds the health and prosperity of others, particularly those that are routinely marginalized and excluded.
  • Strong-tie networks can help drive transformative change: Appreciating that efforts to create equitable health and well-being in regions across the country require new kinds of working relationships, many stewards are asking: What is the right network to accomplish the work at hand? We are seeing that many stewards are able to drive action through what network scientists call strong-tie networks (to learn more, check out Damon Centola’s book How Behavior Spreads). In a nutshell, when organizing for transformative change, a bigger network is not always better; it’s important to be attentive to the quality and nature of the relationships at play relative to the task at hand. While there is not a one-size-fits-all approach—different collaborative structures are needed for different purposes—efforts to form a smaller group of stewards bound together through mutual understanding and trust can sometimes be a more effective way to drive progress. It is also imperative to build strong-tie networks with inclusion and diversity of perspectives from the outset—ensuring that those whose experiences are typically unheard become co-designers and full partners in the decision-making process.

Next up in our Insight Spotlight blogs…
Within each ReThink Health project, stewards are working in different ways to drive transformative change. In the Portfolio Design for Healthier Regions project, they are exploring new ways to shift organizational and regional investments. In the Hospital Systems in Transition project, they are reimagining their organizational roles. And in Amplifying Stewardship Together, they are diffusing stewardship practices to build a stronger field and more forceful movement for well-being and justice.

Each week over the next month, Insight Spotlight will delve more deeply into patterns we are seeing within these projects. We’ll share more about how the patterns we’ve highlighted here are playing out, along with others that are beginning to surface in each project. Up next is Amplifying Stewardship Together. Stay tuned for more!