The Stew BLOG

Regional Transformation Efforts Conduct Governance and Management Activities Differently Than We Thought

Jane Erickson, Project Director | 01/15/2019

What does it look like when stewards (both people and organizations), including multisector partnerships, effectively lead and collaborate around the common purpose of transforming health and well-being in their region? Our research and fieldwork has shown us that it doesn’t look like what we thought it did.

For some time, The Rippel Foundation’s ReThink Health initiative (like many others) has been advancing the idea that a single backbone organization, or integrator, can oversee the collaborative work needed to advance transformative change across a region. It turns out that in most regions, many organizations and their leaders conduct the activities required for successful region-wide collaboration—not just one. These activities include establishing a shared vision, coordinating and facilitating meetings, synthesizing shared data, communicating across partners, and beyond.

Different organizational members of a single partnership, or different multisector partnerships and organizations within a network, often distribute the roles and leadership functions needed to drive change. For cross-sector efforts that are just starting out, or boundary-spanning groups that are looking to shift how they are working, it might be more effective to think about distributing and coordinating a range of “integrative activities” across a region, rather than standing up a distinct organization, typically called a “backbone,” to conduct these activities. We use the term “integrative activities” to describe the efforts of many people, organizations, and partnerships to integrate their efforts across a region to support collaboration.

Last week, my ReThink Health colleagues Nina Burke and Ruth Wageman started this conversation with their blog post about distributed leadership. They promised we’d explain integrative activities in more detail this week and next. Here goes…

A closer look at integrative activities

Integrative activities involve both governing and managing the work happening within and across the different multisector partnerships and organizations that are collaborating to achieve a common purpose in a region. Governance functions ensure accountability, transparency, and fairness across the various groups that are collaboratively stewarding transformative work in their region. Examples of governance functions include establishing shared vision and strategy across the multiple partnerships and organizations, setting ethical standards, and ensuring appropriate use of resources. Management functions are focused on establishing and maintaining the basic infrastructure that supports stewards’ working relationships. Examples of management functions include planning meetings, facilitating communication and networking among stewards, and evaluating progress.

Your region might have a single multisector partnership with the purpose of transforming health and well-being in your region. Alternatively, you might have a number of multisector partnerships and organizations with distinct purposes (e.g., to improve early education or reduce heart attacks) who come together for the common purpose of transforming regional health. No matter the arrangement, when the common purpose shared by people and organizations is to transform the system that produces health and well-being across a region, stewards should strive to ensure that—between them—eight integrative activities are carried out.

They should further strive to ensure the activities are carried out in ways that are adapted to the needs of the region and its population. For additional details on the eight integrative activities, see this chart. The graphic below depicts how this can work in practice, and briefly summarizes the eight activities. (Note: It’s  possible that not all functions will be served when collaborative efforts are in early stages of development; as stewards launch and build their work some needs will naturally take precedence over others.)

What does this look like in practice? An example from the Finger Lakes.

The Finger Lakes region of New York, one of six regions participating in the ReThink Health Ventures project, provides a great example of multiple partnerships and organizations forming working relationships and, between them, ensuring that integrative activities are conducted effectively. Common Ground Health plays an important role in regional health planning and in convening stakeholders for cross-sector collaboration. Part of the reason it has been so successful is that its leadership recognizes Common Ground is just one of several organizations and institutions taking responsibility for conducting integrative activities across the Finger Lakes.

Common Ground leads stakeholders to collectively set a region-wide vision for achieving the Triple Aim in health care: lower costs, better outcomes, and improved patient experiences. It is perceived as an authority in regional health planning because it sets audacious goals with a range of organizations across these domains and provides the data and analytic support to help measure progress toward such goals. However, much of the implementation of those goals is handled by people at other institutions in the region, including many who sit on the Common Ground board. For example, the Finger Lakes Performing Provider System (FLPPS) leads work on regional Medicaid reform. Common Ground played a lead role in developing the initial proposal and helped to launch the initiative, but FLPPS conducts the governance function of strategically overseeing implementation.

The Rochester RHIO (regional health information organization) runs a health information exchange that provides data to all major medical providers in the region. Providers realized that by working with Rochester RHIO they could achieve the double purpose of securing the data they need for their business and sharing data that Common Ground needs for regional health strategy planning. Sharing data is one reason why the Finger Lakes region has achieved important goals related to cost containment over recent decades, but it wasn’t necessary to run the coordination of both strategy and data coordination through one group to achieve those goals.

Recognizing that so many different organizations across the region are already successfully conducting integrative activities led Common Ground to realize that it did not need to be at the center of all integrative work in order to achieve its mission and vision for the region. Instead, it is encouraging at least one collaborative effort to adopt a distributed leadership governance structure in which each member organization is responsible for leading in its area of expertise. Importantly, this approach requires that each member organization has a robust understanding of who is doing what across their nine-county region. Distributed leadership also requires well-established relationships, trust across all levels of many organizations, and effective lines of coordination and communication. To strengthen integrative activities across the region, Common Ground is now working to even better define and build the distributed governance structures and norms with a network of organizations.

Assessing the Eight Integrative Activities in Your Region

If you’d like to examine and map the extent to which stewards in your region are conducting the eight integrative activities necessary for transforming health, we invite you to explore ReThink Health’s Integrative Activities Assessment Tool. It will help you understand which integrative activities are already being conducted well in your region and where there are gaps. The results will help to shape and guide conversations with other stewards to better coordinate regional integrative activities.

Next week, in our fourth blog post of this Ventures Stewardship blog series, we will share some of what we’ve learned about how regional leaders use stewardship practices to seek and secure financing for conducting integrative activities. After that, we’ll blog about the importance of paying attention to leadership transitions, especially in a distributed leadership structure.   

In the meantime, please share how stewards in your region, or regions you work with, distribute integrative activities. Use the hashtag #ThinkWithUs or email us at [email protected].