The Stew BLOG

Six Rules To Engage Communities for Health Systems Change

Kate Hilton | 04/21/2015

A core focus of ReThink Health is to help build the capacity of regional leaders to design and develop sustainable health systems. We do this by working closely with organizations and cross-sector coalitions to help them develop more active stewardship, create focused high-impact strategies, engage local community members, and guide resources into smarter more sustained investments. Our team of engagement experts have been working closely with the CMS Quality Improvement Organization (QIO) Program, one of the largest federal programs dedicated to improving health care quality for seniors and vulnerable people, fostering better health outcomes, and lowering cost in regions.

Over the years we have seen how thoughtful, respectful, and provocative conversations, as well as support for diverse cross-sector teams, can be powerful forces that lead to real change. Drawing on our deep roots in organizing and community engagement, we offer six rules that are core to effectively engaging communities for health systems change.

  1. Know what matters to you and why you care. An adage among community organizers is, “People do not care what you know, until they know that you care.” When working with residents in a community, you need to understand your motivation for the effort. Why do you want to improve the health care system? Why do their local health needs matter to you? Plumb yourself for your own motivation and share it to engage people to join your effort.
  2. Develop an intentional strategy to build relationships. Relationships matter, and they need to be established early. This is particularly important when tackling complex change efforts. Some tactics community organizers can use to build relationships include one-to-one meetings, or gathering small groups at “house meetings” or in community centers. As many as 60 to 100 meetings may be advisable when first entering a new community. These meetings create an opportunity for organizers to learn about residents’ interests and skills, what matters to them, and how they might like to be engaged in the local effort, and—importantly—how to support them. Relationship-building is also key to eliciting motivations and the “glue” that sustains engagement in the face of challenge and uncertainty. Keep in mind that this process requires earning residents’ trust over time.
  3. Find opportunities to create relationships across existing silos or stakeholder groups. It is important to find ways for groups already established in the community to sustain new connections with one another. To create change at the local level, engage people around their shared values. As noted in the rule above, relationship-building can be accomplished in a variety of ways – at large gatherings or in smaller groups at house meetings. The idea is to bring people together, and create a spirit of collaboration and community.
  4. Allow the group to establish a motivating vision and shared purpose. Having a shared purpose and vision binds individuals to their work. Members of the community will need to decide together how they want to create change. What are the health outcomes they would like to see in the future? What does a better health system mean to them? How do they want to draw on existing assets to solve the problems in their health system? Having shared answers to these questions shows that the effort is truly driven by the community, drawing on its strengths and addressing its needs.
  5. Revisit and renew the relationships. Never underestimate the power of rebuilding and renewing relationships. Continue to have one-to-one meetings to check in with people about their work, reconnect them to their motivation, and hold them accountable to their commitment. This process builds trust, creates space for people to continue to be heard, helps you stay attuned to the ongoing issues in the community, and allows you to face challenges together.
  6. Beware of the snare of preparation. Although community engagement builds a foundation for future work through relationship building and collective decision-making, it ultimately must lead to action. Focusing on action early helps avoid what Jane Addams called the “snare of preparation.” Don’t be afraid to move to action early on: create the space to innovate, take risks, learn from outcomes, and co-create pilot programs with your community. As our QIO partners say: “Everyday is a PDSA cycle!” This is the only way you will find out what’s effective and what adds value to the local health system.

To learn more, please see our Engaging Communities case study on the ReThink Health website.