In part 1 of this five-part series, I explained how health care uses three inter-relating biases to control the dialog in health. In part 2, I described how I went to find a new dialog only to discover that many practitioners already understand the importance of things like trust, reciprocity and cooperation as a pathway to improve lives, including health. In part 3, I shared how I learned that the 12 Principles are about control – a way to foster it amongst communities and enable health care to share it. And in part 4, I shared how we tried to make the Principles a product and find a market, and what we learned through the process.
In this final part I’ll sketch out what Bridging Health & Community will do next, and why.
I began this work as a response to our collective inability to have a proper conversation about the future of health (see part 1). My response was to found the Creating Health Collaborative (described on this page), partly through highly-curated meetings of practitioners operating on the basis of how people and communities define health. We’ll go back to holding these meetings. Next year’s (which will be called CHC2019) will be informed by a recurring piece of feedback that was crystallized in a commentary by Erin Hagan of Evidence for Action in response to our 2017 symposium:
For CHC2019 we’ll be looking for examples of how entities in health care have ‘participated’ and what it meant for their operations. As ever, we’ll be looking to aggregate what we learn with a view to iterating the Principles in our ongoing quest to ‘de-fluff’ community-building work for the health care sector (see part 2 to understand the ‘de-fluff’ comment). If relevant, we’ll also consider how our implementation tool can become all the more useful.
Principles and tools are important but what’s also needed is real-world experimentation. As I explained in part 4, we thought we’d achieve this through consulting funded by grants and delivered through a nonprofit. That didn’t happen and, although it could be argued that we need to try harder and for longer, it’s clear to me that ‘the market’ for community-facing work is in helping health care to overcome the social circumstances that are impacting the delivery of care. Although this work is important, it’s a long way from considering agency and control as fundamental to health.
Rather than wait for ‘the market’, then, we’ll recruit five brave health care organizations willing to explore the importance of agency and control, including their role in fostering it. We’ll be designing a ‘learning environment’ for these organizations to apply at least three of the 12 Principles to their community health work. Leaders of these organizations will not only learn from each other but also from a curated group of speakers who’ll share their insights, either from research or practice. The idea is to create a safe and supportive space for these organizations to find a new way of working.
We have no doubt that this will be hard work but we are going to make it even harder (yes, you read that right). First, by asking the five organizations to invest in the ‘learning environment’ (as of right now, we’re thinking it’s about $50k per organization per year), and second, by only working with those willing to write about their work, including the experience of it, at least monthly (and for that writing to be as honest as possible).
With regards to investing, we suspect this money will come from budgets dedicated to either community engagement, organizational development or innovation. We doubt it could come from clinical budgets because, while it’s clear that agency and control matter to health (see part 3), the pathway from them to, say, reduced HBA1c is unclear.
We also want organizations to pay so that we’re held accountable to their needs. If we meet those needs — in other words, if we provide value that’s core to their operations — we start to make the business case for authentic community engagement in health care, something that I think is fundamental to this work ever becoming a sustainable reality.
With regards to writing, one of my observations of the field is that while there are initiatives left, right and center, all too often they’re silent until they have some major success to share. Even a cursory look at rates of things like diabetes or obesity over the last three or four decades will tell you that our prevailing experience of working with communities is failure. Combine that with the well-accepted ‘fact’ that up to 95% of start-ups fail and it’s clear that only communicating ‘success’ misses the big picture. In fact, paradoxically, only communicating success is probably part of why we’re failing.
That’s not to say that we want the five organizations to repeatedly share their failures in some bizarre public self-flagellation. Rather, we want to find organizations willing to share the realities of organizational change — the process. It’s clear to me that it’s in this experiential knowledge, this nitty gritty of the day-to-day, that we’ll discover what it truly takes for health care to engage with communities. And I genuinely believe that the more we share, the more others in health care will be emboldened to try.
A Strategy, Of Sorts
So, there you have it. Over this five-part series, I’ve taken stock of where we’ve come from and what we’ve done as a way to understand what we should do next. The next step for me is to work with the Board on the details so that we have something that looks like a strategy. How do we find practitioners for CHC2019? What does the ‘learning environment’ need for five health care organizations to invest? And what is the right vehicle for all of that work? While we work on all of that, I’ll also continue to speak at health care events and help the occasional client, activities that underwrite BH&C.
In due course I’d like to return to the possibility that we’re yet another extractive force making a living by packaging and selling the misery of being exploited and ignored (see part 4). I don’t have a good answer to this yet but I’m intrigued by what Juan Mata, the Manchester United player, is doing in donating a percentage of his wages to charity and encouraging other footballers to do the same. I’d like to explore whether we, together with leaders in health care, can pool a percentage of our revenue into a fund that connects community-based practitioners with people in power so that, collectively, they can surface and begin to address the myriad ways in which health care, whether intentionally or otherwise, suppresses community agency.
Thanks for reading this five-part series. We may go silent for a few weeks while we work on the details but if you’re interested in CHC2019 or the learning environment do feel free to drop me a line.