transforming health across the state of vermont …...2016/06/03 · ach peer to peer learning...

ACHPeertoPeerLearningTransformingHealthAcrosstheStateofVermont

CURRICULUM

“Neverdoubtthatasmallgroupofthoughtful,committedcitizenscanchangetheworld;indeed,it'stheonlythingthateverhas.”MargaretMead

ACHPeertoPeerLearning:CURRICULUM(June2016DRAFT) 2

VermontACHPeertoPeerLearningCURRICULUMTABLEOFCONTENTSAcknowledgements 3 Introduction 4

Welcome+HowtoUsethisCurriculum 5OurContext:ChallengesandOpportunities 6WhyAccountableCommunitiesofHealth(ACH)? 8ObjectivesofACH 10

ScheduleandLogistics 11

ImportantDates 12 CurriculumOverview:MajorMilestones 13 StayingConnected 15OurApproachtoCo-learningandCo-Creating 16 ThinkingandActingSystemically 17OurFrameworkandJourney 24 Overview 25 SteppingUp:SharedIntent 28 AgendaandMaterialsforJune7 SteppingIn:DeepImmersion 36 SteppingIn:MeaningMaking 38 SteppingIn:Co-Prototyping 40 SteppingOut:Co-Evolving 42Celebrate! 43OverarchingResources 44Appendix: Pleasenote:Thereisarobustappendixwithresourcesthatrefertoeachstepinthepeer

learningjourney.EachACHfacilitatorhasaprintedcopyofthisandallparticipantswillsoonbeabletoaccessitelectronically.


ACKNOWLEDGEMENTSThankyoutotheStateofVermontforthewisdom,planning,fundingandguidanceoftheAccountableCommunityofHealth(ACH)PeertoPeerLearningLaboratory.Thisexperiencebroughttogether10ACHsfromacrossVermont,supportingthedevelopment,relationshipsandknowledgethatcanonlyoccurwhenwecometogethertolearn,co-createandinnovatesolutionsforthefutureofahealthyVermont.FundingforthisreportwasprovidedbytheStateofVermont,VermontHealthCareInnovationProject,underVermont'sStateInnovationModel(SIM)grant,awardedbytheCenterforMedicareandMedicaidServices(CMS)InnovationCenter(CFDANumber93.624)FederalGrant#1G1CMS331181-03-01.However,thesecontentsdonotnecessarilyrepresentthepolicyorviewsoftheU.S.DepartmentofHealthandHumanServicesoranyofitsagencies,andyoushouldnotassumeendorsementbytheFederalGovernment.

TheguidewaswrittenbyDanaPearlman,ConsultantandFacilitatorandSueGrinnell,PublicHealthInstitute’sPopulationHealthInnovationLabwithinputsfromTeresaPosakony,SarahKinsler,DepartmentofHealthCareAccessandHeidiKleinoftheVermontDepartmentofHealth,graphicstrategyanddesignbyGingerDanielandutilizedmanyopensourcesresources,andwearegratefulformanyopensourcecreator’sgenerosityforsharingthisrichandvaluableinformationopenly,contributingtotheco-creationofhealthysystemsintothefuture.


INTRODUCTION


WELCOME:HowtousethisCurriculumWewanttoextendawarmwelcometothe10VermontACHsembarkinguponthisPeerLearningjourney!Thisisyourcurriculumforthe8-monthLearningLaboratoryexperience.Thecurriculumincludeslogistics,concepts,exercisesandmaterials(intheappendix)tosupportyouandyourACHsaswebecomeaCommunityofPracticeandPeerLearning.Itisrecommendedthatyoureadthroughthecurriculum,appendixandotherresourcesatahighleveltogetafullsenseoftheresourcesavailable.Duringourin-personsessions,wewillreferencepages,sowerecommendyouhaveitwithyouduringoursessions.Theappendixoffersmanyexercisesforyouruseonanasneededbasis,aswell.Feelfreetousetheresourcesfromherefreely,wejustaskthatyoureferencewherethematerialscamefrom.Ourintentisthatthiscurriculumwillbeavailableforuseandreplicationacrossthestateandotherlocationswhereapplicable.UponcompletionofourLearningLaboratory,thecurriculumwillbeupdatedandre-distributedtoyouincorporatingthetoolsandresourcesweaddinthroughoutourtimetogetherbaseduponlearningneeds.


OURCONTEXT:ChallengesandOpportunities

ACHLEARNINGLABORATORYSHAREDCHALLENGE:

Howmightwelearntogether,acrossourACHstobuildourleadershipcapacities,becomestrongerandmoreequippedtoaddressPopulationHealth

withandforourcommunities?Creatinghealthandwell-beinginandacrossourcommunitiesisacomplexsystemicchallengeandopportunity.Notoneperson,community,ororganizationhastheanswers.Throughpeerlearningthereisanopportunitytocometogetheraslearners,shareourperspectives,andthenbroadenthemthroughexploringsharedpurpose,inquiriesandofferingdiverseviewpoints,whiletappingintocollectivewisdomtogainawidersystemicperspectiveofPopulationHealthandhowtobemoreequippedtoaddresstheneedsofourcommunities.PeerLearningforComplexSystemicChallengesPopulationHealthisacomplexsystemicchallenge.Itiscomplexbecausetherearevariousissues,perspectivesandintereststhatmustbetakenintoaccount.Itisasystemicissuebecauseitsrootsandimpactorconsequencesareinterconnectedwithmanyotherissuessuchasindividualandcollectivevaluesandbehaviors,butalsostructuralissuessuchasresourceavailability,distributionofwealth,amongmanyotherrelatedandintimatelylinkedissues.Inordertocreatelastingandimpactfulchange,itisessentialthatmultipleperspectivesanddiversestakeholdersdirectlyaffectedbythechallengesareinvitedtoactivelytakepartintheprocessoffindingholisticsolutions.Thisprocessrequiresmovingawayfrombusinessasusual,whereexpertsaloneorindividualsholdingformalhierarchicalpositionscreatesolutionsonbehalfofthewhole.Incomplexity,notoneperson,noragroupofexpertshavealltheanswers.Holisticsolutionscanonlybefoundwhendiversestakeholderscometothinkandco-createtogether.Thisrequirestolistenwithintentiontoeachother’sperspectives,beingwillingtohaveone’spointofviewchallengedandseeingtogethersolutionsthatnobodycouldhaveseenontheirown.Asshownintheimagebelow,sixblindmenareeachtouchingapartofanelephant,butdon’tknowwhatthewholeelephantlooksorfeelslikeoreventhatitisanelephant!Together,iftheysharetheirideasandsensations,theymayeventuallyfigureoutthattheyaretouchingahugeanimal-anelephant.Similarly,stakeholderswithinacomplexsystemcanonlyseepartofthesystemtheyareworkingin.Whiletheirindividualvantagepointsareessentialtosolvingapieceofthepuzzle,ittakesmanyvantagepoints,learningtogether,toseemoreofthewholesystem.Itismerelyimpossibleforonepersontoseeanentirecomplexsystem,soitbecomesimperativetoincludeasmanydiverseperspectivesaspossible,andtohelpstakeholdersincreasetheircapacitytoseebroadly,througheachother’seyes.


TheintentofthisLearningLabistobecomeacommunityofpractice,wherewehaveasharedpurpose,acommonlanguageandcommontoolsandresourcesatourdisposaltoworkandthinktogether,tocomeupwithsolutionstocomplexchallengesbyreframingthemasopportunities.Weknowthatwhenworkingincomplexsystems,wearestrongerandmorecapablewhenwecometogetherandlearnwithoneanother.Thisisaninvitationtofullybringyourperspectivetothetable,andlearntogetherwhatwecouldneverlearnonourown.Weareexponentiallywiserwhenwehavetherightstructuresinplacetolearnwhatitiswedonotyetknow.Thisisatimeofsharingandexpandingourperspectivessothatwecanhavegreaterimpactsinthecommunitiesweserveandhavemorepeopleinournetworksthatcansupportuswhenwedon’thavetheanswers.ThisisanopportunitytobecomeacommunityofpracticewellintotheextendedfutureforthesakeofVermont,andthehealthandqualityoflifeforallofthestate’sinhabitants.


WHYACCOUNTABLECOMMUNITESFORHEALTH(ACH)?TheACHmodelisoneresponsetoaddressingthecomplexhealthneedsinourcommunities.TheACHis:

Anaspirationalmodel—accountableforthehealthandwell-beingoftheentirepopulationinitsdefinedgeographicareaandnotlimitedtoadefinedgroupofpatients.Populationhealth

outcomesareunderstoodtobetheproductofmultipledeterminantsofhealth,includingmedicalcare,publichealth,genetics,behaviors,socialfactors,economiccircumstancesand

environmentalfactors.AnACHsupportstheintegrationofhigh-qualitymedicalcare,mentalandbehavioralhealthservices,andsocialservices(governmentalandnon-governmental)forthoseinneedofcare.Italsosupportscommunity-widepreventioneffortsacrossitsdefinedgeographic

areatoreducedisparitiesinthedistributionofhealthandwellness.ThePreventionInstitute’sengagementwithVermontprovidedasetofrecommendationsforanACHstructure.Therecommendationsinclude9CoreElements(listedbelow).ThispeerlearningopportunityisinparttosupporttheexplorationandintegrationofthesecoreelementsintoyourACHstogivestructure,formandtoolsforarobustACH.Someofyoumayhaveidentifiedthesealready,someofyoumaynothavedonesoandsomemaywanttoenhancewhathasalreadybeendoneasaresultofnewlearnings.9CoreElementsidentifiedbythePreventionInstitutefortheACHmodel:1. Mission–AneffectiveACHmissionstatementprovidesanorganizingframeworkforthework.Astrong

missiondefinestheworkaspertainingtotheentiregeographicpopulationoftheACH’sregion;articulatestheACH’sroleaddressingthesocial,economic,andphysicalenvironmentalfactorsthatshapehealth;andmakeshealthequityanexplicitaim.

2. Multi-SectoralPartnership–AnACHcomprisesastructured,cross-sectoralallianceofhealthcare,public

health,andotherorganizationsthatimpacthealthinitsregion.Partnersincludethebreadthoforganizationsthatareabletohelpitfulfillitschargeofimplementingcomprehensiveeffortstoimprovethehealthoftheentirepopulationinitsdefinedgeographicarea.

3. IntegratorOrganization–Tomaximizetheeffectivenessofthemulti-sectoralpartnership,itisessentialfor

theACHtohaveanintegratororganization.TheintegratorhelpscarrythevisionoftheACH;buildtrustamongcollaborativepartners;convenemeetings;recruitnewpartners;shepherdtheplanning,implementation,andimprovementeffortsofcollaborativework;andbuildresponsibilityformanyoftheseelementsamongcollaborativemembers.

4. Governance–AnACHismanagedthroughagovernancestructurethatdescribestheprocessfordecision

makingandarticulatestherolesandresponsibilitiesoftheintegratororganization,thesteeringcommittee,andothercollaborativepartners.

5. DataandIndicators–AnACHemployshealthdata,sociodemographicdata,anddataoncommunity

conditionsrelatedtohealth(suchasaffordablehousing,foodaccess,orwalkability)toinformcommunity


assessmentandplanning,andtomeasureprogressovertime.Itencouragesdatasharingbypartnerstoinformtheseactivities.Equallyimportant,anACHseeksouttheperspectivesofresidents,healthandhumanserviceproviders,andotherpartnerstoaugmentandinterpretquantitativedata.

6. StrategyandImplementation–AnACHisguidedbyanoverarchingstrategicframeworkand

implementationplanthatreflectsitscross-sectorapproachtohealthimprovementandthecommitmentbyitspartnerstosupportimplementation.Theprocessfordevelopingthisframeworkincludesapreventionanalysisthatidentifiescommunityconditionsthatareshapingillnessesandinjuriesacrossthecommunity.Theimplementationplanincludesspecificcommitmentsfromhealthcare,localgovernment,business,andnonprofitpartnerstocarryoutelementsoftheplan.

7. CommunityMemberEngagement–Authenticcommunityengagementisawell-recognizedbestpracticein

thefieldofcommunityhealththatrequirescommitmentfromthehighestlevels,designatedstaff,andcommensurateresourcestoensureeffectiveintegrationintoACHprocessesandsystems.Authenticcommunityengagementrecognizesandharnessesresidents’ownpowerinidentifyingandaddressingchallenges,whilealsocreatingleadershipforandbuy-inoftheworkinamannerthatacknowledgesandbuildsuponexistingcommunityassetsandstrengths.

8. Communications–AnACHemployscommunicationsplatformstobuildmomentum,increasebuy-in

amongstitspartners,recruitnewmembers,andattractgrantinvestmenttosupportitswork,andsharesuccessesandchallengeswithothers.Communicationsisalsoakeytoolforframingsolutionsintermsofcommunityenvironmentsandcomprehensivestrategies.

9. SustainableFinancing-AnACHrequiresresourcestosupportbothitsintegratorfunctionandACH

implementationworkbyothers.AnACHmakesuseofexistingandnewfundingsourcesandbetteralignsthemtoadvancebroadcommunitygoals.(PreventionInstitute,July2015)

Formoreinformation,goto:AccountableCommunitiesofHealthReport

http://www.preventioninstitute.org/component/jlibrary/article/id-366/127.html


OBJECTIVESOFACHPEERTOPEERLEARNINGOverthecourseofthenext8monthswehopeto:

• IncreaseparticipatingAccountableCommunityofHealthsitesunderstandingofthe9CoreElementsofanACH;

• IncreaseAccountableCommunityofHealthsitesreadinesstoimplementthe9coreelementswithandforcommunities;

• Increasecommunities’understandingofcommunity-basedpreventionandpopulationhealthimprovementstrategies,andsupportcommunitiesinimplementingthesestrategies;

• Increaseparticipant’scapacitytonavigatecomplexchallengesandco-createsolutionswiththeirpeersintothefuture;

• OfferrecommendationstothestateonpoliciesandguidancethatcouldsupportfurtherdevelopmentofACHsinVermont.


SCHEDULE+LOGISTICS


IMPORTANTDATES

JOURNEYMILESTONES DATESACHKick-offWebinar

June1,2016

1. STEPPINGUP:SHAREDINTENTDesignTeamMeeting(localfacilitators,optional)ACHFullGroupConveningFacilitatorsPrepDay(LocalFacilitators)

June6,2106June7,2016June8,2016

2. STEPPINGIN:DEEPIMMERSIONKnowledgeCamp

(EachLocalACHwillsetuptheirownschedulesfortheyearwiththeirteamsandlocalfacilitators)

Dates:TBD

3. STEPPINGIN:MEANINGMAKINGDesignTeamMeeting(localfacilitators,optional)ACHFullGroupConveningFacilitatorsCall

September29,2016September30,2016TBD

4. STEPPINGIN:CO-PROTOTYPINGKnowledgeCamps

(EachLocalACHwillsetuptheirownschedulesfortheyearwiththeirteamsandlocalfacilitators)

Dates:TBD

5. STEPPINGOUT:CO-EVOLVINGDesignTeamMeeting(localfacilitators,optional)ACHFullGroupConvening

January12,2017January13,2017


CURRICULUMOVERVIEW:MILESTONES+OBJECTIVESPhase1:June7Convening

STEPPINGUPSharedIntent:BecomingaPeerLearningCommunityObjectives

• Becomeapeerlearningcommunityandgettoknowoneanother• ProvideanoverviewoftheACHPeerLearningLabinpreparationforouryear• Learnandusetoolsandmethodologiestosupportco-learning,co-creationandreplication• IncorporatingasystemicperspectiveofwhatisneededinVermontACHs• UnderstandthecollectivedesignchallengeandbegintoworkinourteamsaddressingtheDesign

Challenge(9CoreElements)• Setuptheframeworkfortheyearforlearning,leading,andchange

Phase2:KnowledgeCampDateTBD

STEPPINGINDeepImmersion:GainingaSystemsChangePerspectiveObjectives

• Increaseawarenessofthecurrentsystemyouareoperatingin• Completestakeholderinterviewswithindividualsdirectlyaffectedbyissuesofconcernandthosethat

careaboutthematterathand• Increaseabilitytoobserveandlistentothosewhoseknowledgeandexperiencecanhelpparticipants

fast-trackthelearningprocess

Phase3:September30Convening

STEPPINGINMeaningMaking:SharingandIntegratingwhatwearelearningfromthefieldObjectives

• Reflectonlearningsfromyourexperience• DesignChallenge:Co-exploreourlearningandworktogethertosolvecomplexchallengesand

opportunitiesemerginginourACHEsandcommunities• Learntools,models,andframeworksforworkingwithcomplex,adaptivechange• Planfornextstageoftheaction-learningjourney-howtocreatelearningandimpact• Identifyemergentsolutionstoissuesofsharedconcern/intentthatarearisingfromthelearningsand

observations• Co-Explorethe9ACHcoreelementsandothertopicsthataremeaningfulandrelevant


Phase4:KnowledgeCampsTBD

STEPPINGINCo-Prototyping:Co-creatingtheFutureObjectives

• IncreasecapacitytopilottestandprototypeideasgeneratewithintheACHteam• Engageinexperimentations(prototyping)ofideasandactionsthatmaytakethemtothedesiredstate

oftheACH• Crystalizeideasthroughaniterative(repeatedmovementofgoingforwardandbackwardwiththeaim

ofimprovingsomething)processofcoachingandsupportfrompeersandsubjectmatterexperts(includingusers,practitioners

• Documentlearnings

Phase5

STEPPINGOUTCo-Evolving:PlanningNextStepsintotheFutureObjectives

• Presentandsharedesignchallengeoutcomeandlearningtodate• Reflectuponthelearningexperience• Plannextstepsandimplementationplanforandourongoingworkintothefuture-includingpreparing

formeetingsandactionlearningemphasis• Offerrecommendationstothestateonpoliciesandguidancethatcouldsupportfurtherdevelopmentof

ACHsinVermont


STAYINGCONNECTEDStayingConnectedInadditiontotheFullGroupConveningsandKnowledgeCamps(notedonthescheduleonpage12),wewillbeusinganumberofinformationsharingresourcestofacilitateourlearningtogether.Alloftheseareoptional,butweencouragetoexploreallofthemincasetheycansupportand/orinspireyou:HumanConnections

LocalfacilitatorsManyofyouhaveafacilitatorwithinyourACHthatissupportingyouthroughoutthePeerLearningLab.Wewillbeprovidingthemwithsupportandmaterials.IfyoudonothaveafacilitatorwithinyourACH,AdrienneGilfromtheVermontPublicHealthInstitutewillbesupportingyourACH.Adrienne’semailaddressiswilscheka@yahoo.com.Pleasecontactherforsupport.TechnologicalConnections

Linkedinhttps://www.linkedin.com/groups/7050279LinkedinwillbeasharedplatformfortheentireACHPeerLearningcommunitytoconnect,shareandcontinuelearning,particularlywhenwearenottogether.Pleasepostresources,questions,requestsandoffershere.Ifyougotolink,pleaseasktobeinvited.TheBlueprintofWewww.blueprintofwe.comTheBlueprintofWeisanonlinecollaborationtoolthatmaybeusefulinbuildingafoundationofknowledgeandunderstandingaboutyourteammates.Thetoolenablesteamstocustomdesignrelationshipstoreallyfitwhoyouareandwhatyouwanttobuildtogether.Itwiresyourbrainformoreconnectionandcompassionandactsasathirdpartymediatorwhentheneedarises.StateandNationalConnections

Dialogue4Health(D4H)http://www.phi.org/dialogue4health/ThisistheplatformwewillbeusingforKnowledgeCamps.D4HisaprojectofPHI,isacommunitythatconceives,buildsandsharesstrategiestoimprovethepublic'shealth.D4Hpartnerswithlocal,nationalandglobalorganizationstohostWebForumsandsharecriticalresources.Formoreinformationonthisplatform,pleasecontactMaricsaMontereymgutierrez@s-r-g.orgVermontStateHealthCareInnovationProjecthttp://healthcareinnovation.vermont.gov/ThisisthesponsoringagencyofACH.


OURAPPROACH:Co-LearningandCo-Creating


OVERVIEWOFRESEARCH-BASEDAPPROACHESANDLANGUAGEGUIDETosupportourpeerlearningtogether,wewillutilizemanymethodologies,practices,toolsandframe-workstosupportadultlearningthroughactionlearning.Includedinourapproach,butnotlimitedto:TheoryofUwww.presencing.com/overviewTheoryUproposesthatthequalityoftheresultsthatwecreateinanykindofsocialsystemisafunctionofthequalityofawareness,attention,orconsciousnessthattheparticipantsinthesystemoperatefrom.Sinceitemergedaround2006,TheoryUhascometobeunderstoodinthreeprimaryways:firstasaframework;second,asamethodforleadingprofoundchange;andthird,asawayofbeing-connectingtothemoreauthenticofhigheraspectsofourself.ThetheorywasdevelopedbyOttoScharmerisaseniorlectureratMIT,Boston,avisitingprofessoratTsinghuaUniversity,Beijing,andco-founderofthePresencingInstitute.Aglobalactionresearcher,Ottoworkswithleadersingovernment,globalcompanies,andNGOstoachieveprofoundinnovationacrosssectorsandcultures.HechairstheMITIDEASprogramforcross-sectorleadershipcapacitybuildinginChinaandIndonesia.ArtofHostingConversationsthatMatterhttp://www.artofhosting.org/what-is-aoh/case-stories/isaglobalcommunityofpracticethatusesmanymethodologies,frameworks,practicesandtoolsthatsupportco-learningandco-creation.TheArtofHostingisanapproachtoleadershipthatscalesupfromthepersonaltothesystemicusingpersonalpractice,dialogue,facilitationandtheco-creationofinnovationtoaddresscomplexchallengesandopportunitieswithemergentsolutions.LivingSystemsareopenself-organizinglivingthingsthatinteractwiththeirenvironment.Thesesystemsaremaintainedbyflowsofinformation,energyandmatter.Throughourwork,welooktopatternsfoundinnaturetosupportself-organizationthroughconceptssuchasincludingdiversity,decentralizedleadership,innovationhappeningattheedgesofaneco-system,utilizingcollectiveresourcesandotherconceptsandmetaphorstogleanwisdomfromnaturetoinformouroperatingprinciples.Systemsthinkingistheprocessofunderstandinghowthosethingswhichmayberegardedassystemsinfluenceoneanotherwithinacompleteentity,orlargersystem.Withinasystem,theinterrelatedandbigpicturethinkinghelpsuscreateholisticsolutionsbyincludingdiverseperspectivesandmovingawayfromsiloedapproaches.Wecreatesolutionsthataddressrootcauses,informedbymanyperspectivesratherthanquickfixesorexpertdrivenwhenachallengeiscomplexandnotoneperspectivehastheanswer.CynefinFrameworkhttp://cognitive-edge.com/resources/case-studies/providesatypologyofcontextsthatguideswhatsortofexplanationsorsolutionsmightapply.Itdrawsonresearchintocomplexadaptivesystemstheory,cognitivescience,anthropology,andnarrativepatterns,aswell


asevolutionarypsychology,todescribeproblems,situations,andsystemsandproposesnewapproachestocommunication,decision-making,policy-making,andknowledgemanagementincomplexsocialenvironments.HumanCenteredDesignDesignThinkingfocusesontheend-usersatthecenterofitsapproach.Akeyelementoftheapproachistoobserveandinterviewtheenduserstoincreaseunderstandingoftheirperspectivesandneeds.Forexample,ifyouwanttoseehowachildselectstheirlunchfood,observethemgoingthroughthecafeterialine.Thentrytoseewhatitisliketobeintheirshoes,alsoknownasempathy.Byengaginginbothempathyandobservation,co-creatorsbecomemoreequippedtodesignsystemsthatsupporttheendusers,orinourcase,communitiesweareserving.


THINKINGANDACTINGSYSTEMICALLYThinkingandActingSystemically:ConcentricCircleFramework

Whatdoesitmeantohaveasystemicapproach?ThinkUpstreamandAddressRootCausesAsasystemsthinker,itisanimportanttolookforupstreamsolutions--solutionsthataddressthesourceoftheproblemratherthandownstreamsolutions-whichoftenworkonlyonsymptomsoftheproblem,onlyforittoreemergeasanotherchallenge.Ananalogyfordownstreamsolutionsiswhack-a-mole!Youkeeptryingtohitthemolethatpopsupandthenitcomesupinanotherlocation-itisneverreallydealtwith.


“EffortstoimprovehealthintheUnitedStateshavetraditionallylookedtothehealthcaresystemasthekeydriverof

healthandhealthoutcomes.TheAffordableCareAct(ACA)increasedopportunitiestoimprovehealthby

expandingaccesstohealthcoverageandsupportingreformstothehealthcaredeliverysystem.Whileincreasingaccesstohealthcareandtransforming

thehealthcaredeliverysystemareimportant,researchdemonstratesthat

improvingpopulationhealthandachievinghealthequityalsowillrequire

broaderapproachesthataddresssocial,economic,andenvironmental

factorsthatinfluencehealth(reference.)”

http://kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-

health-and-health-equity/)SocialdeterminantsofHealtharereferredtoasconditionsintheenvironmentsinwhichpeoplelive,learn,work,play,worship,andagethataffectawiderangeofhealth,functioning,andquality-of-lifeoutcomesandrisks.Conditions(e.g.,social,economic,andphysical)inthesevariousenvironmentsandsettings(e.g.,school,church,workplace,andneighborhood)havebeenreferredtoas“place.”Inadditiontothemorematerialattributesof“place,”thepatternsofsocialengagementandsenseofsecurityandwell-beingarealsoaffectedbywherepeoplelive.http://www.cdc.gov/socialdeterminants/faqs/index.htmSocialDeterminantsofHealthpayalargefactorinone’shealthandwellness.Ifweonlyaddressillnessuponitsoccurrenceandorrecurrenceandwedon’ttakeasystemsapproachtopreventillnessfromthestart,weareconstantlygoingtobereactingtoillnessratherthanpreventingitinthefirstplace.AsanACHitwillbenecessarytocollectivelyemploysystemsthinkingtoaddresstherootcausesofaproblem.Whenyoubegintolookatchallengesinyourcommunities,youneedtogodirectlytothesource,toaskpowerfulquestionsandtobegintoseetherootcausesandworkingtoaddressthoserootcausesratherthansymptomsthatshowupasillnessorlackofwellness.LeveragePointsLeveragePointsareplacesinacomplexsystemwheresmallshiftsinonethingcreateBIGimpactsandshiftsonalargescale.(D.Meadows,SystemsThinking).Identifyleveragepointsthatwillenablechangeandidentifythesepriorityareaswithinthesystem.


ConcentricCircles:LeveragePointsforImpactLEADERSHIPATTHESYSTEMICLEVELAtthecenteroftheconcentriccirclemodel,isleadership.Thisisanindividualwithinthesystemworkingtoaffectchange.Thereisaneed,asaleadertoidentifyhowyouinfluencethesystemsaroundyou.Whatimpactsdoyouhopetomakeandwhere?Howdoyoushowupasateammemberandenablestrongcoreteamstoemerge?Howdoyouinitiateengagingthecommunityyouareworkingtosupport?

HigherPurposeConnectingtoyourhigherpurpose,youruniquegiftsandskillsandwhatyourcommunityisaskingofyouisanimportantaspectofleadership.Explorewhyyouareembarkingonthispeerlearningjourneyandtheimpactsyouhopetomake.

WorldvieworMentalModelsAsaleaderyouhaveaworldview,whichinformshowyoumakesenseoftheworldaroundyou.Ourworldviewsormentalmodelsaremadeupofourvalues,beliefs,assumptions,attitudes,andideas.Theseimpacteverythingfromhowweunderstandthenatureofrealitytohowwerespondtotheenvironmentaroundus.Eachperson’sworldviewinfluencestheirgoalsanddesires,consciouslyandunconsciouslyshapingperceptions,motivations,andvalues.Theconvergenceofourindividualcharacteristicsandouruniquehistory,includingourlifeexperiences,region,culture,religion,socioeconomicstatus,andfamilyareexpressedthroughourworldview.Ourworldviewsinformandaffectourindividualrealitiesandtheactionswetakeintheworld.Thereisaninfinitemultiplicityofworldviewsandmorethanone“right”wayorperspective.Eachofushasourownuniqueworldview.Weareeachpartofacomplex,ever-changing,interconnectedlivinguniverse.Whatwedoinfluencestheworldaroundus,andtheworldaroundusinfluencesus,evenwhenwearenotawareofexactlyhow.Greaterunderstandingoftheinterdependenceofalllifeleadstoamorecompleteviewofreality.(AoHWorkbookJournal)

LimitingbeliefsSomuchofwhatwedowhenweorganizeourselvesisbasedonunquestionedmodelsofbehavior.Thesepatternscanbehelpfulbuttheycanalsolimitusinfulfillingourtruepotential.Wecannotcreateinnovationintheworldusingoldmodelsandapproaches.Itpaystoexaminewaysinwhichweassumeworkgetsdoneinordertodiscoverthenewwaysthatmightserveworkwithnewresults.Engaginginthisworktogetherbringsusintoaco-creativeworkingrelationship,wherewecanhelpeachotherintonewandpowerfulwaysofworkingtogether,alleviatingthefearandanxietyoftheunknown:Whatmakesustremble,andwhatdowefearaboutnewwaysofworkingtogether?Whowouldwebewithoutourstoriesofoldwaysofworking?Whatwillittakeforustofullyenterintoworkinginnewandunfamiliarways?Whatisourownlearningedgeinworkingtogether?Whatdoyouneedfromourcoreteamtofeelsupportedintheplacesthatmakeyouanxious?- ChrisCorrigan,ChaordicSteppingStones


STRONGACHCORETEAMSStrongCoreTeamsarethefoundationfordoinggoodworkandnavigatingcomplexadaptivesystems.Creatingtheconditionsthatenabletrust,listening,sharing,beingpresentandco-creatinginanenvironmentwherelearningtakesrootisessentialtothiswork.Whenworkingincomplexsystems,weneverknowwhattheoutcomeswillbeandoftentimesweneedtoadaptourapproachandcomeaboutourworkinanewway.Havingateamwithopenminds,curiousandwillingtofindemergentsolutionstogethermakesallthedifferencebetweenteamsuccessandbreakdown--whichinturnimpactsouroverallsuccessinsupportinghealthycommunities.

AnEffectiveTeamTakethetimetobetterunderstandyourteam.Anessentialpartofforminganallianceistheabilitytocollaborateandworkwellwithyourteammates.SeetheStayingConnectedsectionforinformationonananonlinecollaborationtoolandprocesscalledTheBlueprintofWe(www.blueprintofwe.com).Theaimofthiscollaborationdocumentistobuildafoundationofknowledgeandunderstandingabouteachother,sothattheteamcandiveinandactivatetheircreativityandcollectiveintelligencetobringgoodthingstolife.

COMMUNITYENGAGEMENTATTHELOCALLEVELItisnotunusualtoassumewehavetheanswerstocomplexchallenges,whenwedonotyethaveasenseofthesystem.Ittakescuriosity,anopenheartandanopenmindtotakethetimetodeepenyourunderstandingofthecommunitiesyouaimtoserveandlistentothemanyperspectivesthathaveapieceofthepuzzleforthecomplexchallengeyouareworkingtosolve.Therearemanyresourcesforyoutousetoengagecommunitiesanddesignexperiencestodeepenyourunderstandingofthesystemsyouworkingtocreateimpactin.SeeArtofHostingJournal,CollectiveActionToolkit,DesignThinkingWorkbooksandthinktogetherwithyourcoreteamandstakeholdersinthesystemtoformulatearelevant,meaningfulandproductivecommunityengagement.COMMUNITYOFPRACTICEInordertobecomeasystemofinfluence,itisimportanttohavesharedlanguage,practices,methodsandframeworkstousetogether.Thisenablesyoutocometogethermorequicklyandtodiveintowhatneedsyourattentionandworktogetheradaptivelyandeffectivelytogether.AsaPeerLearningCommunity,youarestrongertogetherthanyouareonyourown.Ourhopeisthatyouwillcontinuethisworklongintothefuture,beyondthese8months.Duringourworktogether.ourhopeistoleaveyouasaCommunityofPracticewithtools,frameworks,methodsthatyoucontinuetousetogether,acrosstheState,inservicetocreatinghealthinandforyourcommunities.

HEALTHYVERMONTANDBEYONDAllofthisisinservicetocreatingaHealthyVermont.Supportingtheentirestateinmovingtowardswellbeingtakesalotofdedication,commitment,sharedunderstandingandcomplexadaptiveproblemsolving.Usethisbookinservicetohoningonwhatisyourindividual,team,communityandstateworktodoinrealizingthisfuture,together.


Onceyoucreatehealthacrossthestate,seeifyoucanwidentheboundariesofthesystemandbeginsupportingothersoutsideyourstateincreatinghealthandwell-beingintheircommunities.


OURFRAMEWORK+JOURNEY


OVERVIEW:OurCo-CreationFramework

TheoryU+SystemsChangeOurframeworkisaversionofco-creationmethodologyforsystemschangeknownasTheoryU,whichwasoriginallycreatedbyOttoCScharmeroftheMassachusettsInstituteofTechnology(MIT).Itisbasedonavastbodyofresearchofthepracticeofsomeofthemostinnovativeleaders,teamsandorganizationsaroundtheworld.Ithasprovencapacitytodeliverqualityresultsbytappingintothethinkingandexperiencesofdiversestakeholdersfromacrosssectors.Whydoourattemptstobringaboutsustainablelarge-scalesystemchangeorinnovationoftenfail?Theansweroftenliesintwoissues.First,ourinabilitytoworkbeyondsilosofdepartments,organizations,orsectors.Secondthefailuretotapintotheknowledge,wisdomandexperiencesofmultiplestakeholders.Thismethodologyaimstoactivelyincreaselevelsofawarenesstopreventsystemicfailure,andactivelycounterthesetwoissuesthroughsystemsthinkingandtappingintocollectivewisdomofdiversestakeholders.TheKeyStagesoftheCo-creationFrameworkThefollowingstagesaresequential,butnon-linear.Asonestagestartsitcancontinueorrepeatedlyappearthroughoutthewholeprocess.However,asawholewewillframeourlearningyearas:Phase1willbethefirstpartofourPeerLearningJourney:SteppingUPPhase2,3and4willbethesecondpartofourPeerLearningJourney:SteppingINPhase5willbethethirdandlastpartofourPeerLearningJourney:SteppingOut


SteppingUpPhase1:SharedIntentThisphaserequiresparticipantstostartbylisteningtooneanother,sharingthedeepestintentthroughengaginginconversationsandseekingsolutionstocreatinghealthacrosstheStateofVermont(VT).Asmanyofusaregatheringfromvariousbackgrounds,itisimportanttohearwhatistheintentforoursharedworkandhowcanwebestsupportoneanotherincreatinghealthwithandforourcommunities?Likewise,begintolistentoyourowncommunities,howtheybelievehealthiscreated,thebarrierstheyconfronttoaccessinghealthandthemanymanyavenuesthatcanleadonetowardslivingahealthylifeandwell-being.Theseindividualstoriesandintentionsevolveintoonecommonintent–thedesireandcommitmenttoensuringhealthacrosstheVT.Itisthiscommonintentthatisgeneratingthecommitmentandenergyneededtoworktogetheracrossourcommunitiestoachievethetasksathand.SteppingINPhase2:DeepImmersionAftergeneratingsharedandcommonintent,participantswillembarkuponsensingjourneystodeepentheirlearningaboutthetask.Co-sensingisaboutlearningfastthroughobservingandlisteningtothosewhosedepthofknowledgeandexperiencecanassistparticipantsfast-trackthelearningprocess.DivideintoACHgroupsandimmerseyourselvesinalearningprocess.Participantssuspendtheknowledgetheyhadonhealthintheircommunitiessothattheycouldlearnwithfresheyes.Gotodifferentinstitutionsandpeople(experts,practitionersandusers)tolearnfastaboutthechallenges.Forinstance,planadayintownandaskcommunitymembersonthestreetshowtheydefinehealth,whatmakesthemhealthyandwhatbarriersdotheyconfronttobeinghealthy.Gooutandspeaktocommunitymembers,academics,policymakers,otherACHsinandoutsideVermontandfindouttheirperspective.SteppingINPhase3:MeaningMakingAfterimmersingyourselvesintofastanddeeplearningexperiences,participantsgathertogethertoreflectonthemeaningofwhattheyhavelearnt.Varioustechniques,atthisstageareusedtodeepenthelearningandpicturethevisionofthefuturetheywantedtoworktowards.Sometimesitisessentialtoembarkupona“Solo-Walk”.Asolo-walkisapracticewhereoneobservesreflectivesilenceforaperiodoftime,takingadvantageofthenaturalbeautyfoundinnaturetoreflectuponwhattheyarelearning,andperhapstheirroleinsupportingthechangeneeded.Afterthesolo-walk,participantscomebacktogethertosharetheinsightstheyhadgainedduringreflectivemoment.Thiscanalsobeaparticipatoryprocessformulti-stakeholderdialoguethatallowsparticipantstocreatesharedvisionofthefuture,identifykeygapsandbarriersanddevelopinitiativesforclosingthegaps.SteppingINPhase4:Co-PrototypingAftermakingmeaningfromdeepimmersion,beginco-creatingthedesirablefuturethatiswantingtohappen.Thisisatimeforexperimentations(prototyping)ofideas,services,productsandpotentialactionsthatwillbringustoourdesiredstate.Inthisphaseweexperimentandplaywithpotentialideasandsolutions.Thegoalhereistocrystalizeideasthroughaniterative(repeatedmovementofgoingforwardandbackwardwiththeaimofimprovingsomething)processofcoachingandsupportfrompeersandsubjectmatterexperts(includingendusers,practitioners,communitymembersandthosedirectlyaffectedbythechallenge).


Theprocesssupportscontinuouslearninganditerationsothatallworkisimprovedupontoproviderigorandincludemultipleperspectives.SteppingOutPhase5:Co-evolvingIdeasthathavebeentestedandimprovedintheprototypingphasecanbetranslatedintoadetailedimplementationplanwithclearindicationoftheresourcesrequiredtobringaboutdesiredchange.Issuesthatcould‘power’initiativesorresponsesaremovedforward.Itisimportanttoharvestandmakeknownthelearningandhowitleadstothisplan.


PHASE1:

STEPPINGUPSharedIntent:BecomingaPeer

LearningCommunityThisphaserequiresparticipantstostartbylisteningtooneanother,sharingthedeepestintentthroughengaginginconversationsandseekingsolutionstocreatinghealthacrosstheStateofVermont(VT).Asmanyofusaregatheringfromvariousbackgrounds,itisimportanttohearwhatistheintentforoursharedworkandhowcanwebestsupportoneanotherincreatinghealthwithandforourcommunities?Likewise,begintolistentoyourowncommunities,howtheybelievehealthiscreated,thebarrierstheyconfronttoaccessinghealthandthemanymanyavenuesthatcanleadonetowardslivingahealthylifeandwell-being.Theseindividualstoriesandintentionsevolveintoonecommonintent–thedesireandcommitmenttoensuringhealthacrosstheVT.Itisthiscommonintentthatisgeneratingthecommitmentandenergyneededtoworktogetheracrossourcommunitiestoachievethetasksathand.

CONVENING1:AGENDAJune7,2016

Objectives• Becomeapeerlearningcommunityandgettoknowoneanother• ProvideanoverviewoftheACHPeerlearningLabinpreparationforouryear• Learnandusetoolsandmethodologiestosupportco-learning,co-creationandreplication• IncorporatingasystemicperspectiveofwhatisneededinVermontACHs• UnderstandthecollectivedesignchallengeandbegintoworkinourteamsaddressingtheDesignChallenge(9Core

Elements)• Setuptheframeworkfortheyearforlearning,leading,andchangeAgendaItem TimeWelcome 9:30amMorningSessionWeavingourLearningCommunityTwoLoopsofSystemsChangeWorldCafe

9:30am–12:45pm

12:45pmto1:45pmLunchBreakAfternoonSessionACHsWorkingGroupsRequestsandOffers

1:45pm4:30pm

ClosingandComplete 4:30pm


ActivitiesandToolstosupportyouinthisPhase(seeAppendix)⇒ FourLevelsofListening+Talking

⇒ Co-CreatingOperatingPrinciples⇒ VermontLearningLabBaselineAssessment:9CoreElements⇒ DesignChallenge⇒ Backcastingexercise⇒ SculptingCurrentReality⇒ IdentifyingSharedIntent⇒ HowMightWe….⇒ NineWhy’s⇒ Crowdsourcing⇒ AffinityMapping⇒ ChaordicSteppingStones⇒ Buildingastrongcoreteam⇒ Hostinganeffectiveconferencecallormeeting⇒ Check-inCircles⇒ SettingGoalsfortheYear⇒ Harvesting:SeeArtofHostingWorkbookaboutdocumenting,disseminatinginformationandproducing

materialsafteryouconvenetoensuretheoutputsaresharedandusedmovingforward.


PeertoPeerACH

LearningLabDesignCHALLENGE:

HowmightwecreateanawardwinningACH?

StartingJune7,2016,weareissuingtheVermontACHChallenge!

TheAccountableCommunityofHealth(ACH)modelhasemergedasonestrategyforseveralstatesandlocal/regionalcommunitiestocometogethertoimprovehealth.

WecallontheVermontACHstoacceptthechallengetobuildmeaningfulpartnershipswithcommunity

members,hospitals,healthsystems,providers,community-basedorganizationsandlocalhealthdepartments,tocreateanAccountableCommunityofHealthrecognizedbythecommunityforitsinnovativeand

collaborativeapproachestoimprovepopulationhealth.TheVermontDepartmentofHealthCareAccessandtheVermontDepartmentofHealthhavejoinedinpartnershiptosupportlocalcommunitiesacrossthestateofVermonttocreateanACHthatgeneratesapositivehealthimpact.DuringtheVermontACHPeerLearningLab,communitieswilllearnandworktogethertoidentify,accelerate,andspotlightwhatworksbestforthemintheirACHstructure.In2015,theDepartmentofVermontHealthAccesssecuredthePreventionInstitute(PI)toresearchtheemergingACHmodel.ThePIreportidentifiedninerecommendedelementsofanACH(seebelowforlistofelements).TheACHmodelisinthedevelopmentalstageandmostcommunitiesdonothavealltheenvisionedelementsinplace.NominationsfromeachACHcommunitymakeitpossibleforaward-winningstrategiestogaintherecognitionandsupporttheydeserve.ThisawardprovidesanopportunityforthecommunitytorecognizeexceptionalcontributionstheACHmadetoimprovehealthandqualityoflife.OnJanuary13,2017,eachACHsitewillsharetheirworkthatthecommunityrecognizedasvaluable.Possibleexamples:• CommunityrecognizesandvaluesthestrongalliancestheACHhaswithbusiness,governmentandothersneededto

supportcommunityhealth• Demonstratedreturnoninvestmentthatsustainsandsupportsupstreamprevention• Disparitiesaredecreasedthroughacomprehensivesystemsapproachthatcreatedincreasedaccesstohealth

promotingservicesforall• Communitymembersunderstandandusetheirbenefitsdemonstratedthroughimprovedpatternsofutilization

(preventiveservices,unnecessarycare)andpatientexperience• ProgressonACHelementsandleadershipidentifiedsupportsimportanttoyourcommunity


TheVermontPopulationHealthWorkGroup’sworkingdefinitionofanACHis:

“Anaspirationalmodel—accountableforthehealthandwell-beingoftheentirepopulationinitsdefinedgeographicareaandnotlimitedtoadefinedgroupofpatients.Populationhealthoutcomesareunderstoodtobetheproductofmultipledeterminantsofhealth,includingmedicalcare,publichealth,genetics,behaviors,socialfactors,economic

circumstances,andenvironmentalfactors.AnACHsupportstheintegrationofhigh-qualitymedicalcare,mentalandbehavioralhealthservices,andsocialservices(governmentalandnon-governmental)forthoseinneedofcare.Italso

supportscommunity-widepreventioneffortsacrossitsdefinedgeographicareatoreducedisparitiesinthedistributionofhealthandwellness.”

9ElementsofanAccountableCommunityofHealth1. Mission–AneffectiveACHmissionstatementprovidesanorganizingframeworkforthework.Astrong

missiondefinestheworkaspertainingtotheentiregeographicpopulationoftheACH’sregion;articulatestheACH’sroleaddressingthesocial,economic,andphysicalenvironmentalfactorsthatshapehealth;andmakeshealthequityanexplicitaim.

2. Multi-SectoralPartnership–AnACHcomprisesastructured,cross-sectoralallianceofhealthcare,public

health,andotherorganizationsthatimpacthealthinitsregion.Partnersincludethebreadthoforganizationsthatareabletohelpitfulfillitschargeofimplementingcomprehensiveeffortstoimprovethehealthoftheentirepopulationinitsdefinedgeographicarea.

3. IntegratorOrganization–Tomaximizetheeffectivenessofthemulti-sectoralpartnership,itisessential

fortheACHtohaveanintegratororganization.TheintegratorhelpscarrythevisionoftheACH;buildtrustamongcollaborativepartners;convenemeetings;recruitnewpartners;shepherdtheplanning,implementation,andimprovementeffortsofcollaborativework;andbuildresponsibilityformanyoftheseelementsamongcollaborativemembers.

4. Governance–AnACHismanagedthroughagovernancestructurethatdescribestheprocessfor

decisionmakingandarticulatestherolesandresponsibilitiesoftheintegratororganization,thesteeringcommittee,andothercollaborativepartners.

5. DataandIndicators–AnACHemployshealthdata,sociodemographicdata,anddataoncommunity

conditionsrelatedtohealth(suchasaffordablehousing,foodaccess,orwalkability)toinformcommunityassessmentandplanning,andtomeasureprogressovertime.Itencouragesdatasharingbypartnerstoinformtheseactivities.Equallyimportant,anACHseeksouttheperspectivesofresidents,healthandhumanserviceproviders,andotherpartnerstoaugmentandinterpretquantitativedata.

6. StrategyandImplementation–AnACHisguidedbyanoverarchingstrategicframeworkand

implementationplanthatreflectsitscross-sectorapproachtohealthimprovementandthecommitmentbyitspartnerstosupportimplementation.Theprocessfordevelopingthisframeworkincludesapreventionanalysisthatidentifiescommunityconditionsthatareshapingillnessesandinjuriesacrossthecommunity.Theimplementationplanincludesspecificcommitmentsfromhealthcare,localgovernment,business,andnonprofitpartnerstocarryoutelementsoftheplan.


7. CommunityMemberEngagement–Authenticcommunityengagementisawell-recognizedbestpracticeinthefieldofcommunityhealththatrequirescommitmentfromthehighestlevels,designatedstaff,andcommensurateresourcestoensureeffectiveintegrationintoACHprocessesandsystems.Authenticcommunityengagementrecognizesandharnessesresidents’ownpowerinidentifyingandaddressingchallenges,whilealsocreatingleadershipforandbuy-inoftheworkinamannerthatacknowledgesandbuildsuponexistingcommunityassetsandstrengths.

8. Communications–AnACHemployscommunicationsplatformstobuildmomentum,increasebuy-in

amongstitspartners,recruitnewmembers,andattractgrantinvestmenttosupportitswork,andsharesuccessesandchallengeswithothers.Communicationsisalsoakeytoolforframingsolutionsintermsofcommunityenvironmentsandcomprehensivestrategies.

9. SustainableFinancing-AnACHrequiresresourcestosupportbothitsintegratorfunctionandACH

implementationworkbyothers.AnACHmakesuseofexistingandnewfundingsourcesandbetteralignsthemtoadvancebroadcommunitygoals.(PreventionInstitute,July2015)

http://healthcareinnovation.vermont.gov/sites/hcinnovation/files/Pop_Health/VT%20ACH%20Opportunities%20and%20Recommendations.pdf


ACHPlanningSessionTemplate2-3:30pm

RolesforeachACHWorkingGroup:Facilitator:Supporttheteamwiththeprocess

Scribes:Takenotesforthegroupwhennecessary,sharethenoteswiththeteamandlocalfacilitator.Ensurethattheresultsoftheafternoonaredocumentedorphotographedforfuturereference

TimeKeeper:Keeptrackoftimeandkeepthegroupmovingforwardwiththefacilitator

Note:forlargegroups(over6),divideupinto2groups,eachgrouphavingtheseroleslistedabove.Readthroughall5stepsbeforebeginning:1.ACHLeadershipReflectionShare(20mintotal)Withyourteam,shareleadershipreflections:whatisyourpurpose/ourpurposeforbeinghere?2.ReviewDesignChallenge--seeabove(5mintotal)WehaveissuedadesignChallenge.Itisuptoyoutoacceptit.PerhapsyourACHwantstocreateyourownDesignChallengeforyourACH,youarewelcometochangeit.Comeupwithitnoworusetheonewehaveoffered.3.FocusAreas(10mintotal)


BasedupontheDesignChallenge,wheredoesyourACHwanttocreateanimpactandfocusattentioninthenext8months?Eachpersonidentifytheirpriority,writeitdownonapieceofpaper-sharewiththegroupforaquickround--30secondseachperson!Wewillworkontheseideasthisafternoonandsharethemagainattheendofourworktoprioritizeourfocusareas.4.15%Solutionstriads(30min)Getintogroupsof3(orpairsifthenumbersdon’tpermit)ThiswillbePeertoPeerCoachingandConsultingroundsseehttp://LiberatingStructures.comforfuturereferenceRoles:1personsharestheirIdea(IdeaSharer)2peopleactasPeerCoachesorConsultants.(Youwillrotate3times.AllthreepeoplewillbeIdeaSharersandConsultantstwotimesbytheendofthe30minutes)Steps:

1. Formgroupsof3andhave7-9minutestotalperrotation(3rotationstotal)2. IdeaSharersspend2minutessharingtheidea3. Spend5minutesreceivingfeedbackfromthetwoConsultants4. IdeaSharerspend1-2minutesreflectingbacknewlearningandthankingconsultants5. RotatetonextIdeaSharer

5.PrioritizeFocusAreas(10minutes)ReturntoyourlocalACHgroup(ifyoudividedupintosmallergroups,gobacktotheothergroup)andshareyourideasagainwithnewinsights,posttheIDEAonthewallafteryoupresent.Aftereveryonepresents,everyonevotes(putastaronpage)ontop3ideas.TheIdeaswiththemoststarsbecomestheteam’spriorityareas.SCRIBES:pleasetakenoteofthesepriorityareasforlater.NOTE:whenyoureturntoyourlargerteams,presenttothemhowyougotthesepriorityareasandseeiftheyhavefeedbackandadditionstoconsider.

Returntofullgroupby3:30pm


“Ifyouhavecomeheretohelpme,youarewastingyourtime.Butifyouhave

comebecauseyourliberationisboundupwithmine,thenletus

worktogether.”--LillaWatson


PHASE2:

STEPPINGINDeepImmersion:GainingaSystems

ChangePerspective

Aftergeneratingsharedandcommonintent,participantswillembarkuponsensingjourneystodeepentheirlearningaboutthetask.Co-sensingisaboutlearningfastthroughobservingandlisteningtothosewhosedepthofknowledgeandexperiencecanassistparticipantsfast-trackthelearningprocess.DivideintoACHgroupsandimmerseyourselvesinalearningprocess.Participantssuspendtheknowledgetheyhadonhealthintheircommunitiessothattheycouldlearnwithfresheyes.Gotodifferentinstitutionsandpeople(experts,practitionersandusers)tolearnfastaboutthechallenges.Forinstance,planadayintownandaskcommunitymembersonthestreetshowtheydefinehealth,whatmakesthemhealthyandwhatbarriersdotheyconfronttobeinghealthy.Gooutandspeaktocommunitymembers,academics,policymakers,otherACHsinandoutsideVermontandfindouttheirperspective.

KNOWLEDGECAMPLessonsLearnedfromACHsinotherStates

Objectives

• Increaseawarenessofthecurrentsystemyouareoperatingin• Completestakeholderinterviewswithindividualsdirectlyaffectedbyissuesofconcernandthosethat

careaboutthematterathand• Increaseabilitytoobserveandlistentothosewhoseknowledgeandexperiencecanhelpparticipants

fast-trackthelearningprocess


ActivitiesandToolstosupportyouinthisphase(seeAppendix)⇒ Mapthecurrentsystem

⇒ Co-createSculpturesofCurrentReality

⇒ IdentifyStakeholders

⇒ AnalogousInspiration

⇒ MappingStakeholders

⇒ StakeholderInterviews

⇒ Talkingtothoseworkingwiththischallengeinothercontextandexploringtheirlessonslearnedfrom

thefield

⇒ Hostdialogues

"...itisproposedthataformoffreedialoguemaywellbeoneofthemost

effectivewaysofinvestigatingthecrisiswhichfacessociety,andindeedthewholeofhumannatureandconsciousnesstoday.Moreover,it

mayturnoutthatsuchaformoffreeexchangeofideasandinformationisoffundamental

relevancefortransformingcultureandfreeingitofdestructivemisinformation,sothatcreativity

canbeliberated."--DavidBohm


PHASE3:

STEPPINGINMeaningMaking:Sharingand

Integratingwhatwearelearningfromthefield

Afterimmersingyourselvesintofastanddeeplearningexperiences,participantsgathertogethertoreflectonthemeaningofwhattheyhavelearnt.Varioustechniques,atthisstageareusedtodeepenthelearningandpicturethevisionofthefuturetheywantedtoworktowards.Sometimesitisessentialtoembarkupona“Solo-Walk”.Asolo-walkisapracticewhereoneobservesreflectivesilenceforaperiodoftime,takingadvantageofthenaturalbeautyfoundinnaturetoreflectuponwhattheyarelearning,andperhapstheirroleinsupportingthechangeneeded.Afterthesolo-walk,participantscomebacktogethertosharetheinsightstheyhadgainedduringreflectivemoment.Thiscanalsobeaparticipatoryprocessformulti-stakeholderdialoguethatallowsparticipantstocreatesharedvisionofthefuture,identifykeygapsandbarriersanddevelopinitiativesforclosingthegaps.

CONVENING2Objectives

• Reflectonlearningsfromyourexperience• DesignChallenge:Co-exploreourlearningandworktogethertosolvecomplexchallengesand

opportunitiesemerginginourACHEsandcommunities• Learntools,models,andframeworksforworkingwithcomplex,adaptivechange• Planfornextstageoftheaction-learningjourney-howtocreatelearningandimpact• Identifyemergentsolutionstoissuesofsharedconcern/intentthatarearisingfromthelearningsand

observations• Co-Explorethe9ACHcoreelementsandothertopicsthataremeaningfulandrelevant


ActivitiesandToolstosupportyouinthisphase(seeAppendix)Aftergreatlyincreasingyourperspectiveofthelargersystemthroughinterviews,scanningmaterials,mappingthebiggerpicture,talkingtoimpactfulACHsandcommunityengagement,begintomakesensebothindividuallyandcollectivelywithyourteamregardingwhatyouarelearning.Whatpatternsareemergingfromallthecomplexity?Bothaloneandtogetherwithyourteam,focusonmakingsenseofthepatterns,systemneeds,andhigherpurposefromthemanyperspectives,togetherasagroup-letyourcollectivewisdombroadenyourperspectiveandinformthewayforward.

⇒ ReflectQuietlyandTogether+What,SoWhat,NowWhat--TransformativeLearningCycle

⇒ SoloReflectionandPairShare(similartoReflectQuietlyabove,pleaseseewhichmakesmoresenseforyourgroup)

⇒ DivergenceConvergenceFramework

⇒ Dialogue

“IfIhadanhourtosolveaproblemI'dspend55minutesthinkingabouttheproblem

and5minutesthinkingaboutsolutions.”

--AlbertEinstein

“Youneverchangethingsbyfightingtheexistingreality.Tochangesomething,buildanewmodelthatmakestheexisting

modelobsolete.”--R.BuckminsterFuller


PHASE4:

STEPPINGINCo-Prototyping:

Co-creatingtheFuture

Aftermakingmeaningfromdeepimmersion,beginco-creatingthedesirablefuturethatiswantingtohappen.Thisisatimeforexperimentations(prototyping)ofideas,services,productsandpotentialactionsthatwillbringustoourdesiredstate.Inthisphaseweexperimentandplaywithpotentialideasandsolutions.Thegoalhereistocrystalizeideasthroughaniterative(repeatedmovementofgoingforwardandbackwardwiththeaimofimprovingsomething)processofcoachingandsupportfrompeersandsubjectmatterexperts(includingendusers,practitioners,communitymembersandthosedirectlyaffectedbythechallenge).Theprocesssupportscontinuouslearninganditerationsothatallworkisimprovedupontoproviderigorandincludemultipleperspectives.

KNOWLEDGECAMPSObjectives

• IncreasecapacitytopilottestandprototypeideasgeneratewithintheACHteam• Engageinexperimentations(prototyping)ofideasandactionsthatmaytakethemtothedesiredstate

oftheACH• Crystalizeideasthroughaniterative(repeatedmovementofgoingforwardandbackwardwiththeaim

ofimprovingsomething)processofcoachingandsupportfrompeersandsubjectmatterexperts(includingusers,practitioners

• Documentlearnings


ActivitiesandToolstosupportyouinthisphase(seeAppendix)

⇒ Createanatmosphereoftrust+fun+brainstormingthroughIMPROVexercises**⇒ CoCreateandSculptVisionsoftheFuture**⇒ 15%SolutionsandTroikaConsulting**⇒ FeedbackandIteration***⇒ PrioritizeIdeas***⇒ HostaProactionCafe(seeyourArtofHostingWorkbook)andcollaborativelyworkshopprojectsand

questionsontheteam(youcanworkshopupto25%oftheteam’sprojectsinthisprocess)⇒ NarrowtheSet--SeeCollectiveActionToolKitByFrogDesign


PHASE5:

STEPPINGOUT:Co-evolving

Ideasthathavebeentestedandimprovedintheprototypingphasecanbetranslatedintoadetailedimplementationplanwithclearindicationoftheresourcesrequiredtobringaboutdesiredchange.Issuesthatcould‘power’initiativesorresponsesaremovedforward.Itisimportanttoharvestanddocumentandmakeknownthelearningandhowitleadstothisplan.

CONVENING3Objectives

• Presentandsharedesignchallengeoutcomeandlearningtodate• Reflectuponthelearningexperience• Plannextstepsandimplementationplanforandourongoingworkintothefuture-includingpreparing

formeetingsandactionlearningemphasis• Offerrecommendationstothestateonpoliciesandguidancethatcouldsupportfurtherdevelopmentof

ACHsinVermont

ActivitiesandToolstosupportyouinthisphase(seeAppendix)

⇒ Identifywhowillchampionaninitiative⇒ HostaProActionCafe:SeeArtofHostingresourcesforthis2.5hourmethodologytoworkshopyour

projects

⇒ HostanOpenSpaceTechnology:SeeArtofHostingresourcesforthismethodologytoworkshopyourprojects

⇒ SeeCollectiveActionToolkit:MakingSomethingRealexercises

⇒ SeeArtofHostingWorkbookforideasonHarvestingandDocumenting

⇒ Createanimplementationplan

⇒ BusinessCanvasModel


CELEBRATE!

Aschangeagents,itisessentialtocelebrate.Takethetimetodosomethingthatiscelebratoryforyourself,withyourteamandenjoyalloftheexperiencesyouhavehadalong

theway.Hopefullyyoucandothismorefrequentlythanintheend,infact,whynotcelebrateinsomewayeachtimeyour

teamgathers?


OVERARCHING REFERENCES


OVERARCHINGREFERENCESThesereferencessupporttheoverallframingofthePeertoPeerLearningJourney.TheAppendixprovidesspecifictoolstosupporteachphase.Pleasereviewandrefertoboth:ArtofHostingWorkbookhttps://drive.google.com/file/d/0B2BJJr-U5ttgLVVMVUkxRm44OWJocnRRUFY0ajhRNEhON2Vz/viewCynefinFrameworkvideowithDavidSnowdenhttps://www.youtube.com/watch?v=N7oz366X0-8EngagingEmergencehttp://peggyholman.com/papers/engaging-emergence/LiberatingStructureshttp://www.liberatingstructures.com/bookstore/OnaskingpowerfulquestionsTheArtofPowerfulQuestions:CatalyzingInsight,InnovationandAction,byVogt,BrownandIsaacshttps://www.principals.ca/Documents/powerful_questions_article_(World_Cafe_Website).pdfShapingpowerfulquestions,byKathyJourdainhttps://shapeshiftstrategies.com/2011/11/15/shaping-powerful-questions/WebinarsAccountableHealthCommunitiesDeepDive:CurrentModelsandLessonsLearned,Dialoge4Health.orgFebruary25,2016Videohttp://www.dialogue4health.org/web-forums/detail/ahc-models-and-lessons-learnedRecommendedReadingsCommunityDevelopmentNeedsaQuarterback,byAndrewsandMchalehttp://www.liifund.org/wp-content/uploads/2014/11/SSIR_Community-Development-Needs-a-Quarterback-2014.pdfPreventionInstitutesACH-AnEmergingModelforHealthSystemTransformation.pdfhttp://www.blueshieldcafoundation.org/sites/default/files/covers/ACH%20-%20An%20Emerging%20Model%20for%20Health%20System%20Transformation.pdf


AccountableCommunitiesofHealthReportfromthePreventionInstitutehttp://www.preventioninstitute.org/component/jlibrary/article/id-366/127.htmlTheoryU:LeadingfromtheFutureasitEmerges,byC.OttoScharmer,2007TheoryUExecutiveSummaryhttps://www.presencing.com/sites/default/files/page-files/Theory_U_Exec_Summary.pdfCharodicSteppingStones,byChrisCorriganhttp://chriscorrigan.com/Chaordic%20stepping%20stones.pdfArtofHostingWorkbook,bymanypractitionershttps://drive.google.com/file/d/0B2BJJr-U5ttgLVVMVUkxRm44OWJocnRRUFY0ajhRNEhON2Vz/viewCollectiveActionToolKit,byFrogDesignhttps://drive.google.com/file/d/0B2BJJr-U5ttgWC1tak5RQzdrU01FaW83bnFYVHpJYXlZZjdJ/view?usp=sharingTheoryU:AddressingtheBlindspotofourTimes,ExecutiveSummary,byOttoScharmerhttps://www.presencing.com/sites/default/files/page-files/Theory_U_Exec_Summary.pdfDesigner’sWorkbook:DesignThinkingforEducatorshttps://drive.google.com/file/d/0B2BJJr-U5ttgWS1YRjNKbTgyb1lFVkY5VUF5ajdKcEVDMkMw/viewFieldGuidetoHumanCenteredDesign,byIDEOhttps://drive.google.com/file/d/0ByOQvJHM3mr4TEkzZ3A2NlRMN28/view