What is collective impact?

What is Collective Impact?

Tomas J. Aragon, MD, DrPH

Health Officer, City and County of San FranciscoDirector, Population Health Division (PHD)San Francisco Department of Public Health

July 5, 2016

Tomas Aragon, Health Officer (SFDPH) What is Collective Impact? July 5, 2016 1 / 18

Overview

1 Complex health challenges

2 What is collective impact?

3 What is our future course?


Complex health challenges

Poster from collective impact conference, Australia, 2014

What is collective impact?

Why has it captured imaginationsworldwide?

What does this mean for SanFrancisco?

What does this mean for ourorganization?

What does this mean for our staff?

What are the limitations ofcollective impact?

How does collective impactcomplement other public healthapproaches to population healthimprovement? Source: http://www.collaborationforimpact.com/

collective-impact-2014-melbourne-in-pictures/


http://www.collaborationforimpact.com/collective-impact-2014-melbourne-in-pictures/

http://www.collaborationforimpact.com/collective-impact-2014-melbourne-in-pictures/


The Kresge-sponsored SFDPH LEAD* InitiativePublic health leadership is “the practice of mobilizing people, organizations, andcommunities to effectively tackle tough public health challenges”

* LEAD = Lean-inspired • Equity-focused • Aspirational goals • Disruptive innovation



Tackling social and health problemsProblems and solutions can be simple, complicated, or complex.

Simple (agreement on problem, cause,and effective solution)

Complicated (technical solutionsknown or solvable)

Complex (problems, root causes, andsolutions are unknown, poorlyunderstood, and/or not agreed upon)

“The temporary homeless shelter at Pier 80 wasa place for David Tompkins to find himselfagain. ‘People say I’m changing, but I’m notreally changing. When you’re out there, youbecome something you’re not,’ says Tompkins,56. ‘I’m becoming me again.’ The shelterallowed him to bring his dog, provided himaccess to a clinic and a place to sleep, andhelped him get the care that he needed.”

Source: Portraits of life on SF’s streets. SFChronicle, Photos by Lea Suzuki, June 28,2016; http://projects.sfchronicle.com/sf-homeless/faces-of-the-streets/


http://projects.sfchronicle.com/sf-homeless/faces-of-the-streets/

http://projects.sfchronicle.com/sf-homeless/faces-of-the-streets/


Tackling complex social and health problemsTraditional approaches are not solving our most complex social problems

Funders select individualgrantees

Organizations work separatelyand compete

Corporate and governmentsectors are often disconnectedfrom foundations and nonprofits

Evaluators attempt to measurean organization’s isolatedimpact

Large scale change is assumedto depend on scalingorganizations



Tackling complex social and health problemsImagine a different approach: Multiple partners working together to solve complex issues

Problems solving and solutionsarise from interaction of manypartners within larger system

Cross-sector alignment withgovernment, nonprofit,philanthropic and corporatesectors as partners

Organizations activelycoordinating their action andsharing lessons learned

All working toward the samegoal and measuring the sameindicators of success



The five conditions of collective impact (www.fsg.org)“Collective impact is the commitment of a group of key stakeholders from differentsectors to a common agenda for solving a specific social problem at scale.”


http://www.fsg.org


Collective impact “Principles of Practice” (www.fsg.org)“Collective impact is the commitment of a group of key stakeholders from differentsectors to a common agenda for solving a specific social problem at scale.”


http://www.fsg.org


The four phases of collective impact



The collaboration continuumCollective impact outlined in red

Source: The Tamarack Institute (http://www.tamarackcommunity.ca/)


http://www.tamarackcommunity.ca/


Selected collective impact initiatives in San Francisco

Initiative Lead Common agenda

Vision Zero (VZ) PHD Zero traffic deaths by 2024

Getting to Zero (G2Z) PHD Zero HIV infections, deaths, and stigma

SF Health ImprovementPartnership (SFHIP)

DPH,UCSF,HC

Behavioral health, Access to care, Healthyeating and physical activity

Preterm Birth Initiative(PTBi)

UCSF,MCAH,PHD

Pre-term births, esp. African American

Our Children, OurFamilies (OCOF)

CCSF,SFUSD

Two-generational life course health andwell-being

Black/African AmericanHealth Initiative (BAAHI)

SFHN Heart health, Women’s health, Behavioralhealth, Sexual health



PHD—collective impact using results-based lean (RBL)RBL is the synergistic integration of lean management and results-based approaches.

Source: http://resultsbasedlean.com


http://resultsbasedlean.com


Getting to Zero SF (http://gettingtozerosf.org/)

Goal

Zero HIV infections • Zero HIV deaths • Zero HIV stigma

Strategies

RAPID: Support for persons newly diagnosed with HIV

Retention: Engaging those living with HIV in high quality care

PrEP: Reducing HIV transmission among HIV-negative persons

Ending Stigma: Reducing HIV-related stigma

Population (1) and Performance (2, 3) Indicators 2012 2013 2014 2015

1. New HIV diagnoses (number) 453 382 309 2552. Diagnoses → First care (median days) 8 7 73. First care → Viral suppression (median days) 104 71 52


http://gettingtozerosf.org/


Vision Zero SF (http://visionzerosf.org/)


http://visionzerosf.org/


SF Health Improvement Partnership (http://sfhip.org)

Draft population health indicators (bottom)

VisionHealthy People, Healthy Families, Healthy

Communities for San Francisco

VisionHealthy People, Healthy Families, Healthy

Communities for San Francisco

MissionMobilizing San Francisco and resources to eliminate health disparities and inequities

ValuesHealth Equity: Providing opportunities for all San Franciscans to enjoy highest

level of health

Community Engagement: Partner with residents and community based organizations to support health and

well being

Alignment: Ensuring maximum impact of resources to advance

health priorities

Overarching GoalsCoordinated services and care, that are culturally and linguistically appropriate across the continuum

Have healthy hearts and access to nutritional meals to prevent complex chronic diseases

Are physically, emotionally and mentally healthy

Community Health PrioritiesBehavioral Health Access to Care Healthy eating + physical activity

Adult hospitalizations for major depression

Public school kindergarteners who have not experienced dental carries

Pregnant women on Medi-Cal who are food insecure

Emergency room rates due to alcohol abuse

Preventable hospitalizations due to heart attack

Seniors waiting more than 30 days for a home delivered meal

Rates of children experiencing child maltreatment

Preventable hospitalizations due to diabetes

Public school 5th graders meeting 6 of 6 Healthy Fitness Zone standards


http://sfhip.org

What is our future course?

Public health tools for improving population health

Source:Tomas Aragon, Health Officer (SFDPH) What is Collective Impact? July 5, 2016 17 / 18

What is our future course?

Selected bibliography

1 Kania J, Kramer M. Collective Impact. Stanford Social Innovation Review. 2011 Winter;Available from: http://www.ssireview.org/articles/entry/collective_impact.

2 Hanleybrown F, Kania J, Kramer M. Channeling Change: Making Collective Impact Work.Stanford Social Innovation Review. 2012. (Available from URL in no. 1)

3 Turner S, Merchant K, Kania J, Martin E. Understanding the Value of BackboneOrganizations in Collective Impact: Part 1. Stanford Social Innovation Review. 2012.(Available from URL in no. 1)

4 Kania J, Kramer M. Embracing Emergence: How Collective Impact Addresses Complexity.Stanford Social Innovation Review. 2013. (Available from URL in no. 1)

5 Friedman M. Trying Hard is Not Good Enough: How to produce measurableimprovements for customers and communities. 3rd ed. CreateSpace IndependentPublishing Platform; 2015. (Best book to understand Results-Based AccountabilityTM)

6 Maccoby M, Norman CL, Norman CJ, Margolies R. Transforming health care leadership: Asystems guide to improve patient care, decrease costs, and improve population health. 1sted. Jossey-Bass; 2013. (Modern leadership for knowledge [including health] professions)

7 Barnas K. Beyond Heroes: A Lean Management System for Healthcare. 1st ed.ThedaCare Center for Healthcare Value; 2014. (Lean management in health care settings)

8 Spetzler C, Winter H, Meyer J. Decision Quality: Value creation from better businessdecisions. 1st ed. Wiley; 2016. (Best book to learn strategic decision making and analysisin the face uncertainty)


http://www.ssireview.org/articles/entry/collective_impact

What is collective impact?

Health & Medicine

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