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World Café Dialogue Event: Summary and Takeaways A Call to Participate We are living in a time of widespread systemic breakdown; from food scarcity, high rates of chronic disease, climate change and the increasing gap between the rich and the poor. Population health is a complex systemic challenge, and neither one single person nor one organization has all of the answers. Simultaneously, the greatest opportunities of our time are emerging when we collaborate around these shared complex challenges and come up with solutions, across organizations with diverse stakeholders addressing health equity.

That is why the Public Health Institute (PHI) is launching the Population Health Innovation Lab (PHIL). PHI is dedicated to improving the health, well-being, and quality of life for people across the nation and around the world. PHIL is a transformative strategy with intentions to increase mission impact on health equity through innovation and design of new solutions with and for communities most impacted by poor health and lower quality of life. PHI staff gathered on November 30, 2015 in a facilitated dialogue process led by Sue Grinnell and facilitated by Dana Pearlman. The purpose was to discuss population health, its meaning, what needs our attention, and how PHIL might better collaborate across PHI to become a stronger leader for breakthrough innovation in population health. The purpose of this document is to share what transpired at the event as a reference for both those who attended and those who did not attend. In addition, this information can serve as reference for others that may be interested in replicating a similar process. Population Health Innovation Lab (PHIL) Sue Grinnell provided a short overview on the current aspirations of the Innovation Lab. The word “lab” conjures up the idea of experiments, research, lab coats, and petri dishes. While we do not wear lab coats, the Innovation Lab is a space for experimentation and testing. Addressing population health is complex and traditional approaches to these problems are insufficient. Through the four strategies, our intent is to support the incubation, acceleration, and dissemination of solutions that improve health and improve quality of life.

PHIL includes four strategies that form the framework around which the Lab operates:

Build and strengthen leadership capacity to support innovation Promote innovative practices that improve health and quality of life Facilitate production, adoption, and adaption of tools, resources, and solutions Convene and support public private partnerships to maximize impact

Population Health Innovation Lab World Cafe Dialogue Artifact November 30, 2015

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Words from Leadership Mary Pittman, our CEO, was not able to join us at the World Café event; she took the time to shoot a video on the Population Health Innovation Lab (thanks Mary and Joanna Hathaway!). Some key points from the video:

o Population Health is now a “buzzword and everybody is claiming this as their work o PHIL is an opportunity to establish PHI as one of the preeminent organizations

addressing population health o Request for staff to help us to frame out what the Lab might look like and how

programs may be involved and today will be asking for volunteers o Population health is a priority for the board and is reflected in the new strategy

map

Click on the link to see the video: https://vimeo.com/146428829 Password: philvideo

Melange Matthews, our COO kicked off the event by sharing experiences and perspectives in her work in public health addressing population health; noting the Healthy Cities initiative, the first and largest program of its kind in the United States. She encouraged PI/PDs to collaborate and think outside the box. It was great to have her there participating to show support for the Innovation Lab.

GROUP ASPIRATIONS

Prior to diving into dialogue – Dana Pearlman asked us to recall a time when we experienced effective collaboration and to share the conditions that make for a good conversation and a collaborative culture. Dana shared three barriers to creating an innovative culture and their antidotes (from Theory U: Leading from the Emerging Future by Otto Scharmer): Barriers and Antidotes:

1. The Voice of Judgment is a common barrier one confronts when innovating solutions in a collaborative setting. The antidote is having an Open Mind – being curious about everything you are learning, as opposed to judging, even when you do not agree with your collaborators.

2. The Voice of Cynicism is another common barrier in this work, and the antidote is having an Open Heart –being compassionate and encouraging honesty and vulnerability with every single stakeholder.

3. The Voice of Fear is another barrier one is sure to confront when moving towards innovation and collaboration. The antidote to fear is having an Open Will, despite the fear of it not working out and stepping into the unknown with courage and the capacity to take risks!

The participants shared the conditions that allowed them to experience a collaborative culture in the past, where they fully shared their perspectives and listened openly to those they were working with. Below are some key insights shared on what is needed to create this type of collaborative learning environment:

True Engagement Commitment to ideas/process/concept and not just the money Shared purpose- we know the end goal and it is doable Action Oriented--how do we bring it to the table to move forward? Trust everyone – they are in it for the common good Diversity of thoughts, ideas, perspective are equally valued Capacity to listen to each other Safe space and all ideas welcome and respected Leave agendas behind or be transparent about your agenda Clarity around decision making Discord addressed and discussed Institution is transparent- responds and listens Adapt and overcome as we face challenges, from disagreement move

towards understanding

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Dialogue Question 1 What does Population Health mean to YOU? What part of the elephant are you working on? There is a fable of a group of blind men gathered around an elephant, not clear what they are touching. They are only able to perceive what is immediate to them. Each one feels a different part, but only one part, such as the tail or the tusk. Only when the blind men start talking to each other about their part of the elephant are they able to identify it is indeed an elephant! This tale illustrate a range of truths that implies that one's subjective experience can be true, but that such experience may be limited by a failure to account for other truths or a totality of truth. Metaphorically, Population Health is the elephant. Before we begin collaborating, we are the blind men, only seeing a part of the picture. Only by working together, can we come up with a more holistic understanding of Population Health and begin to address the myriad of complex challenges before us. The responses and discussion generated from Dialogue Question 1 demonstrate a need for a PHI shared definition and framework on Population Health. Here is some of what we heard:

Population health requires interest in greater good and behaviors, policies that align and support such. Caring for and addressing the needs of a population by understanding root causes (poverty, etc.) of ill

health Equity, community wellbeing, health of children, intersection of housing, policy and government will,

health care, prevention, economic resilience, and education Equal access to healthy choices and better quality of life and health outcomes for all social justice in

action to eliminate health inequities. Level of knowledge (or lack thereof) among youth and adults

about how to be healthy i.e. what to eat, how to exercise, how to manage stress and how to access health care.

Bringing the health care system into partnership with public health to focus more on prevention and addressing inequities

Population Health – opening the door between public health and the health care system to work in alignment for healthier and more equitable communities

Systems thinking – equity for all multiple perspectives, not a specific group of population. Not managing health but about creating a healthier life for all environmental and behavioral, etc.

What is Population Health?

“If you want me to work collaboratively with people, we must have shared values. I want to work with people who are as frustrated as I am by people that are living in unacceptable conditions. We need to have this in common – when we see how bad things are for folks and it is coupled with anger, it

should motivate us and call us to action. Anger is activating and has led to massive culture shifts (e.g. suffrage, black lives matter) and the generative

spark was fueled by frustrations for change. That is what I want to do - alleviate the suffering of others.

We have amazing resources at PHI and we need to activate those. I want to go into “battle” with these kinds of people.”

Participant Comment

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Dialogue Question 2 When it comes to Population Health, what needs our attention? This question aimed to see what is most meaningful to the participants in regards to Population Health. Some had a bit of difficulty transitioning from the first question as there was still much to explore. There was definite agreement that we do not have a common shared definition of population health – and PHI needs a definition, common language and messaging.

Other areas needing attention: Adverse childhood experiences Mind, body and spirit intersections A conversation about the tension between the rights of the individual versus community Address tension between prevention focus and disease orientation Systems thinking – equity and opportunity perspective Incentives for cross sector collaboration (including health care, businesses, education, housing, etc.)

Dialogue Question 3 How might we better collaborate across our organization to become a stronger leader for breakthrough innovation in Population Health?

The group recognized there is much expertise and resources within PHI. Many expressed the isolation felt – not knowing who to turn to for information or what other partnerships might be possible within PHI. While they are anxious to collaborate on a shared vision, there was a collective understanding that a value proposition is a necessary consideration. Suggested ideas for increased collaboration included:

Find ways to generate demand for services that fit PHI Centralized funding model for those that opt to collaborate Develop a catalogue of programs, training and TA products, resources, and competencies- i.e. PHI At a

Glance Resources to convene people in a structured and regulated manner Create a population health academy- 1 week. Bring PHI resources to bear and creates a network Collective project – joint goal – project/initiative – leads to collective impact, leverage PHI expertise,

attach resources and funds to it Interdisciplinary approach- fellowships, internal tech salons This all needs to be bi directional and neutral benefit gain. All parties benefit in some way. PHI dispatch or individual programs What’s the vision, who is doing it, what is the value add? How does it benefit? Need a joint physical space, need a shared work hub, PI room – allows for organic quick chats and

collaborative Real need for information exchange, learning and exchange – programs getting to know each other

before collaboration

“Can we come up with an alternative definition of population health;

creating, collective impact frameworks for health and equity?”

Participant Comment

“I thought I knew what population health is - after this I am not so sure I know.” “Bigger than healthy communities, linked to social determinants of health approach, could be geographically/ demographic defined.”

Participant’s comments

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What may not have been said aloud…………………..

Each table had paper and markers to draw, write notes and explore possibilities together. While dialogue was occurring, some wrote their thoughts and doodles to express their thinking.

In order to collaborate we need - “Brilliant ideas to save forever” - o PI/Programs cultural shifts about how we do things o Break out of mold and need to take risks o Is jumping to collaboration too big a jump? Buy in?

motivation? Incentive? o Physical Space-need joint space “PI room” or a landing spot o Program funding urgency fluctuates – timing/ urgency o Competition of funding – how to address o Disconnect between PHI programs o Lack of funding makes collaboration impossible o PHIL needs resources Branding all PHI programs as PHI Programs o CEO requirement for collaboration or attempt at synergy 2x year

Heart Table Cloth How do you draw hospitals into caring about equity, policy vs. individual behavior change or programs for Population Health? Can we work on cross sector collaboration with incentives (school, business, and housing?)

o Business community investment incentive o Social Innovation investment/community land trust o Collective Impact Incentives

Other Notes and Doodles

o Concerns regarding competition for funding (project and central)

o Collaboration is usually on top of daily work with staff/programming, who pays for this? What is the value add?

o Want PHI to be transparent – Is there a vision or goal of PHI merging programs?

o How do we share resources? Can we find ways to bring in experts (i.e. tech people, economist?)

o Create vision of PHIL that aligns with program work o Strength in working with other programs -- (new ideas and lessons learned) o Idea to “dispatch” staff to a program who has a need for skills and expertise (fee for service) teams

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Our Harvest: Key insights from the day The idea of harvesting is to conclude what we understand at this moment – and then introduce that insight or

understanding “back into the system” This is helpful for the next conversation so that our exploration can deepen instead of going round in circles.

A need for a shared vision/purpose of PHIL; need clarity of vision o Technology and Group work for collectively meaningful definitions/values

Need for shared definition and framework on Pop Health Elephant and blind men parable – this revealed to be true for PHI What is population health and how is it different from public health? The overarching system is not coherent Needs:

o A collective space, when programs come to Oakland, a place to gather, network and talk “Innovation Stations”

o “Batman” dispatch consultancy group - PHIL: potential developmental opportunity How to create the beginning of the consultancy group; different ways to leverage PHI

resources Form a Community of Practice/Art of Hosting three day training

o Develop a new business model: ways to generate demand for their services o Opt in to centralized funding model to collaborate

Top leadership support, there was skepticism about the commitment and transparency People are isolated: Folks got to connect with their peers People want to make an impact and be action oriented; PHIL could be one vehicle to do that Need resources for PHIL

High Level Next Steps:

o As we build PHIL, collaborators are essential. We need a team of dedicated learners that want to increase their own leadership capacity in creating a collaborative culture and innovating solutions with invested stakeholders. The co-creation team will help us continue to launch PHIL, while learning by doing as apprentices in the methods, frameworks, and practices for this work. One of the first activities the Co-Creation Team will be involved in will be to design the Community of Practice formation and invite PHI staff to a three day Art of Hosting experience, that will increase our capacity for collaboration and innovation organizational wide. The training will center on this question: How might we better collaborate across our organization to become a stronger leader for breakthrough innovation in Population Health?

o An important next step will be to seek opportunities to fund PHIL and to obtain the necessary resources to create a viable and thriving LAB for PHI to collaborate across our organization and provide a platform externally that offers co-created solutions from a systemic perspective in the face of complex challenges, leading society towards health equity while mitigating disparities.

o In conclusion, If you were not present, but interested in collaborating, please contact Sue Grinnell, Sue.Grinnell@phi.org