Fannie E. Rippel Foundation

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“The Dartmouth Atlas of Healthcare” and Dr. Atul Gawande’s influential New Yorker article, “The Cost Conundrum”, highlight striking regional disparities in health, care and costs. To better understand the roots of these disparities, Rippel joined with the Institute for Healthcare Improvement, the Brookings Institute, Dartmouth College and others to sponsor a conference in 2009 where ten communities that achieve lower Medicare cost and above average care quality were asked “How Do They Do That?” A key theme emerged: local culture matters. In closing the meeting, Dr. Donald M. Berwick summarized the challenge as follows: “If culture matters so much, how do communities with a different cultural heritage get from ‘now’ to ‘there’?”

Recognizing the importance of culture and regional differences, it is increasingly evident that the deep, systemic change necessary to create a sustainable U.S. health system will require multiple efforts – all with the flexibility and scope to deal with the complexity, fragmentation, and broad nature of the problem itself. Diverse groups of stakeholders are being challenged to work together in ways that bridge traditional boundaries and allow for large-scale institutional reform that is appropriate for regional conditions. To do this, a new form of leadership is needed.

Organizing for Health, a project of ReThink Health, is developing, testing, and documenting the contributions that organizing can make to the transformation of health and health care.  As a form of leadership development, organizing is a tool for engaging diverse constituencies in communities to create new and sustainable support for change. Led by Kate Hilton, JD, MTS, and Ruth Wageman, PhD, Organizing for Health builds on their work with Marshall Ganz, renowned for his work with Cesar Chavez, the California Farm Worker Movement, and the 2008 Obama for President Campaign.

Drawing on the Ganz framework, leadership is a practice of identifying a set of shared values and then turning those values into effective actions that achieve new outcomes. Cultural change is not a matter of messaging, marketing, or managing, but rather involves helping members of a system rearticulate values in a new narrative, reconfigure the relationships in which that narrative is told, commit to strategic goals that require mobilization, redeploy resources toward new ends, and create a leadership structure capable of making all this happen. These are the practices of community organizing.

Current leaders are trained to innovate and discover technical solutions rather than to lead others to make the changes needed. In this context organizing as a form of leadership becomes a powerful tool. It supports leaders in accepting responsibility for enabling others to achieve purpose in the face of uncertainty. Embracing the belief that there is no single, universal model for improved health, care and costs, organizing engages leadership teams in identifying, recruiting and developing leaders, building community around that leadership, and creating power from community’s resources.

History shows that organizing works. The principles and practices of organizing have contributed to making measurable social change on issues ranging from Civil Rights to the adoption of the Kyoto Protocols by major U.S. cities to fight climate change. These goals are achieved through the mastery of five leadership practices:

1. Story telling: Motivating people to turn their values into action articulated as a shared story
2. Relationship building: Committing people to work together on behalf of shared values and common interests by building relationships and exchanging resources
3. Team structuring: Creating interdependent teams designed to collaborate across multiple levels of coordination
4. Strategizing: Devising tactics to achieve clear objectives by creatively translating resources into outcomes at each level of organization
5. Acting: Producing specific, observable and measurable results to evaluate progress, exercise accountability and adapt strategy based on experience

Organizing for Health is currently piloting its activities in health with a cross-sector campaign team in South Carolina. A growing set of community representatives and leaders – including physicians, community members, health educators, administrators, students, pharmacists, insurers, nurses, and volunteers – are coming together to rethink the delivery of primary care in underserved communities. Organizing for Health’s distance learning course, as well as its trainings and webinars, campaign coaching, and research, support leadership development and regional efforts across the country and the world.