Fannie E. Rippel Foundation

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Americans are increasingly recognizing that health is a system in crisis. They are acknowledging that national reforms alone cannot elevate population health, improve the quality of care, or lower costs. And they are realizing that many of the drivers of both the problems and the solutions are largely under the control of diverse local decision makers – hospitals, providers, local governments, patients and payers.

In response, there has been significant movement to drive change at the local level. Yet many reform efforts, including those led by diverse groups of regional leaders, have foundered in their attempt to tackle problems and achieve sustainable results. Importantly, there exist significant gaps in our collective understanding of why some efforts succeed and others fail, as well as in how success might be fostered. ReThink Health Research focuses on the systematic study of the conditions and predictors of success in communities and among networks of change leaders. The goal is to produce new and practical knowledge that enables and supports the creation of leadership and environments for innovation and sustainable change.

ReThink Health Research focuses specifically on enhancing health system understanding and system-intelligent action by leaders from inside and outside of health. Research methods include data-based comparisons of leadership teams and their regional change efforts, qualitative case studies, and the implementation of systematic evaluation processes in all of the ReThink Health efforts. Through these, ReThink Health Research captures emerging patterns and supports reflective learning about the conditions under which leaders and teams can effectively engage with others in taking action to transform their health systems. It also informs understanding of the impact of their actions on systems, communities and populations. ReThink Health Research is explicitly designed to result in new tools, frameworks, and support resources to enable working leaders to take ever more impactful, successful and sustainable action. In addition, it is designed to develop a strong evidentiary basis and collective credibility among thought leaders and change agents who share aims of transforming health and health care.

To guide ReThink Health’s research effort and assure its value and impact on leaders and communities striving to achieve better health, better care and lower costs, a set of key hypotheses have been developed. These form the foundation for research design, as well as provide a basis for evaluation. Among these are:

• Leaders require concrete models from which to learn in developing context-specific innovations and interventions. They benefit from an understanding of the challenges others have faced and an array of strategies for overcoming those challenges.
• Leaders struggle to build genuine shared leadership and collaboration. There are conditions which can be put in place to increase the chances of effective leadership teams built of diverse stakeholders. These conditions are not all yet known but are discoverable.
• Because of their potentially competing interests and differing institutional cultures, cross-sector leadership teams are distinct from teams within a single institution. Therefore they require distinct interventions and support in building their collaborative and strategic capacity.
• Narrative-rich and personally-engaged leadership teams will increase stewardship values and will result in greater collaborative capacity and substantive change in health, quality, and costs.
• Building alignment around shared values, building strategic capacity, and developing learning-focused norms in such leadership teams will influence the degree to which they:
  • Identify appropriate system levers for simultaneous change in health, care and costs – not just single-focused change efforts,
  • Develop a strategy that shows understanding of power dynamics in the system,
  • Design and implement successful innovations for system-wide impact and sustainable change,
  • Build a lasting community coalition and capacity to take on additional changes.