Creating Effective Multi-Sector Health Systems: How States, Communities and Tribal Groups are Using a Structured Heath Systems Assessment and Planning Process to Leverage Resources and Achieve Targeted Outcomes Part 1

The purpose of this course is to help public health practitioners and their affiliated partners learn how a diverse array of States, counties, communities and tribal groups at all levels and stages of health system development have been using a structured systems assessment and planning process to develop comprehensive public health systems capable of leveraging a broad array of resources and responding effectively and systematically to priority health issues. Outcomes to date for those that have adopted this process include the creation of strategic, sustainable partnerships with the authority to set priorities, select appropriate interventions, and allocate or reallocate resources as needed; sizable increases in the acquisition of both cash and in-kind resources; and significant reductions in targeted behavioral health problems and consequences. As background, systems thinking applications within the public health field have been providing new insights about the etiology of disease states and the limited effectiveness of single interventions to address issues that are embedded within synergistic systems of intertwined problems and conditions. The term “syndemic” is increasingly being applied to acknowledge and describe the disproportionate burden of disease that is created when interactions (or “synergy”) between seemingly disparate problems and conditions produce effects that far exceed—and are different from—those generated by individual problems or conditions on their own. Systems theory posits that syndemics can only be effectively addressed through a comprehensive, coordinated and systematic response in which the same application of synergy among system partners and stakeholders results in collective outcomes that far exceed those that are possible through the summation of individual efforts alone. While public health practitioners and their partners are being called upon to transition toward comprehensive systems approaches, to date there has been little formal guidance and few structured tools to help guide them. The health systems assessment and planning process explored in this course uses a structured format to elicit and capture stakeholder and decision maker knowledge and information pertinent to local health systems development. While the process generally involves outside facilitation, it relies heavily upon “local wisdom” and knowledge. This is because efforts to intervene effectively within a system require an in-depth understanding of how the system “works,” and intimate understanding of: the system's history, culture, and values; the relationships between individuals and institutions; the economic and political climate; the demographics; the capacity, readiness, and political will of system members and leaders to define certain behaviors or conditions as problematic and act to address them; and the resources that are available to support action. Participants will explore case studies and lessons learned from groups that have been using this system assessment and planning process (which is based on systems theory and basic strategic planning principles) to establish baselines of their existing health system infrastructure, and then plan and implement—and monitor the progress of—efforts to facilitate ongoing health system development over time. Key areas of analysis include the degree to which the members or parts of the system are working together to achieve common outcomes and ward off threats, adapt to changing conditions, and maintain stability across the entire system to minimize disruption to system efforts. More specifically, the process engages stakeholders and decision makers in an analysis of the degree to which: 1) leadership is coordinated across sectors or organizational boundaries, 2) system capacity is adequate to achieve desired outcomes, and 3) effective processes and practices are being used by the system and its members. The process generates assessment ratings for specific and targeted indicators in subareas such as “political will,” “influence,” “conceptual clarity,” “use of evidence-based practices,” “cultural competence,” “accountability,” and “sustainability” to help users examine current system behavior and prioritize future infrastructure development efforts. Almost invariably, the process has generated new insights and significant shifts in attitudes and perceptions of current system capacity, which in turn frequently has led to the substantive adoption of new organizational behaviors by the systems and their members. Because achieving desired health system outcomes is almost always dependent upon changing organizational behaviors and practices, participants will also learn how States, counties, communities and tribal groups have used the assessment and planning process to 1) identify the key leverage points most likely to facilitate positive system change, and 2) incorporate assessment findings into comprehensive planning efforts with specific health system goals, objectives and outcomes as well as implementation, evaluation and sustainability plan components. Finally, participants will engage in interactive discussion and analysis of the tools and processes used in the health system assessment and planning efforts, and how they might be used or adapted to maximize outcomes within their own existing or emerging public health systems.

NOTE: Presentation split into two parts to accommodate the mandatory attendee break.