Identity: An unprecedented collaboration of change agents pursuing

an unprecedented result:

100 million people living healthier lives by 2020

Vision: to fundamentally transform the way we think and act to

improve health, wellbeing, and equity.

Equity is the “price of admission.”

Convened by the Institute for Healthcare Improvement as a partnership across

organizations.

100 Million Healthier Lives

www.100mlives.org

Approaching health equity

⚫ “Just and fair inclusion into a society in which all can

participate, prosper, and reach their full potential.

Unlocking the promise of the nation by unleashing the

promise in us all.” -Policy Link

⚫ 100 Million Healthier Lives approach: to ask and try to

answer open and honest questions:

“Who isn’t thriving? What would it take for that to change?

What is perpetuating poor health and life outcomes?”

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Theory of change – 100 Million Healthier Lives

Unprecedented collaboration

Innovative improvement

System transformation

100 Million People Living

Healthier Lives by 2020

A growing network: >1850 members in 30+ countries worldwide reaching >500 million people – come join us! www.100mlives.org/map

• 220+ communities on the journey

• 500+ health care organizations engaging

• 17 states advancing equity

• 30 countries –members advancing change, some at the country level

Shared priorities

“Whats” “Hows”

⚫ Shift culture and mindset

⚫ Develop the health workforce

⚫ Build the capability of key sectors and youth to transform

health

⚫ Elevate peer to peer approaches

⚫ Build improvement capability at the community level

⚫ Use chronic diseases and risk factors to build the health

continuum

⚫ Improve high quality primary health care access for all

⚫ Integrate data across siloes

⚫ Create new financing strategies

⚫ Transform from a health care system to a health system

⚫ Close equity gaps (price of admission)• Transform neighborhoods of concentrated poverty to

communities of solutions

• Interrupt the school to prison and incarceration pipelines

⚫ Help veterans to thrive

⚫ Address and improve social determinants across the continuum

⚫ Improve well-being of indigenous communities

⚫ Help all kids have a great start to life and thrive from cradle to career

⚫ Make mental health everybody’s job and take a prevention approach

⚫ Engage people in their own health (nutrition, exercise, sleep, stress, food security)

⚫ Improve employee health and well-being

⚫ Create well-being in the elder years and end of life

6 core strategies + equity as the price of admission

Health, wellbeing and equity

People

Systems (society)

Places

1. Create healthy, equitable communities

2. Build bridges across sectors

3. Create a health care system that is good at health AND good at care

4. Promote peer-to-peer approaches and people-driven change

5. Create enabling conditions

6. Develop new mindsets

Working in Unprecedented Collaboration To Make

5 Key Shifts

1. From a “sick care system” to a “health and wellbeing system”

2. Take our work on equity from “doing good” to a recognition that we are

interconnected and cannot afford the price of poverty and inequity in terms of

health and life outcomes or cost

3. From people and communities of poverty to people and communities of trapped

and untapped potential

4. From pathology to vision – change is possible

5. From scarcity to abundance

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What Skills are needed to

Achieve a Community’s

Health, Wellbeing and

Equity Goals?

Changing our ways of thinking and acting to create

health, wellbeing and equity: Community of

Solutions skills

Leading from within

Leading together

Leading for outcomes

Leading for equity

Leading for sustainability

www.100mlives.org/initiatives

The Community of Solutions

Framework

Overall Content Theory

• Leading from within (LW)

• Leading together (LT)

• Leading for outcomes (LO)

• Leading with equity (LE)

• Leading for sustainability (LS)

Community of solutions skills

• How people relate to themselves, one another, and to those affected by inequity

• How the community approaches the change process

• How the community creates abundance

Community of solutions behaviors, processes, systems

• Health as a shared value

• Thriving cross-sector partnerships

• Healthy, equitable communities

• Improved population health, wellbeing and equity outcomes

Culture of health outcomes

Leading from Within

● Leading from Within (LW) skills involve one’s inner journey as a

leader, including the ability to:

• Know oneself and what brings one to leadership (including biases and

"growing edges")

• Reflect, “fail forward,” and change as needed

• See and commit oneself to unlocking the leadership of others, especially

those with lived experience of inequity

• Approach change from a place of abundance, even in the midst of

scarcity

• Value difference – Habits of the Heart: (Palmer P., 2000)

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Leading Together

● Leading Together (LT) skills are grounded in a perception of

the community as a dynamic network of interacting people,

organizations, structures, and systems that are related to a place.

It is necessary to lead together with others in a community to

create effective, equitable change. Elements of Leading Together

skills include:

• Developing trust, relationships, and interconnectedness

• Effective teamwork

• Collaboration (including integrating people with lived experience in your

work)

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Leading for Outcomes

● Leading for Outcomes (LO) skills support communities in

applying design skills to co-create a theory of change, identify

measures, test the theory, and plan for implementation and

scaling up in a way that makes these tasks easier.

• Innovation/Design Thinking – Using stories to understand the experience

of people affected by a change

• Improvement science – Developing aims, drivers, and measures, and

running tests of changes

• Implementation skills – Making implementation easier, more effective,

and more joyful

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Leading for Equity

● Leading for Equity (LE) skills apply Leading from Within,

Leading Together, and Leading for Outcomes skills through an

equity lens:

• Leading from Within – Understanding implicit bias, understanding power

and privilege

• Leading Together – Recognizing interconnectedness; everyone owning

the process of creating equity; fostering ownership and solutions by

people with lived experience; mapping assets to potential levers

• Leading for Outcomes – Using data to identify those who may not be

thriving; identifying potentially replicable bright spots; testing policy and

programmatic changes that have the potential to disrupt systems

perpetuating inequity – Equity Action Lab

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Leading for Sustainability

● Leading for Sustainability (LS) skills facilitate an ongoing

process of transformation in a community (generative

sustainability) as opposed to maintaining programs as they are.

Four key elements of sustainability are:

• Environmental sustainability – Stability of the physical, political, and

cultural environment

• Resource sustainability – Availability of intrinsic (will for change,

relationships) and extrinsic (financial, in-kind) resources needed to

maintain, spread, and scale changes

• People sustainability – Cultivation of change leaders in a community

• Change sustainability – Growth and sustainability of the change process.

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● SCALE Regions of Solutions - 18 communities spreading the “Community of Solutions” approach regionally to accelerate improvement in health, wellbeing and equity at the community and regional levels

● SCALE States of Solutions – 17 states working to build unprecedented collaboration, engage in innovative improvement, and system transformation to advance equity in a state

● SCALE Health & Care (Pathways to Population Health) – builds capacity of 500+ health care organizations to advance on the journey to population health

● Community Health Accelerators Initiative (CHAI) - an online training, coaching and support system that can help people, organizations and communities anywhere to develop core skills to advance improvement

● Generously funded by Robert Wood Johnson Foundation

17100MLives Capability Development Initiatives

100 Million Healthier Lives Measurement: Top Level

Whose Lives Are Getting Better Because We Are Here?

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Would they

agree?

If not, what will

we do

differently?

Valuing lived experience in measurement: People-reported

outcome measures (PROM) as measures for wellbeing

⚫ People-reported outcome measures are validated, objective outcome

measures of people’s perception of their health and wellbeing.

⚫ People’s self-perception of their health and wellbeing is as or more accurate

than anything else we have to predict long-term morbidity and mortality.

⚫ When combined with predicted life expectancy, the two serve as powerful

and objective drivers to improve health, wellbeing, and equity.

⚫ Recommended for global adoption by the Organisation for Economic Co-

operation and Development.

⚫ Recently adopted by the National Center for Vital and Health Statistics as

part of the Wellbeing in the Nation measurement framework

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A simple, powerful approach to outcome measures for

health and wellbeing20

Age

Sex

Race/Ethnicity

Education

Zip code

Veteran status

% people thriving

% people suffering

% people with hope

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Ove

rall

wel

l-b

ein

gSo

cial

Ph

ysic

alM

enta

lSo

cial

Spir

itu

al

Common

Measures for

Adult Well-

being

4 subdomains:

mental,

physical,

social, spiritual

Measuring Equity Equitably

People

• Difference in health

and wellbeing

• Years of life gained

___________________

_

Places

• Safety

• Reincarceration

• Education

• Employment

• Racial segregation of

neighborhoods

Wellbeing Measurement

Community indicators related to what you are

working on

Wellbeing measured with an equity lens

Equity gaps in wellbeing closed

Hope

Years of life gained

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Downtown Women’s Center Results 24

Figure 1. % of people suffering

Figure 2. % of people thriving

Leading indicators:

84% improvement

in healthier lives

92% improved

blood pressure

44% improved diabetes control

Measure What Matters

⚫ A free, powerful platform

to help you measure and

create equitable

improvement

⚫ Co-designed with

communities.

⚫ Helps you find measures

that matter to you.

⚫ Helps you administer

questionnaires (like the

wellbeing questionnaire)

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Change Library http://changelibrary.100mlives.org/

5 tools for the road to make your path easier

1. Map of the Movement – Helps people to find collaborators

2. 100MLives approach to equitable measurement – Helps people to measure

what matters to them

3. Measure What Matters - Helps people measure, track, and share data

across sectors

4. Change Library - Makes it easy to see for people to find the bright spots,

stories and tools they need across organizations

5. Pathways to Population Health framework and website

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Thank you!

Contact Information:

Shannon Welch, MPH

Project Director, 100 Million Healthier Lives

swelch@ihi.org

www.100mlives.org

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