Thank you to everyone who participated in the 2024 TACHI Convening, “Achieving Health Equity and Building Accountability in ACHs: Authentic Community Engagement, Partnerships, and Power Sharing.”
The convening was energizing, interactive, and included several breakouts that allowed participants an opportunity to immerse themselves in big concepts.
In systems change work, an intentional approach is needed to build the trust that brings change. Without that intentionality, communities can feel like their input is not valued in the process.
Sue Grinnell, Population Health Innovation Lab, and Dana Pearlman, ChangeLeaders Network, facilitated exercises that focused on the importance of building relationships and listening in community engagement.
These immersive experiences created a safe space for vulnerability and a practical way for participants to experience ways in which they could build trust in their communities.
Conversations for Relationships, Possibilities, and Action Framework
One impactful exercise centered around the Conversations for Relationships, Possibilities, and Action Framework (pictured below). The framework seeks to shift our mindsets about relationship building and encourages partners to exercise value building connections initially, as opposed to jumping directly to action. The interactive exercise provided a meaningful experience in participatory leadership through listening.
The exercise determined a speaker and a listener so that participants could embrace both roles. Because ‘listeners’ in the group weren’t able to respond, the ‘speakers’ were able to deeply share their story. It was a powerful way to quickly develop trust in a new relationship. The activity emphasized relationships as the foundation for action, and sites were excited to take the exercise back to their communities to build relationships and find common ground in challenging situations.
Two Loops of Systems Change
Grinnell and Pearlman also facilitated a breakout that discussed the challenges and opportunities of various roles within systems, emphasizing the importance of power-sharing, innovation, and collaboration. In the session, they used ropes to demonstrate the Two Loops of Systems Change stages (pictured below). Participants were asked to identify what stage in the system (ex: healthcare, philanthropy) resonated with them most and discuss their experiences with others that identified with the same stage. More importantly, people shared how they felt connected (or disconnected) with other stages, and they shared what other groups at different stages needed to know about their experiences.
The discussions at each stage of the two loops of systems change validated strengths and frustrations people experience, along with developing a network of folks with shared experiences to hopefully lean on in the future. Despite each stage being a critical component of the system, in the report-outs from groups, we heard that they don’t feel like the other stages understand or are connected to them.
This calls out the importance of cross-sectoral and cross-stage partnerships in a system. Other takeaways included the vulnerability and excitement of being part of the system, the need for clarity and support from the community, and the importance of shared language and data in bridging gaps.
“The sessions were very interactive and mixing up the table seating was a great opportunity to meet and network with others.”
– Backbone Organization Participant
“Learning from each other and providing space for vulnerability and listening really created a space where we could share and I feel like I took away more useful tools from this style of convening.”
– Backbone Organization Participant
Power sharing and collaboration are essential to creating meaningful partnerships that drive sustainable health improvements. In the keynote presentation, Anne Morris Reid, MPH, Policy Director of the Funders Forum on Accountable Health, highlighted the critical role of community-based, cross-sectoral collaboratives in promoting better health outcomes.
Reid emphasized that the TACHI collaboratives tackle upstream challenges to improve community health in a sustainable way. She noted that key learnings from the Accountable Communities demonstration model have become standard practice in newer Innovation Center models, and in Medicare and Medicaid quality and reimbursement mechanisms. Reid stated, “proof point one on this health-related social needs for non-medical drivers of health screening and referrals is now widely adopted in all the current and new models. It is also baked into reimbursement mechanisms, including in Medicare.”
Reid also pointed out that nearly 200 Accountable Communities for Health (ACH) sites exist across 33 states and the District of Columbia. These models are anchored by trusted backbone organizations that align communities with partners, facilitate shared resources, and apply an equity lens. According to Reid, “ACHs are a mechanism to shift power and to address underlying social structures of health,” achieving this through meaningful community partnerships. ACHs demonstrate a value continuum, starting with evidence of return on investment for non-medical health services in the short term, strengthening community capacity in the medium term, and positioning multi-sector partnerships as civic assets in the long term.
To ensure sustainability, Reid offered several action items for TACHI sites including articulating the value proposition of ACH work, considering diverse funding streams, and focusing on empowering communities through co-creation and power sharing. These steps, she suggested, are crucial for maintaining the impact of ACHs over time.