Being an ACH Backbone: a Conversation with Kitty Bailey (Part 2)

This post is the second of two based on interviews with Kitty Bailey, CEO of the San Diego Wellness Collaborative.

This post is the second of two based on interviews with Kitty Bailey, CEO of the San Diego Wellness Collaborative. (See first post here.)

With a grant from the California Accountable Communities for Health Initiative in 2016, the Collaborative became the backbone organization for the San Diego Accountable Community for Health. Kitty is a technical advisor for TACHI, with a special focus on providing guidance related to backbone functions.

While every ACH backbone will have a unique journey – influenced by community and state contexts – the San Diego experience provides some useful lessons for TACHI sites.

We left off with talking about how challenging the first years of your ACH were and your role as the backbone leader in keeping the broader vision at the forefront. Could you talk a little bit about how you did that?

Some people just don’t like as much process work as an ACH requires, because you cannot move quickly into action. Being part of an ACH requires many meetings, time spent getting to know each other and the work they do, figuring out how partners will work together, and what commitments different organizations will make. You have to stick with the process for at least a year or two, and some people just don’t want to do that kind of process work.

One way we kept partners engaged through all the process-focused work was to create a set of values that we were very explicit about. The values we created in San Diego were around equity, transparency, neutrality, and accountability. When the focus on process starts to feel like it’s taking too long, we go back to our values.

We remember that building a new way of doing business focused on equity, transparency, neutrality, and accountability takes time.

It’s about revisiting the values, and reminding ourselves that through the process we live our values. If people have bought into these values, they’re more likely to understand why we’re spending so much time on process.

Are there other strategies you use to create buy-in and maintain engagement?

I also think that it’s important to be clear about what each partner individually can get out of this for their organizations. It’s also being aware of what are the different sectors’ motivators. What matters to your partners? We want the ACH to be a place where our partners can contribute to a greater goal but also see their own organizational needs being met. We’ve had people come back to us and say, “My organization has a valuable new partnership that would have never happened if we hadn’t been sitting here at this ACH table and coming to the meetings.” This is a very common occurrence and I think one of the first values that our partners realize by participating in the ACH.

This may not happen in the first year or two.

In the first year or two our partners had difficulty in grasping what the ACH was about and what we would be able to accomplish together. During this period I found that the relationships between the backbone leadership and the partners was critical to continued engagement. In the third year our activities started to take shape and the partners could more clearly see the value.

Another way we kept people at the table by having meaningful conversations on topics that were not otherwise happening in our community.

One of the most important things to do as the backbone is to be plugged into what’s going on in your community at all levels, and be able to curate conversations. It is a very important mindset for a backbone leader to be a curious learner.

One of the ways I think about our next ACH meeting agenda is what’s got me curious lately? What am I unclear about? What have I been hearing our partners talk about that they’re curious about or they’d like to know more about? Then bringing a set of speakers together to really how highlight a topic that is emerging, looking for those emerging topics that people are interested in.

I’ve heard you use two phrases – disrupt the status quo and transform the way we do business. Can you talk a little bit more about both?

I like to say if you’re not having hard conversations, you’re not actually doing an ACH. There was an early meeting at our ACH leadership table where one of the participants said out loud in the meeting, “I don’t even know half of the people here.” They meant it as a bad thing. They didn’t know that this was an intentional part of the design of the ACH. And I saw it as a positive, but it was definitely a challenge. People did walk away from the table in the beginning years.

One of the reasons for an ACH is because there is a missing piece in the healthcare system.  By definition we have to disrupt the system to get the long-term health quality outcomes we want. When you think about a healthcare system in any community or region, we’ve got the hospitals, the clinics, the public health department, the health plans. If we think more broadly, we have social services agencies, school systems, businesses, faith-based organizations, community-based organizations and others that help create lifelong health. Community as a whole is another player in this system.

What’s been missing is this intermediary, this hub, this place where conversations across all those different organizations take place. Fundamentally we exist to be a new kind of player and get new kinds of outcomes through new ways of doing business, to get outcomes that we haven’t been able to get with everybody operating in their silos.

Are there strategies you use in the process of disrupting the status quo and changing the way you do business?

As an ACH backbone, this is all about building relationships, keeping the relationships going, building trust. At the same time you’re also trying to disrupt the system.

Backbone leaders have to be mindful and conscientious about relationship building and trust building, while at the same time trying to hold a space for disruption to happen.

You cannot get to equity without disruption, and you can’t navigate disruption without building relationships. How I think about the work is I literally think about both pieces at the same time, and how I’m going to do both successfully in order to achieve equity.

At the end of the day, we work with people. The folks that are in healthcare, education, public health, community-based organizations, most people are there because their heart is in it. If we can align along the greater value of what we’re trying to achieve, people come together, and they have a self-interest in the disruption.

Building trust and relationships for disrupting the system towards our long-term vision, you can get that buy-in and you can get people to come to the table, and they want to work together even if it means disrupting their own systems and changing power.