By C.J. Hager
Senior Research and Innovation Officer
Episcopal Health Foundation
2022 marked an important year for TACHI.
The six TACHI sites switched from learning to doing. At times, this transition felt comfortable and natural. Other times, it felt like we went from reading an article about learning to swim to being thrown into a pool’s deep end.
The transition from learning to doing was built in from the beginning. Alongside the sites, EHF wanted to take time to learn about the ACH framework, dig into its individual elements and learn from experts. By the end of the learning phase in December 2021, each site was positioned to make an independent, informed and deliberate choice—do we move forward with implementing the ACH framework? Or do we let the opportunity pass by?
All six sites decided to dive into implementation. The challenges that we studied from other ACH communities now became real—not only for the sites, but also for EHF. From EHF’s perspective, supported by St. David’s Foundation (an initiative partner) and a strong bench of technical advisors, we had developed a strong suite of tools to support the sites in implementation. These tools had come from other ACH initiatives, including California Accountable Communities for Health Initiative (CACHI) and The Funders Forum on Accountable Health. In many ways, we were in a similar position to the sites: we had studied the ACH model diligently, designed TACHI with these learnings in mind and now it was time to jump in the deep end with implementation.
By the end of 2022, we knew we could swim. We learned the tools were helpful. However, we also learned they needed to be refined. Feedback from the sites, our technical advisors and our evaluator helped us identify where we could do better and provide inspiration on how. We entered 2023 with the same tools, only better.
Below are a few of the more notable changes we made to TACHI starting in January 2023.
From phone book to operator.
EHF assembled a talented pool of technical experts to be of service to sites. The sites were introduced to the experts and encouraged to call upon these experts at any time; we didn’t want to be the gatekeeper to this valuable resource. In essence, we gave them a phone book of valuable resources.
The result: the experts were underused. We heard from sites and the advisors that challenges or questions didn’t neatly fit into one of the expert’s areas. Or sites might “miscategorize” the challenge before them and contact the wrong expert. We also heard from the sites about the frustration that they had to brief each expert on their site with each new encounter.
We also heard from our technical advisors that they lacked connection to the sites. Our technical assistance system leaned toward transactional — one-off conversations with sites that call upon them — which kept the advisors from understanding context or identifying challenges early.
In response, we repurposed our existing technical consultants; each site was assigned a lead TA. This new arrangement came out of conversations with the sites (who have you developed a strong relationship with? who do you trust? who’s approach fits with your site?) as well as the technical advisors (we posed similar questions to them).
With this transition, we don’t expect any of the consultants to fully fill all the technical assistance needs of an individual site. We do expect that they can bring in other experts as needed, and when doing so, they can brief their peer in preparation, relieving the site from that role. They can act as a phone operator.
Refining the who and what of learning.
As mentioned, before committing the implementation, sites were part of a learning process, one that spanned 15 months. This learning phase was led by PCCI, a Texas expert in the accountable health communities model. The learning approach was driven by academic learnings and monthly. When we entered into implementation, we reduced the frequency of the learning sessions to quarterly. But the audience and the topics largely remained the same: all TACHI partners and general ACH topics (e.g., governance, financing strategies, data collection.)
Similar to the technical assistance structure, we started to receive feedback from the sites that these sessions weren’t serving their needs. Our evaluation results backed that up.
Meanwhile, our understanding of the importance of backbone organizations evolved. We truly recognized the importance of their role and stability. While the critical nature of the backbone organization isn’t a new concept—it shows up in literature from collective impact as well as ACHs—it caused us to re-orient our learning opportunities to a community of practice model that centers the experience of the backbone.
You’ll learn more about this change in an upcoming blog.
More frequent evaluation data to inform “real time” changes in strategies and practice.
Georgia Health Policy Center (GHPC) has been the TACHI evaluation partner since the beginning. During the planning phase, GHPC generated a year-end report summarizing progress. During the implementation phase, we designed the evaluation to gather most of its data mid-year, through a thorough site partner survey and interviews. Smaller touchpoints with the sites came occasionally through the year, but the vast majority of data came from the survey and interviews.
EHF wanted more evaluative data throughout the year. We wanted real-time data that could allow us to change our support mechanisms quickly, rather than waiting for the once-a-year evaluation report. Meanwhile, we also didn’t want to burden our site partners with additional long surveys throughout the year.
GHPC developed a quarterly pulse-check, focusing on one or two topics to be answered quickly (ideally less than five minutes.) They will continue their more in-depth mid-year review.
If you want to learn more about the TACHI evaluation, look out for an upcoming blog soon.
TACHI embodies the idea that learning and doing are different experiences. We know the basics and fundamentals of swimming and we discovered more was needed. TACHI takes place in a real world that is ever-evolving, such as changing priorities, organizational realignments, and unplanned staffing changes. TACHI requires us to refine our swim strokes, learn new moves, and revisit the fundamentals every now and then. We don’t want to become pros, we just want to make waves of change in our Texas communities.