Creating a Structure for Improvement in Complex Health Systems
Children’s brains develop at a faster rate during their first few years than at any other point in their lives. Because of this, even small improvements in early childhood health can have a significant impact on children’s developmental outcomes. Yet, millions of children continue to approach kindergarten without the necessary skills to learn. While the research shows that this period is our best opportunity to act, it is difficult to know how to best improve the complex systems that serve families during these critical years.
Early childhood health is a complicated and layered system comprised of public health facilities, parents providing care, health insurance organizations, local and national legislation, among many other systems. These systems are often purposefully siloed and lack the appropriate resources to support cross-sector collaboration and communication. This becomes especially challenging when seeking to address social determinants of health, such as race and economic stability, because successful change requires active collaboration from across many sectors.
Positively intervening in early childhood development means creating a system that supports people at all levels, from those working in healthcare and social services settings, to daycare and community support networks, to those in the child’s home. When we create such a system, it is possible to close the gap between research and practice and take positive steps toward change.
The NICHQ-led Early Childhood Comprehensive Systems Collaborative Improvement and Innovation Network (ECCS CoIIN), which connects teams from 12 states and 28 communities, is implementing such strategies to improve early childhood health outcomes and help more children achieve kindergarten readiness. In the first year of this project, we’ve identified three essential lessons learned about how to use collaboration and quality improvement as catalysts for change in early childhood systems.
Lesson 1: Find the Existing Energy and Places of Opportunity
Rather than start from scratch, it’s important to capitalize on the energy and determination already happening in the communities. When we identify states, communities or organizations as bright spots, we can build off lessons that are already learned and harness energy that is already focused. For example, says ECCS CoIIN Project Director Zhandra Levesque, MPH, "we see the Florida Association of Healthy Start Coalitions (FAHSC) as a bright spot because it has done an incredible job of working with their communities to bring parent partners directly to the table and engage them in state level decisions. FAHSC brings together the energy that already exists, and then scales it up to create state-wide change."
Similarly, state health departments should work to amplify the voices of those in the existing communities who have already made strides in tackling early childhood issues. For example, states like New Jersey are successfully leveraging the expertise of their placed-based communities by taking advantage of their existing resources and advice. "The energy is there," says Levesque. "To be effective change agents, state and national initiatives need to use the existing voices to inspire new allies."
Engaging national, state and community partners, across private and public sectors, can yield impressive results. The ECCS CoIIN project map and key documents, developed from the combined expertise from NICHQ, the Maternal and Child Health Bureau and state and project partners, is a concrete example of what effective collaboration and co-creating can accomplish.
Lesson 2: Create a Space for Conversation
From addressing staff turnover, to understanding and managing data, there are many shared challenges that states and communities will face when looking to drive systems-level change. Creating a space to discuss these common challenges and lessons learned, especially in real time, is where the most valuable learning happens. Those working within the early childhood systems are already well-versed in the challenges and opportunities, which means they can offer constructive and practical advice to peers.
For backbone organizations in collaboratives like the ECCS CoIIN, supporting this inter- and intra-team conversation sometimes means getting out of the way and letting improvement teams take the lead. “When we do this, we encourage participant investment, which is essential to NICHQ’s change management approach,” shares Levesque. “We seek out individuals or groups that are willing to lead a conversation on strategies implemented and lessons learned, and then we develop the structure for these conversation by providing the platform, resources and facilitators.”
Lesson 3: Listen First, then Respond
People typically work across a wide array of sub-systems and services, and each site is accustomed to receiving prescribed technical advice. The idea of group-learning in a collaborative can make participants feel that their individual needs might not be met.
To counteract this expectation, change facilitators and improvement coaches must engage in every conversation with a willingness to listen and a genuine desire to address each group’s specific needs. Participants are the experts in their field, which means they best know their needs and what can help them accelerate their improvement. When teams feel heard, they are more likely to share their true pain points and make progress. We can then take the individual lessons-learned, mine them for core strategies that apply to the children’s health field and use them in future and ongoing initiatives.
When we harness the power of group learning, we maximize our resources and comprehensively address needs across a diverse system.
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