Adaptive Learning and Improvement

Effective change efforts embed structures and processes to engage diverse stakeholders in real-time learning to continuously improve their efforts and rapidly respond to emerging needs and opportunities (Foster-Fishman et al., 2001; Hargreaves et al., 2017). This involves creating multiple feedback loops to gather input on unfolding changes and responding to this feedback with adaptive action (Eoyang & Holladay, 2013).

Adaptive learning and improvement involve putting the following elements in place over time (Foster-Fishman et al., 2018):

ADL Main fin.jpg

Why is this important? The health problems facing communities are complex and ever-changing. Transformative change requires an ongoing, dynamic process where uderstanding, doing, learning, and adapting become more important than planning (Foster-Fishman & Watson, 2012). In short, an adaptive learning and improvement orientation allows collaborative change efforts to translate their shared vision into transformative outcomes for the community (Latham, 2014).

Five people working together to put a puzzle together.

Effective change initiatives establish a shared measurement system and promote collective accountability for the processes and outcomes of the work (Latham, 2014). Building consensus among partners about what will define success and how that success will be measured is vital to pursuing the shared vision goals as it helps to create accountability and keeps the project on track (The Intersector Project, 2016).

Promoting shared measurement and accountability could involve creating:
- a shared set of short, intermediate, and long-term outcomes to track progress toward shared goals (Preskill et al., 2014).
- common metrics and data collection tools that can be used across organizations to track progress on outcomes (Preskill et al., 2014).
- a commitment among members and partners to collect data to inform progress on outcomes (Preskill et al., 2014).
As a result, members of the change initiative are more likely to feel and hold each other accountable for achieving results (e.g. achieving outcomes, achieving policy changes, and improving community conditions; Preskill et al., 2014) and creating a system that is responsive to resident needs (Hargreaves et al., 2017).

Tools to Promote Shared Accountability and Measurement

Define and Measure Shared Outcomes

Work with local partners to identify outcomes related to the Shared Vision goals, and develop a system for measuring and reporting these outcomes over time. Communicating progress towards achieving shared outcomes to partners is a key way to promote shared accountability.

Use the following resources to help in developing a shared measurement approach for your efforts.

Breakthroughs in Shared Measurement and Social Impact
Reviews 3 types of shared measurement approaches communities have taken to pursue shared goals.
Source: FSG Social Impact Advisors

Defining Targeted Problems and Inequities
Planning guide to help define specific outcomes related to your shared vision goals.
Source: ABLe Change

Making Outcomes Matter
Resources for how to help your initiative or organization use feedback on its outcomes and progress to promote shared accountability and co-learning. 
Source: Community Tool Box

Effective change initiatives gather rapid feedback on their actions and goals from diverse sectors and residents to inform strategies, decision-making, and continuous improvement (Foster-Fishman & Watson, 2010). This learning orientation enables change efforts to “fail fast” so they can quickly identify how to improve their efforts before spending too much time and resources on ineffective approaches (Giles, 2018).

A learning orientation involves:
- Accessing data needed to track progress and identify successes and failures (Hargreaves et al., 2017)
- Seeking feedback from diverse sectors, organizations, and residents about the needs they see in the community/region and possible solutions (Foster-Fishman & Watson, 2017).
- Creating systems to rapidly assess and respond to data and feedback (Partnership for Healthy Outcomes, 2017)
- Adapting strategies and action in response to what is being learned (Foster-Fishman & Watson, 2010).
Overall, significant personal growth and systems transformation can emerge when action becomes the basis for learning and is coupled with opportunities for reflection (Checkland, 1990).

Tools to Foster a Learning Orientation

Gather Rapid Feedback on Change Efforts

Work with local partners to gather rapid feedback on whether strategies are being implemented effectively and starting to make a difference in targeted outcomes. Focus on feasible ways to gather this information, for example leveraging existing forms, meetings, and service interactions. Compile this information in an easy to use format, such as an action record, that documents actions and emerging systems outcomes related to the Shared Vision.

Plan to Gather Implementation Feedback
Guide to gather feedback on the implementation of local strategies. This information can help you rapidly identify and address emerging barriers to keep your implementation efforts on track.
Source: ABLe Change

Gathering Information: Monitoring Your Progress
Resources to help consistently seek and respond to information about the initiative's efforts to promote learning and improvement.
Source: Community Tool Box

Systems Change Action Record Template
Tool to document actions and outcomes emerging from initiated systems change strategies; use to promote shared accountability.
Source: ABLe Change

Example Systems Change Action Record 
Sample action record tool with example actions and outcomes emerging from initiated systems change strategies.
Source: ABLe Change

Respond to Emerging Needs and Opportunities

Engage local stakeholders in reviewing feedback on local efforts and responding to emerging needs and opportunities. For example, engage collaborative partners in problem-solving strategy implementation barriers or designing ways to expand successful strategies to additional settings and contexts. Use the following resources to help your effort respond to feedback on emerging conditions in your community.

Action Learning Cycle Cheat Sheet
Simple facilitation questions you can use to promote action learning for continuous improvement process.
Source: ABLe Change

Identifying and Addressing Emerging Issues
Simple questions you can ask during meetings to identify and address emerging issues related to your Shared Vision.
Source: ABLe Change

Effective change initiatives embed a learning orientation across the community by helping local organizations adopt a continuous improvement approach within their work.

This can involve local organizations:
- More regularly using data to track their progress and improve their efforts
- Creating a work climate that has a stronger focus on learning and continuous improvement
- Gathering more real-time feedback from the individuals they serve to improve their efforts
Embedding these approaches across vertical and horizontal layers of the community can help ensure new practices and habits become integrated into everyday practice and support the overall change efforts (Foster-Fishman et al., 2007; Lounsbury & Mitchell, 2009).

Tools to Embed Continuous Improvement Practices

Support Organizational Learning and Improvement

Provide resources and supports to help local organizations across the community embed new learning and continuous improvement practices. For example, help organizations adapt the action learning tools and processes used within the collaborative initiative to fit within their organizational setting. Use the following resources to help provide this support in your community.

Action Learning Cycle Cheat Sheet
Simple facilitation questions you can use to promote action learning for continuous improvement process.
Source: ABLe Change

Achieving and Maintaining Quality Performance
Tips and resources for organizations to embed continuous improvement and Total Quality Management (TQM) approaches within their efforts.
Source: Community Tool Box

Effective change initiatives help sustain co-learning and continuous improvement practices by fostering new expectations, supports, and incentives across the community (Foster-Fishman et al., 2018).

For example, this could include encouraging local funders, payers, and hospitals to:
- align their resources to support continuous improvement and data-sharing efforts in the community
- ask local grantees to put a greater emphasis on using data for continuous improvement
Tools to Sustain Co-Learning and Continuous Improvement

Promote New Expectations and Incentives

Work with local funders, payers, and hospitals to explore how they could align their resources and shift their grantee expectations to support co-learning and continuous improvement. For example, some funders have required continuous improvement processes within their requests for proposals, and have developed grantee technical assistance efforts to support the use of these processes.

Working Together for Healthier Communities: A Framework for Collaboration Among Community Partnerships, Support Organizations, and Funders
Resource for how to engage community partnerships and funders in supporting collaborative efforts and problem-solving.
Source: Community Tool Box

Michigan CHIR Learning Community

Tools for Action

Adaptive Learning and Improvement Processes Tools Will Help You:

Effective Convening Tools Will Help you:

Shared Vision and Goals Tools Will Help You:

Engaged Diverse Partners Tools Will Help You:

Aligned Systems Tools Will Help You:

Equity Pursuits Tools Will Help You:

Adaptive Learning and Improvement

Define and Measure Shared Outcomes

Gather Rapid Feedback on Change Efforts

Respond to Emerging Needs and Opportunities

Support Organizational Learning and Improvement

Promote New Expectations and Incentives