Aligned Systems

Effective systems support aligned policies, resources, and practices across diverse sectors and groups. This alignment results in improved care coordination, cohesion across different healthcare approaches or best-practices, and seamless communication and exchanges across relevant stakeholders and sectors (Foster-Fishman & Watson, 2012; Meadows, 2008).

Aligned systems involves putting the following elements in place over time (Foster-Fishman et al., 2018):
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Why is this important? Even the most comprehensive, accessible, and relevant program array is insufficient for addressing the health needs of local residents if the surrounding system is not aligned to support these outcomes (Fixen, Blase, Metz, Van Dyke, 2013; Meadows, 2008). System transformation involves both a focus on programs and the alignment of systems that allow those programs to function well. (Fishman & Watson, 2012; Meadows, 2008).

A picture of ten people meeting around a table.

Effective change efforts build the capacity of local stakeholders and collaborative groups to engage in community problem-solving (Yang et al., 2012).

For example, this capacity could include the skills, knowledge, and practices to:
- understand the challenges facing individuals experiencing local inequities, such as service access barriers and the social determinants of health (Yang et al., 2012).
- improve connections between health care and community service agencies (Nowell & Foster-Fishman, 2011).
- shift policy, environment, and community systems conditions to address social determinants of health (Honeycutt et al., 2015).
- use data and feedback to improve decision-making and actions (Foster-Fishman & Watson, 2010b).
This capacity could also include organizations and collaborative groups having the resources and supports they need to accomplish the goals within the Shared Vision (Foster-Fishman et al., 2001).

Tools to Build Community Change Capacity

Design a system scan

Help stakeholders understand local conditions related to your Shared Vision goals by using a System Scan. A System Scan is a process to gather information from diverse perspectives about needs and opportunities in the community and is used to inform strategy design (Foster-Fishman & Watson, 2012). Use the following to design a System Scan for your community.

System Scan Design Guide
Step by step guide for designing a system scan process in your community.
Source: ABLe Change

System Scan Question Menu
Example questions you can use to understand system root causes affecting your goals and outcomes.
Source: ABLe Change

System Scan Methods Decision Matrix
How to determine which system scanning methods are right for your efforts based on local needs, resources, and capacities.
Source: ABLe Change

Gather information from diverse perspectives and sources

Once you have designed your System Scan, gather the information you need from diverse individuals and data sources to understand local conditions in your community. The following tools can aid in gathering this information.

Root Cause Analysis Template
Simple questions you can use to ask about system root causes driving local problems during meetings, planning process, and conversations.
Source: ABLe Change

Assessing Program/Effort Reach Worksheet
Questions to help assess the reach of local programs and efforts addressing your targeted problems.
Source: ABLe Change

Cheat Sheet for Getting Actionable Information
Use this cheat sheet to help gather detailed information during conversations to guide strategy design.
Source: ABLe Change

System Scan Group Facilitation Tips and Facilitation Cheat Sheet
Use these tools to help facilitate small group conversations in your system scan.
Source: ABLe Change

System Scan Note-Taking Tips for Scribes
Note takers can use this tip sheet to help capture detailed notes during system scan conversations.
Source: ABLe Change

Make sense of system scan information

As you gather your System Scan information, engage local stakeholders in making sense of the data so it can be used to inform strategy design. This involves identifying themes from the information and prioritizing issues to target for change.

Engaging stakeholders in this process is a great way to raise their critical consciousness of local issues and encourage them to take action. The following tools can help with designing and facilitating a sense-making process in your community.

System Scan Data Organizing Tool
Tool to organize and prepare data on root causes for the sense-making process.
Source: ABLe Change

ABLe Sense-Making Guide
Step by step process to organize and make sense out of your system scan data to prepare for strategy design.
Source: ABLe Change

What Do You Want? Choosing a Local Policy Goal
A tool to facilitate meaningful discussion and decision-making around prioritizing policies to focus in within local change efforts.  
Source: Power Prism

Summary of System Scan Priorities
A template to help summarize the prioritized root causes emerging out of the System Scanning process.
Source: ABLe Change

Develop a Shared Agenda

A Shared Agenda is a tool to bring together diverse stakeholder groups, workgroups, and collaboratives around a shared set of community change goals (Foster-Fishman & Watson, 2012). Use the Shared Agenda to summarize priorities emerging out of your system scanning and shared visioning processes, and engage individuals and groups in problem-solving and action to address these priorities.

Shared Agenda Template
Summarizes prioritized change targets to help align action and promote accountability.
Source: ABLe Change

As initiative partners build their community change capacity, they are more likely to initiate actions and changes to address various barriers to the shared vision goals (Yang et al., 2012).

Examples of these changes could include (Foster-Fishman et al., 2018):
- Developing staff skills to advance equity
- Expanding services and programs to address gaps
- Collecting more or different types of data to inform continuous improvement
- Adopting new assessment and referral practices to increase service coordination (e.g. using new social determinants of health screening tool)
- Sharing data about services and outcomes with other organizations
- Expanding efforts to improve community social, health, and living conditions
Change efforts are more likely to succeed and take hold when they saturate vertical and horizontal layers within a community (Foster-Fishman et al., 2007; Lounsbury & Mitchell, 2009); this is often referred to as the ecological model.

For example, research has found that educational reforms are more likely to bring about transformative change when they influence policy and practices within diverse sectors (e.g., early childhood, employment) and saturate multiple layers and spaces within an educational system (Coburn, 2003; King-Sears, 2001).

Tools to Leverage Community Change

Design Powerful Strategies to Pursue Shared Vision

Use the information gathered through the system scanning process (see Community Change Capacity tool section for more details) to design powerful strategies around your shared vision goals. Engaging multiple perspectives in this design process – including local residents - can promote more creative strategy ideas that fit the needs and opportunities within the community (Plattner, 2016). Use the following resources to help design powerful strategies for your community.

Strategy Design Template
A template to capture ideas that will help your community better address prioritized root causes when designing strategies.
Source: ABLe Change

Strategy Design Check List
How to improve the power of your strategies by using the ABLe strategy approaches.
Source: ABLe Change

Example Strategy Resource
List of example systems change strategies addressing powerful system leverage points
Source: ABLe Change

Initiate Action

Help diverse individuals (staff, leaders, community partners, residents) initiate actions to carry out your strategies. If your community struggles with moving to action (as most communities do), consider helping stakeholders initiate small, quick actions to move the overall change process forward (Foster-Fishman et al., 2006; Weick, 1984). These “quick win actions” are accomplished within 1-3 months, meet little resistance because they are easy to carry out, and help build momentum leading to larger wins (Foster-Fishman & Watson, 2018).

Use the following resources to help initiate action in your community.

Quick Wins Guide
Guide for how to identify quick wins to support every stage of the change process.
Source: ABLe Change

Facilitators’ Cheat Sheet to Promote Quick Wins
Tips for how to help individuals plan out quick win actions during collaborative meeting processes.
Source: ABLe Change

Quick Wins Tracking Database
Database to help track and plot (using run charts) actions to pursue the Shared Vision.
Source: ABLe Change

Quick Win Coaching Tool
Guide to provide behind the scenes support and coaching to stakeholders carrying out action.
Source: ABLe Change

100 Day Challenge Planning Guide
Guide to plan and implement a 100 Day Challenge effort to engage stakeholders in initiating action to pursue shared goals.
Source: ABLe Change

As a result of initiating the actions and changes described above, initiatives can bring about more aligned policies, practices, and conditions in support of the shared vision (Yang et al., 2012).

Examples of this system alignment could include improved (Foster-Fishman & Watson, 2012):
- access to services, programs, and resources (e.g., healthcare services, affordable housing, living wage jobs, healthy food, etc.)
- coordination across sectors, including referrals and information sharing
- local partnerships
- equitable practices and outcomes
- system responsiveness to resident needs and voice
- opportunities for residents to get their needs met
Tools to Support Aligned Policies, Practices, and Conditions

Support Effective Implementation

Support changes in local policies, practices, and conditions by tracking and supporting the effective implementation of your strategies. This includes ensuring strategies are being adopted locally, used effectively, and reaching intended individuals and settings. Use the following to help in supporting implementation in your community.

National Implementation Research Network Active Implementation Hub
A collection of free materials, tools, and videos to help support effective implementation of local change efforts.
Source: NIRN

Implementation Drivers Assessment Tool
Tool to assess extent to which key implementation supports are in place to support your efforts.
Source: NIRN

Effective change efforts promote sustainability by working to align local, county, state, and national funding with ongoing efforts to promote health equity in the community (Preskill, 2014).

For example, this sustained funding could come from (Foster-Fishman et al., 2018):
- Health plans expanding investments in health promotion to reduce overall costs and reinvest in population health
- County and city government officials working to align resource allocations to promote health and reduce inequities
- Health plans aligning their resources to support a greater focus on social determinants of health
- Hospital systems addressing broader community health needs by shifting investments away from traditional clinical care and toward community conditions
Tools to Promote Sustained Funding

Pursue Sustainable Funding Sources

Promote sustained funding for your change initiative by redirecting current resources or attracting new resources across diverse funding sources. Use the following resources to pursue sustained funding for your change efforts.

Changing Policies to Increase Funding for Community Health and Development Initiatives
Resources on how to shift policies to align funding in support of community health initiatives.
Source: Community Tool Box

Strategies for Sustaining the Initiative
Tips and recommendations for how to align funding to promote the sustainability of change efforts over time.
Source: Community Tool Box

Obtaining Corporate Resources
Tips and resources for how to engage corporations in supporting local change efforts through various ways (e.g., financial, in-kind, matching, etc.).
Source: Community Tool Box

Communicating Information to Funders for Support and Accountability
Resources for how to effectively communicate information and evaluation results to funders and to the public to build support for the initiative's efforts.
Source: Community Tool Box

Michigan CHIR Learning Community

Tools for Action

Aligned Systems 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:

Adaptive Learning and Improvement Processes Tools Will Help You:

Equity Pursuits Tools Will Help You:

Aligned Systems

Design a system scan

Gather information from diverse perspectives and sources

Make sense of system scan information

Develop a Shared Agenda

Design Powerful Strategies to Pursue Shared Vision

Initiate Action

Support Effective Implementation

Pursue Sustainable Funding Sources