Bringing a Systems Approach to U.S. Population Health

“Our proposed framework would improve how we monitor and manage health for the U.S. population. Essentially, it translates the Baldrige framework to address U.S. population health.”  

—Julie Kapp

Every year a new cohort of Baldrige Executive Fellows gains intensive knowledge about leading organizations to excellence through cross-sector, peer-to-peer learning hosted at the sites of Baldrige Award recipients. Every Baldrige Fellow completes a capstone project as part of the executive leadership program. A paper on the capstone project of Julie M. Kapp, MPH, PhD, a 2014 Baldrige Fellow, is being published this month in Systems Research and Behavioral Science (see hyperlink below). 

Kapp is an associate professor in the Department of Health Management and Informatics at the University of Missouri School of Medicine in Columbia, MO. Following is an interview of Kapp about the publication of the Baldrige-based approach to U.S. population health.

This publication A Conceptual Framework for a Systems-Thinking Approach to U.S. Population Health was inspired by the work I have done up to this point in my career within the health care sector, as well as within the education sector and with community-based organizations. In my past role as the executive director of the Partnership for Evaluation, Assessment, and Research at the University of Missouri in St. Louis,

I met with dozens of community-based organizations that were putting their passions to work for the greater good of the St. Louis area. At that time, within the St. Louis area, 4,076 organizations were registered with the Internal Revenue Service as tax-deductible charitable organizations. Those organizations span sectors and multiple programmatic areas, such as education, public health, crime prevention, mental health, and community development. Many work with area school districts or to improve economic stability.

Despite the vast number of organizations actively focused on such issues in and around struggling areas of St. Louis, much work needs to be done to strengthen their capacity, readiness, and use of strong evaluation planning and evidence-based decision making to ensure effective results for the betterment of the region. This challenge isn’t specific to St. Louis, and a movement around the country encourages a collective impact approach.

This has been defined as the commitment of cross-sector organizations toward a common goal, with five conditions for success identified as (1) a common agenda; (2) a backbone support organization; (3) mutually reinforcing activities; (4) shared measurement systems; and (5) continuous communication (see J. Kania and M. Kramer, Stanford Social Innovation Review, 2011).

The more deeply I became involved—and after I transitioned to my current role at the School of Medicine at the University of Missouri in Columbia—the more I came to believe that the five conditions listed above for collective impact are not enough. To improve the effectiveness of how community-focused organizations address health and other issues, we must change their funding requirements. To change their funding requirements on a broad scale requires change at the federal level. Therefore, what is required is a systems approach. This is a key way in which my proposed framework reflects the Baldrige Excellence Framework.  

What were the milestones of your project? Did you receive any key feedback from sharing your capstone progress with other Baldrige Fellows?

The entire experience was exceptionally beneficial. The chemistry and collegiality among our cohort of Baldrige Fellows elevated the experience even further. I learned so much from each of them, and from the leadership—Bob Fangmeyer [Baldrige director], Harry Hertz [Baldrige director emeritus], Bob Barnett [Baldrige Fellows executive in residence], and Pat Hilton [Baldrige Fellows program manager]. Dr. Steven Kravet, president of Johns Hopkins Community Physicians, co-authored the paper, contributing his physician’s perspective as well as his perspective as another Baldrige Fellow.  

What is your vision for how this capstone project is improving/has improved something significant at your organization? Could you please describe any results or impacts so far?

Our proposed framework would improve how we monitor and manage health for the U.S. population. Essentially, it translates the Baldrige framework to address U.S. population health, with two overarching recommendations: (1) drive a strategic outcomes-oriented, rather than action-oriented, approach by creating an evidence-based, national reporting dashboard; and (2) improve the operational effectiveness of the workforce. The current infrastructure is fragmented and misaligned. A 2013 National Research Council and Institute of Medicine report identifies how the United States has for decades lagged behind our high-income peer countries on a number of health indicators, including life expectancy. To reduce this U.S. health disadvantage through system-level change, we must begin to align and integrate and be able to visually display health and health care organizations’ shared metrics; allocated dollars on shared metrics; programs and activities on shared metrics; progress reports on shared metrics; and evidence-based and effective practices on shared metrics.

With the publication of this framework, I hope to distribute it to as many key stakeholders that impact U.S. health as possible, including researchers, leaders of federal agencies, national organizations, and legislators. It is relevant to the secretary of the U.S. Department of Health and Human Services; Agency for Healthcare Research & Quality; Centers for Disease Control and Prevention; National Research Council; U.S. Surgeon General; AcademyHealth; National Academies of Sciences, Engineering, and Medicine; Centers for Medicare and Medicaid Services Innovation Center; state government organizations; and nonprofit organizations and foundations, among others. Next steps include beginning to operationalize the framework at the local, state, and federal levels. We can’t afford not to consider an aligned and integrated systems-thinking perspective for improving U.S. population health.  
 

What were your key learnings from the Baldrige Fellows program?

Baldrige opened my eyes to alignment and integration, a systems approach, and feedback loops. Those concepts were apparent during our group’s visit to Advocate Good Samaritan Hospital in Downers Grove, Illinois [a 2010 Baldrige Award recipient]. It was so helpful to see what excellence looks like in operation. Good Samaritan Hospital also really brought home the message for me that having the right leadership is everything. The ideas that are part of the Baldrige framework are really helpful. But the real learning and growing comes when you have to do the hard work of answering the questions in addressing your particular challenge.  

Could you please share a few insights you gained from delving into the Baldrige framework during the Baldrige Fellows sessions that you can use for the benefit of your own organization?

Yes. First, make sure you have a clear vision and can communicate it. The “why” is our reason for being. It motivates us each day. Second, the difference between success and failure is in the “how.” Third, being transparent in sharing data and action plans and progress on metrics goes a long way to build trust in an organization’s leadership and confidence in a process. Finally, stay the course. Don’t lose faith.  

Could you please describe the value/benefits you see of the Baldrige framework to your sector?

Health care organizations are familiar with the Baldrige framework [which includes the Health Care Criteria for Performance Excellence], but it is not used widely enough. And as of now, the discipline and implementation of approaches to U.S. population health are not reflecting the Baldrige framework. I hope our paper provides those involved with U.S. population health a framework to use to move forward. With the 2010 Patient Protection and Affordable Care Act initiatives, the country is moving in the direction of integrating these two sectors, which is extremely challenging to do without an overarching framework. I have not yet seen anyone else [but the Baldrige Program] provide such an applied, operational framework that essentially addresses the how, the process.  

More interviews of Baldrige Fellows and information on this executive leadership program is available on the Baldrige Program’s website.