For over two years, Improve Group staff has been fortunate enough to work with several of Minnesota’s Statewide Health Improvement Program (SHIP) grantees. Through SHIP, grantees in each of Minnesota’s 87 counties and several tribes were charged with making policy, systems and environmental changes in schools, communities, worksites and healthcare facilities to help reduce obesity and tobacco use in our State. This month marks a change in the current grant structure, with the work of SHIP continuing in a smaller number of communities across the State. This milestone presents a great opportunity to reflect on some of the lessons we’ve learned evaluating this initiative. From urban city centers, to towns will fewer than 100 residents, we’ve found several lessons ring true across diverse settings:
Making policy, systems and environmental changes is time-intensive. While this finding is certainly not a surprise to anyone who has undertaken systems-change work, time and time again, we heard that the level of time and energy needed to make sustainable changes was even greater than expected. Most often, a champion spearheaded the changes within each community or organization. The champion was most successful in making changes if they were freed up of some other job duties to focus on SHIP, or they had the support of SHIP staff to help with the “nitty gritty” details of making changes.
There is value added in working together to make systems changes. When worksites, school districts or healthcare facilities work together, there is power in numbers. Not only do they have “more heads” to bounce ideas off one another, but working together adds an element of peer pressure. When a school district sees that their neighboring district is improving school lunch offerings, it is easier to support similar changes in your own district.
Take time to fill in decision makers. While key decision makers are often not involved in getting changes off the ground, their support is essential to this work. Decision makers should be equipped to share about the systems-change work with others inside and outside the organization. Some communities held biannual briefings with decision makers; others updated their decision makers informally at least once each month.
Move where the community is ready to move. There are dozens of ways a community can work to improve the health of their community, and it’s not possible to tackle everything at once. One school district wouldn’t consider taking away birthday celebrations, but was ready to pass a healthy snack policy. One community established a Latino Wellness Council centered around developing a soccer field in the community; after their initial success in these efforts, their work branched out to other ways to improve the community’s health. By working with communities where they are at, you can get some successes under your belt and build on them in years to come.
While these lessons derive from our work evaluating systems changes in the health field, these lessons can apply to systems change in any field. To learn much more about the Improve Group’s findings from our SHIP work, you can check out our presentations at most recent American Evaluation Association conference or the Making it Better conference, or go to our website to download four case studies we created in collaboration with Faribault, Martin and Watonwan Counties.
