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3 Hospital Systems Boost Their Work to Build Health Equity With CaseMaking

3 Hospital Systems Boost Their Work to Build Health Equity With CaseMaking

By Jen Rich, in conversation with Iueh Soh, Associate Director, Stewardship Practice at the Rippel Foundation

Last year, TheCaseMade’s Dr. Tiffany Manuel worked with the Rippel Foundation’s ReThink Health Initiative to train a cohort of innovators in their Hospital Systems in Transition project. Our work with Rippel has taught us and them several broad lessons about how to strengthen CaseMaking capacity within an organization or system. We wanted to share more about how that’s played out in their work. So, we sat down with Iueh Soh, project lead and associate director of stewardship practice, to talk about how Strategic CaseMaking™ builds adaptive skills for leaders in the movement for equitable systems change.

TCM: What were you hoping to accomplish with the Hospital Systems in Transition project?

IUEH: Hospital Systems in Transition is a three-year project, supported by the Robert Wood Johnson Foundation, involving three innovative hospital systems — Trinity Health in Michigan, Jefferson Health in Philadelphia, and Carilion Clinic in Roanoke, Virginia — that strive to strengthen their practice of shared stewardship to advance health and well-being beyond the walls of their own institutions.

Trinity Health wanted to develop a new kind of health ministry dedicated to equitable health and well-being in Detroit, even though their last hospital in the area had closed 20 years ago.

Jefferson Health sought to leverage their own philanthropy to enhance health equity in Philadelphia.

The Carillion Clinic wanted to advance mental health given that it repeatedly shows up as a top priority in community needs assessments.

Each organization had an ambitious aspiration for shared stewardship that extended far beyond business as usual. Our work involved close accompaniment with core teams in each organization. We facilitated workshops, coached them through sticking points, and participated in several joint meetings. We also supported their work to develop measurement frameworks to chart progress. Finally, we convened a year-long online series of learning labs, where core team members could invite fellow executives and leaders into the process. Together, they created greater visibility and gained shared experience working together as stewards of their organizations and of their communities.

TCM: What prompted you to do the learning labs?

IUEH: When we started, each hospital system faced a gap between their bold aspiration and the realities of business as usual. They had to confront what DrT and others call an adaptive challenge. You can’t just implement a quick fix with existing know-how. It is more difficult than simply deciding to replicate a program that worked somewhere else. It requires a deeper look inside their own organizations to shift norms, priorities, and values.

Eventually, it becomes about building the will to think and act differently. How do you make the case for that kind of change? How do you negotiate tradeoffs with inside colleagues and outside stakeholders? How do you weigh losses against the promise of new priorities? With these adaptive challenges in mind, we asked: Which stewardship practices (i.e., mindsets and actions) can best help hospital system executives make progress?

TCM: What were you hoping they would get out of the learning labs?

IUEH: Before the learning labs, we had been accompanying core teams to define concrete goals for system change. The labs created a learning space to engage others and anticipate adaptive challenges instead of becoming hyper-focused on tactics. Of course, it had to have a practical focus to maintain interest. So, we designed a three-part series tailored for hospital system stewards. Part one was understanding the ambition of a hospital steward. Part two was about the mindsets of stewardship and seeing yourself as part of a wider ecosystem. Part three was about key specific skills like multi-party interest-based negotiations, resident engagement, new ways of measuring value, and Strategic CaseMaking. That’s why we invited in DrT and TheCaseMade to participate as co-faculty.

TCM: In CaseMaking, we often talk about “building your bridge of understanding” and inviting people on to it strategically as you build your case.

IUEH: It’s interesting to think about where you start. Oftentimes people think things like: we need to go to the CEO, we need to go to Oprah, we need to go to these social stars. But we find that those influential figures first need a periphery of fellow changemakers around them before they will get on board, and more than that, become an advocate. So, how do we build these stable pockets of innovation that have a strong enough identity and then go forth and make the culture change internally? It’s much more strategic. Who can we get today, how can we build enough strength so that we make it advantageous for the “star” to become a champion of the work?

TCM: How do you think about mapping that kind of will building?

IUEH: We started the project assuming that a major element of “authority” is having the title, and that people with titles should be on decision-making committees. With the core team, we used the interest-based negotiation framework to help us map the relevant stakeholders and their interests. If you map backwards from any big achievement, you realize that there were a hundred or more linked agreements with different stakeholders to get there. We began to operate more strategically, thinking about who really matters and who needs to join the work next. Instead of convening every senior leader all at once to join in meetings that may not be the best use of their time, we started to connect with the stakeholders who were pivotal at each step and sequence their engagement over time, or sometimes in parallel. Those kinds of focused interactions are a big part of Strategic CaseMaking.

TCM: Can you share an example of how CaseMaking has been helpful to the project’s participants?

IUEH: We shared examples of hospital stewardship from around the country with a systems’ C-suite as they considered their own strategy to advance health and well-being. We focused on crafting a unifying case for hospital executives, anchoring in calls to action for this legacy moment, creating a “story of us” as well as credentialing stewardship through a rigorous scan of exemplar cases of stewardship actions of peer hospitals around the country. Our effort paid off, getting the executives to lean in to prioritizing stewardship. And importantly, the executives were able to “recycle” the CaseMaking framing, adapting it and using it on their own to bring others on board and advance stewardship as an enterprise strategy.

TCM: What progress have you seen as a result of the Hospital Systems in Transition project?

IUEH: All three organizations have made progress in important areas, and CaseMaking played a critical role. Our partners learned how to frame their goals differently and how to champion them successfully in their organization.

Jefferson heavily emphasized strategic CaseMaking, and used their understanding of shared stewardship to create a new philanthropic strategy for the Philadelphia Collaborative for Health Equity. So far, they’ve raised $40 million out of a $100 million capital campaign.

At Carilion, they are now incorporating community health investments for the first time ever as part their overall five-year strategic plan, thus signaling a new approach to core business planning for the hospital enterprise.

At Trinity Health, they are now poised to relaunch the Detroit Health Ministry with its own board made up of local community leaders. It has been 100 years since the Sisters of Mercy opened their first hospital in Detroit and 20 years since their last hospital closed, so this will open a new chapter in their evolving commitment to equitable health and well-being in Detroit. We look forward to all the success that 2022 brings to these projects and the adaptive leaders who are driving them toward justice.

To learn more about the Hospital in Transition project, visit

Read more about Strategic CaseMaking in TheCaseMade’s Knowledge Center.

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