A learning approach to community response during the COVID-19 pandemic: Applying the Cynefin framework to guide decision-making.

Introduction: The United States has been unsuccessful in containing the rapid spread of COVID-19. The complex epidemiology of the disease and the fragmented response to it has resulted in thousands of ways in which spread has occurred, creating a situation where each community needs to create its own local, context-specific learning model while remaining compliant to county or state mandates. Methods: In this paper, we demonstrate how cross sector collaborations can use the Cynefin Framework, a tool for decision-making in complex systems, to guide community response to the COVID-19 pandemic. Results: We explore circumstances under which communities can inhabit each of the four domains of systems complexity represented in the Cynefin framework: simple, complicated, chaotic, and complex, and describe the decision-making process in each domain that balances health, economic, and social well-being. Conclusion: This paper serves as a call to action for the creation of community learning systems to improve community resilience and capacity to make better-informed decisions to address complex public health problems during the pandemic and beyond.

The community transformation map: A maturity tool for planning change in community health improvement for equity and well-being.

Transforming communities to be healthier and more equitable prosents a systemic challenge best addressed by those with native knowledge of the system. Community coalitions are a promising structure for tackling local health inequities, if they approach the change process with multiple local stakeholders and with systemic change in mind. Maturity models offer a framework for system assessment by defining sequential stages toward ideal development. Providing coalitions with a structure for self-assessing community change, the Community Transformation Map (CTM) is a maturity model that operationalizes concepts hypothesized to foster systemic change. This 40-item tool encourages self-assessment, dialogue, and reconciliation of community transformation priorities via an appreciative inquiry process. The CTM was created and applied with 18 community coalitions participating in the 100 Million Healthier Lives initiative. It was iteratively drafted with representatives from across the initiative. These coalitions self-administered the CTM four times over 24 months. Coalitions used the CTM to reconcile perspectives, identify priorities, and create transformation action plans. After the fourth administration, ten semistructured interviews were conducted with coalition members. Thematic analysis revealed good contextual validity. Coalitions saw value in the CTM's productive dialogue and the shared understanding it created, but reported perceived burden in conducting repeated administration. The CTM's value is in structuring community members' reflection on complex, systemic problems. The CTM is rooted in international improvement and change principles and continues to be adapted for other change initiatives. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Pursuing the Triple Aim: The First 7 Years.

UNLABELLED: POLICY POINTS: In 2008, researchers at the Institute for Healthcare Improvement (IHI) proposed the Triple Aim, strategic organizing principles for health care organizations and geographic communities that seek, simultaneously, to improve the individual experience of care and the health of populations and to reduce the per capita costs of care for populations. In 2010, the Triple Aim became part of the US national strategy for tackling health care issues, especially in the implementation of the Patient Protection and Affordable Care Act (ACA) of 2010. Since that time, IHI and others have worked together to determine how the implementation of the Triple Aim has progressed. Drawing on our 7 years of experience, we describe 3 major principles that guided the organizations and communities working on this endeavor: creating the right foundation for population management, managing services at scale for the population, and establishing a learning system to drive and sustain the work over time. CONTEXT: In 2008, researchers at the Institute for Healthcare Improvement (IHI) described the Triple Aim as simultaneously "improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations." IHI and its close colleagues had determined that both individual and societal changes were needed. METHODS: In 2007, IHI began recruiting organizations from around the world to participate in a collaborative to implement what became known as the Triple Aim. The 141 participating organizations included health care systems, hospitals, health care insurance companies, and others closely tied to health care. In addition, key groups outside the health care system were represented, such as public health agencies, social services groups, and community coalitions. This collaborative provided a structure for observational research. By noting the contrasts between the contexts and structures of those sites in the collaborative that progressed and those that did not, we were able to develop an ex post theory of what is needed for an organization or community to successfully pursue the Triple Aim. FINDINGS: Drawing on our 7 years of experience, we describe the 3 major principles that guided the organizations and communities working on the Triple Aim: creating the right foundation for population management, managing services at scale for the population, and establishing a learning system to drive and sustain the work over time. CONCLUSIONS: The concept of the Triple Aim is now widely used, because of IHI's work with many organizations and also because of the adoption of the Triple Aim as part of the national strategy for US health care, developed during the implementation of the Patient Protection and Affordable Care Act of 2010. Even those organizations working on the Triple Aim before IHI coined the term found our concept to be useful because it helped them think about all 3 dimensions at once and organize their work around them.