In a recent article on Government Technology Insider, our colleagues published an article authored by Ryan Schradin, where they sat down with Ashley Rink, and Erin Sosne, of NC SHIP Community Council (NCDHHS) to discuss the role of NCDHHS in making positive changes in the wellness of North Carolinians and share how Results-Based Accountability and scorecards are helping drive progress across North Carolina. Read on to learn more about how Results-Based Accountability and scorecards can help government agencies drive meaningful change in the communities they serve.
According to a recent Forbes ranking of the best and worst states for healthcare, the State of North Carolina is ranked relatively low in multiple healthcare statistics. The state has a large uninsured population, low access to care, and poor scores in certain health indicators, including infant mortality. But North Carolina has a plan to help turn that around.
About three years ago, the North Carolina Department of Health and Human Services (NCDHHS) released its North Carolina State Health Improvement Plan (NC SHIP) designed to address 21 Wicked Problems –issues impacting the health and wellness of residents across the state. Included in this plan was the establishment of the NC SHIP Community Council, which brings together diverse representation from non-profit, philanthropic, academic, government, business, and community members to drive health improvements across the state.
Three years after its establishment, the NC SHIP Community Council is already paying dividends—implementing programs that improve health and wellness while cutting costs for North Carolinians. Helping the NCDHHS make positive change and measure its success has been an exciting approach to measurement called Results-Based Accountability (RBA) and the dedicated use of scorecards.
We recently sat down with Ashley Rink and Erin Fry Sosne of the NCDHHS to learn more about the NC SHIP Community Council, how RBA has benefited them, and the role of Clear Impact Scorecards in their success.
Government Technology Insider (GTI): Can you tell our readers about the NC SHIP Community Council? Where did it get its start? What is its mission?
Ashley Rink: The Community Council is in its third year of bringing together partners and communities from across the state of North Carolina to address a variety of what we refer to as Wicked Problems. We have identified 21 of these problems—different social drivers and determinants of health—and the Community Council is working to foster policies and programs designed to help solve them.
Erin Fry Sosne: The Public Health Accreditation Board requires all states to have a state health improvement plan as a quality measure. Our decennial state health improvement plan is called Healthy North Carolina 2030, and it was put together through a consensus process with the North Carolina Institute of Medicine.
In drafting this plan, we took those 21 Wicked Problems that Ashley discussed—problems such as the use of tobacco products, insufficient access to housing, and others—and looked at them as a community. We know we are not the only game in town, and a broad range of actors are trying to solve these Wicked Problems. The NC SHIP Community Council was the result.
GTI: In what different areas is the NC SHIP Community Council trying to create change in the State of NC? How do these Wicked Problems impact the quality of life in North Carolina?
Ashley Rink: The Wicked Problems include everything from poverty to unemployment, tobacco use, and access to healthcare. They impact every aspect of a North Carolinian’s life, from finding housing to access to primary care providers.
Erin Fry Sosne: Any of these problems are significant in an individual’s life. Having someone who can’t quit tobacco and has family members suffering ill health effects as a result, not being able to find adequate housing, or having too many short-term suspensions for kids in school are all upstream drivers of things that result in poor health outcomes. And there’s a significant amount of data around that.
Our goal in this effort is not to produce data saying that a lack of housing contributes to many different health conditions. That evidence is very robust and already available. We’re looking to identify how we go upstream.
GTI: What is the State of North Carolina doing directly to improve healthcare, access to care, and the quality of life for North Carolina residents?
Erin Fry Sosne: It’s not for us, as the state, to solve the problems, but rather for us to convene and pull together people who are the real experts. The people on the ground with lived experience have the answers to these problems. That is why we pulled together the Community Council – to have a top-down approach and work with community partners to bring together the folks who do the work.
Ashley Rink: We recognized that there were already folks doing the work. We didn’t want to duplicate any of the work that those groups were already doing, and we didn’t want to duplicate those groups if they existed. However, for problems that didn’t have existing groups, we formed new groups with co-leaders from the Division of Public Health or the Department of Health and Human Services, as well as from the community and other sectors.
The co-leaders head the work groups and identify the partners developing potential solutions for these challenges. They develop action plans to move forward toward their identified priorities. They do so collaboratively as a group comprised of various organizations and perspectives.
GTI: How has an RBA approach helped the NC SHIP Community Council create change in the state? What impact has it had?
Ashley Rink: Using RBA has provided a common language. There’s lots of jargon being used across the Community Council. We have people with healthcare, social services, and government backgrounds, so multiple different languages are being used.
RBA has taught us to be intentional and speak the same language. Even as we’re pulling in other styles, steps, and models, we’ve been able to use RBA to help us move from talk to action in an intentional way. We took the time in the beginning to set that common language, form groups, create collaboration, and do some level-setting. Now that we’re in our third year, we’re transitioning to action, and RBA has really set the stage for that.
Erin Fry Sosne: We produced the NC SHIP using RBA, and different actors have lauded us repeatedly for how clear our language is. Our language is also often used in other documents because it’s widely understood.
Folks keep the NC SHIP on their desks. We get asked for printed copies so they can flip through, bookmark, and make notes. They do that because of the collaborative way the content was developed, the data it contains, and the clarity of language and thought. That’s a partial result of the RBA Framework and the tools it gave us
GTI: How do you keep track of improvements for NC SHIP initiatives? What does this ability to track progress enable?
Ashley Rink: We track our initiatives through Scorecards and this tool enables us to show progress across all work groups. There are 18 work groups across the 21 Wicked Problems. Having one place to track what’s happening across all those work groups is invaluable for assessing our progress and accomplishments.
Scorecards are an essential tool in answering important questions. Is anyone better off? How much did we do? How well did we do? They let us put that story together and show how we’re turning the curve on these Wicked Problems. They also tell that story in a meaningful way, showing who the partners are with a role to play, what they’re doing, how they are doing it, and what results they’re getting.
Erin Fry Sosne: I would like to add that we have adopted Clear Impact Scorecards statewide. 86 local health departments across North Carolina use this tool, which enables us to track common indicators and gives us a common language.
GTI: I know that the RBA approach is relatively new to NCDHHS and that the Council is working to increase health and quality of life by 2030. Has progress been made to date? Have there been any positive advancements or changes implemented?
Erin Fry Sosne: This is a bit of a different type of project because Healthy North Carolina 2030 is tracking all the metrics, but we’re not actually addressing the underlying issues. We’re bringing people together, harvesting the data from initiatives across the community, and identifying the interventions that are making a difference. What’s so special about the Community Council is that they can come together and say, “We’ve tried this in this community, and here are the results.”
Ashley Rink: Starting change at the state level can be very difficult and require making statewide policy change. In a state like North Carolina, doing more direct work at the community or district level may make sense. The Community Council allows individuals to share the changes they’ve made in their communities and analyze the results. We can then figure out how to spread and scale what works around the state to other communities.
One successful NCDHHS program to highlight is the Healthy Opportunities Pilot (HOP). NCDHHS recently published a study about HOP, which involved close collaboration with Medicaid to identify the impact of using Medicaid dollars to address some of these challenging Wicked Problems. It was found that providing things like housing, food, and violence prevention services saved health care dollars down the road.
It’s important to show taxpayers and government leaders that addressing these upstream drivers of health helps save healthcare dollars. In this particular case, approximately $85 was saved per person enrolled in this program. That’s quite significant.
To learn more about how RBA and scorecards can help government agencies drive meaningful change, click HERE to download a complimentary copy of the eBook, “Social Sector Hero.”