Systems Change Should Lift Up Beneficiary Voices

SSIR’s Winter 2015 article, “The Dawn of System Leadership,” contributes needed thought leadership on how leaders and institutions can work together to affect systems-level social change. Senge, Hamilton, and Kania’s article challenges us to approach systems change in a way that transcends institutional matters and elevates the fundamental human elements of social progress: connectivity, relationships, open reflection, and shared vision. In the article’s final paragraph, however, the authors acknowledge that these elements, while essential, are not sufficient to foster an environment ripe for transformation. As they put it: “Last, there is a broad, though still largely unarticulated, hunger for processes of real change.”

We have experienced this hunger at Blue Shield of California Foundation in our work to improve the support systems that are designed to keep Californians healthy and safe. We want to see strategies that, as the authors write, “get at the deeper sources” of the problems we aspire to solve. Yet, not surprisingly, foundation-sponsored research has suggested that definitions of “success” often look very different from the vantage point of organizational leaders relative to the perspectives of the people and communities they serve. What’s more, in our role as philanthropists, we are removed from the processes we seek to influence. As such, we need system leadership to create an accurate and complete picture of the challenges, and of what realizing “success” means.

To that end, we have been more purposeful about asking for feedback from the communities we aim to support. What we’ve learned has been both humbling and motivating. From a 2014 study conducted in California by the Full Frame Initiative, for example, we learned that while many domestic violence service providers define survivor success in terms of changes in the abusive relationship or the provision of formal support services, survivors' own definitions focus on personal achievements and connections with family and friends. We see complementary findings on the health care side through our research on the health care experiences of low-income Californians. While the health care system primarily rewards providers for the clinical quality of the care they provide, our surveys find that the pathway to patient satisfaction and loyalty is actually grounded in relational practices that foster a sense of connectedness and continuity of care for the patient. One of the best predictors of patient satisfaction among low-income Californians, in fact, is whether they feel “someone at my health care facility knows me well.”

This tells us that, even after 12 years of work with California’s health care and domestic violence fields, our organization has not yet done enough to amplify and sustain the voices of the people for whom the systems exist.

In systems-change conversations where beneficiaries are not physically present at the table, the onus is on the system leaders to bring them in and engage them. Senge et al.’s concept on “co-creating the future” clearly resonates with this value. I, however, would take the authors’ concept one step further and explicitly call out the central role that the beneficiary should play in all steps of systems change. We are committed to making this happen, and we have put some processes in place that have proven useful and might help further the conversation for other organizations. For example, for several years we have promoted the use of human-centered design to improve health care delivery in the safety net through a partnership with the Center for Care Innovations (CCI). Historically, the design sessions consisted of only clinic staff. Last fall CCI launched the Co-Design for Better Care program, which proactively engages patients and families as co-designers in the process rather than relegating them as research subjects. Moreover, through our Domestic Violence Cultural Responsiveness portfolio, we are funding successful projects that meet the unique personal and cultural needs of domestic violence survivors in diverse communities across the state. In addition to traditional services, this tailored support may include access to spiritual guidance, vocational training, peer support networks, or transportation assistance. By listening to beneficiaries, the domestic violence field is shifting from a shelter- and crisis-based model to a client-centered model that is more responsive to the needs of survivors.

The meaningful inclusion of beneficiary voices in discussions about systems transformation will require much more time and effort, and many more methods of engagement. It certainly will require more patience from the action-oriented among us who are restless to make change. Authentically incorporating beneficiary perspectives into important points in the process will help us all satisfy our hunger for meaningful and sustainable systems change.

Read more stories by Peter Long.