Systems within communities—including medical care, public health, housing, education, transportation, justice, and human services—directly influence the health and well-being of community members. These systems often operate independently from each other, resulting in inefficient allocation of resources, lack or duplication of services, and poor service quality. These effects hamper systems' efforts to promote equitable health and well-being in communities.
Systems can work together to align their actions and decisionmaking. One way is through shared measurement: using a common set of measurable goals that reflect shared priorities across systems and with community members. With funding from the Robert Wood Johnson Foundation, AIR explored how shared measurement helps systems and communities systematically define collective goals, monitor progress, generate buy-in, and create accountability within organizations and communities.
In January 2021, we published five stakeholder-driven principles for systems (e.g., public health, health care, human and social services) and communities to use measurement as a tool to align decisions, policies, and practices toward equitable health. These actions should reflect and address the needs and priorities of communities served and the effects of institutional policies and practices that have historically created inequitable outcomes for excluded or marginalized groups. To develop these principles, AIR:
- Met with experts: worked with a steering committee to identify and review existing cross-system alignment efforts;
- Examined cross-systems alignment initiatives: developed use cases illustrating how shared measurement can foster alignment;
- Listened to communities’ perspectives: engaged community members in conversations about their priorities and values; and
- Convened stakeholders: engaged a diverse group of 18 stakeholders with expertise in cross-systems alignment, measurement, and community engagement as experts on a Delphi Panel. AIR guided the panel through a modified Delphi process—an iterative process that systematically and progressively gathers input from a panel of stakeholder experts to determine group consensus.
Aligning Systems with Communities to Advance Equity through Shared Measurement: Guiding Principles
Our team developed five Guiding Principles to Align Systems with Communities to Advance Equity through Shared Measurement (English, PDF | Spanish, PDF). These principles can inform measurement that effectively aligns systems’ actions with the needs and priorities of the communities those systems serve, particularly communities that historically have been harmed the most by inequities.
Measurement that aligns systems with communities toward equitable outcomes:
- Requires upfront investment in communities to develop and sustain community partner capacity;
- Is co-created by communities to center their values, needs, priorities, and actions;
- Creates accountability to communities for addressing root causes of inequities and repairing harm;
- Focuses on a holistic and comprehensive view of people and communities that highlights assets and historical context; and
- Reflects shared values and intentional, long-term efforts to build and sustain trust.
Measurement can reinforce the status quo, or be a force for change, depending on how it is used – and by whom. These principles intend to show how community members, system leaders, service providers, and policymakers actively engaged in cross-systems efforts can use shared measurement as a tool to align decisions, policies, and practices toward equitable health and well-being.
Our team developed a companion guide to help cross-systems programs begin putting the principles into practice. The guide highlights promising practices that reflect lessons learned from different programs and communities throughout the country and can help diverse groups of stakeholders engaged in cross-systems alignment work have open discussions about roles and explore how to promote equitable involvement of all who have a stake in a shared measurement effort.
How Different Initiatives Used Measurement to Encourage Systems within Communities to Work Together
Our team conducted an environmental scan to understand the different ways cross-system alignment initiatives use measurement. The report sheds light on three research questions: 1) How do existing efforts use measurement as a lever to create alignment among sectors in addressing health equity? 2) What features of measurement drive alignment across sectors for community well-being? 3) What cross-sector metrics are most commonly used as “north stars” or targets to measure health and community well-being?
Our team then developed use cases for six initiatives, exploring how they used measurement to encourage different systems within communities to align or work together. Each use case includes an overview of the initiative’s key features and context and examples of how they use shared measurement, engage community members and address equity. When aligning systems with communities to advance equity through shared measurement, this set of use cases can facilitate discussion.
- Cincinnati All Children Thrive Learning Network (PDF) - Cincinnati, Ohio
- Connect SoCal (SB-375) (PDF) - Six counties in Southern California
- The Los Angeles Homeless Initiative (PDF) - Los Angeles County, California
- SA2020 (PDF) - San Antonio, Texas
- Vermont Health in All Policies (PDF) - State of Vermont
- Community Schools Initiative (PDF) - National
Communities' Perspectives on Navigating Multiple Systems
To center communities’ perspectives in the principles, our team listened to community members share how they would like to see systems work together to center their communities’ values, needs, priorities and actions. These briefs highlight what community members want to see improved, what having an equal role in initiatives looks like from their perspectives, and what accountability means to them. We partnered with six community-based organizations (CBOs) to conduct virtual community listening sessions in six diverse communities:
- Asheville, North Carolina (PDF)
- Boston, Massachusetts (PDF)
- Denver, Colorado (PDF)
- Chicago, Illinois (PDF)
- Jackson, Mississippi (PDF)
- Wenatchee, Washington (English, PDF | Spanish, PDF)
We also heard from more than 140 CBOs in response to a survey we conducted in Summer 2020 to understand how they serve their communities, what data or information they use as part of that work, and how they work with partners. Given the COVID-19 pandemic and the likely impact on CBOs, we asked respondents about assessing communities’ needs and partnerships both prior to and during the pandemic, as well as challenges they have experienced as a result of the pandemic.
Project Team Members and Collaborators
This work is the result of collaboration among many people who have each contributed ideas, insights, and effort. Collectively, this group brings rich experience in both lived and learned expertise. In recognizing the diversity of our contributors here, we include credentials to acknowledge learned expertise, and we recognize with gratitude and honor those who also bring lived expertise as community champions. We thank:
Aaron Ogletree, PhD (AIR Project Staff)
Al Richmond, MSW (Project Advisor)
Amna Naseem, BA (Project Advisor)
Amy Lin, BA (AIR Project Staff)
Ela Pathak-Sen, MBA (Project Advisor)
Ellen Schultz, MS (AIR Project Staff)
Holly DePatie, BS (AIR Project Staff)
Jane Lowers, PhD (AIR Project Staff)
Kirsten Firminger, PhD (AIR Project Staff)
Kourtney Ikeler, BA (AIR Project Staff)
Madeline Polese, BA (AIR Project Staff)
Maliha Ali, MBBS, DrPH (AIR Project Staff)
Mary Lavelle, MS, PMP (AIR Project Staff)
Mary Thorngren, MSHR (Project Advisor)
Maureen Maurer, MPH (AIR Project Staff)
Meshie Knight, MA (Program Officer)
Michael Muhammad, PhD (Project Advisor)
Paige Castro-Reyes, BA, BS (Project Advisor)
Rikki Mangrum, MLS (AIR Project Staff)
Shoshanna Sofaer, DrPH (Project Advisor)
Shreeva Adhikari, BA (AIR Project Staff)
Tamika Cowans, MPP, PMP (AIR Project Staff)
Tandrea Hilliard-Boone, PhD (AIR Project Staff)
Tania Dutta, MS, MPP, PMP (AIR Project Staff)
Trenita Childers, PhD (AIR Project Staff)
Wizdom Powell, PhD (Project Advisor)
Aisha Shannon, LCSW, CADC, CODP I (Delphi Panel)
Alma Chacón, MS (Delphi Panel)
Caroline Fichtenberg, PhD (Steering Committee)
Clare Tanner, PhD (Delphi Panel)
Dalila Madison Almquist, MPH (Delphi Panel)
Damon Francis, MD (Steering Committee)
David Hayes-Bautista, PhD, MA (Delphi Panel)
Earnest Davis, FACHE, MHSA (Delphi Panel)
Frederick Kiggundu, MBA, MPH (Delphi Panel)
Gail Christopher, D.N. (Delphi Panel)
Georgina Dukes, MHA (Delphi Panel)
Guy D'Andrea, MBA (Steering Committee)
Harvey Hinton III, PhD, MS (Delphi Panel)
Jametta Lilly, MPA (Delphi Panel)
Jennifer Blatz, MS (Delphi Panel)
Jerry Smart, Senior Community Health Worker (Delphi Panel)
Kristin Brusuelas, MPH (Delphi Panel)
Mandu Sen, MS (Steering Committee)
Mary Pittman, DrPH (Steering Committee)
Moira O'Neil, PhD (Delphi Panel)
Raquel Hatter, MSW, EdD (Steering Committee)
Renee Boynton-Jarrett, MD, ScD (Delphi Panel)
Robyn Bussey, MBA, MHA (Delphi Panel)
Somava Saha, MD (Steering Committee)
Uma Ahluwalia, MSW, MHA (Delphi Panel)
We also thank the many individuals who shared their time and insights with us to inform this work, including those from Asheville Buncombe Institute of Parity Achievement, Cincinnati All Children Thrive Learning Network, Colorado Black Health Collaborative, Community Schools Initiative, Connect SoCal, Healthy Washington Heights, LA County Homeless Initiative, Multicultural AIDS Coalition, SA2020, The Community for the Advancement of Family Education, The Drs. Aaron and Ollye Shirley Foundation, and Vermont Health in All Policies.
Support for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.