Leadership Southcoast Case Study

Improving Health Care Access

This work addressed the question of what ought to be done to improve access to health care in the Southeastern Massachusetts region. A pre-legislative deliberation process using Structured Dialogic Design® was designed and implemented to synthesize the voice of regional stakeholders. The process amplified the engagement of the participants by building trust amidst diverse stakeholder perspectives, avoiding a politicized atmosphere, and providing a strong basis for future collaboration.

The Situation

In 2009 over 97% of Massachusetts residents were covered by health insurance, but still 1 in 5 adults reported difficulties obtaining care, with evidence of increased barriers as demand for services increased.

This is the type of complex situation that is likely to be under-conceptualized by small groups of decision makers, with the risk of premature commitment to a policy position. The challenge is how to achieve a comprehensive understanding that takes account of perspectives from multiple groups, especially when stakeholders and technical experts have limited time to invest.

The Approach

As an exercise in pre-legislative research, a structured dialogue management process was applied. The process of deliberation amplified the engagement of the participants by building trust amidst diverse stakeholder perspectives, setting a collaborative tone rather than a politicized atmosphere.

The process consisted of a discovery phase in which background information was collected on an online website (a “wiki”), followed by a one-day Co-lab involving two dozen healthcare professionals for part of the day. The group was able to co-develop a systems view of the challenge in the form of an Influence Map, which revealed a handful of ‘deep drivers’, issues that would need to be addressed as a priority to make significant improvements. This map was then used as the basis for developing a consistent set of narratives representing the varied perspectives of the participants.

The Results

Through the dialogue and the process of co-creating a situational understanding of the challenge, Leadership Southcoast illustrated how a large group of individual civic leaders could rapidly co-construct a shared understanding of a complex situation and take ownership of the priorities for responding to the challenge.

This project illustrates how, with minimal investment of stakeholder time, a strong consensus for collective action can be constructed and placed into a community’s narrative for change. The experience with the approach and the methods enriches local social capacity for taking on complex civic problems.

We will take this body of knowledge that we developed today along with other knowledge that is available, and people will be able to get to it, and take it, and use it to start to make some of these things happen.

Michael Metzler, Executive Director (2010), Leadership Southcoast

I believe that regional development must be driven by deliberative dialogue with the community. South Coast Design builds that deliberative capacity here. Our certitude in this practice derives from our personal experience. My commitment to it is driven by breakthrough experiences.

Craig Lindell, Board Member, Institute for 21st Century Agoras

References and acknowledgements

Summarized from ‘A Deliberation on Health Care Access’, Dr. Thomas Flanagan, PhD. MBA and Kevin Dye, 2010, and ‘Leadership Southcoast Explores Healthcare Access Assurance through a Structured Design Dialogue: A pre-legislative process for policy makers and legislators confronted with highly complex social system challenges’, T.R. Flanagan, K.M.C. Dye, M. Metzler & C.H. Lindell (Draft, 2010)

Structured Dialogic Design (SDD) is a registered trademark of a dialogic process advanced through the Institute for 21st Century Agoras, a global non-profit organization for promoting the use of systems science in civic deliberations. www.GlobalAgoras.org

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