This story was originally published in the 100 Million Healthier Lives Change Library and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.

Our Theory of Change

Leaders using these five Community of Solution skills will build a culture of health and equity.

When we learn and use the "Community of Solutions" leadership skills, we develop behaviors, processes and systems that result in improved population health, well-being and equity.

With the support of The Robert Wood Johnson Foundation (RWJF), the Healthy Northern Kennebec (HNK) coalition in Waterville, Maine, participated in the 100 Million Healthier Lives "Spreading Community Accelerators through Learning and Evaluation" (SCALE) initiative from 2015 – 2019. The SCALE initiative helped our community achieve unprecedented success in addressing social determinants of health, promoting health equity, and accelerating our journey toward a Culture of Health, using this "Community of Solutions" framework.

We believe that confident, connected, collaborative, and caring community leaders will create a culture of health for all. The Healthy Northern Kennebec coalition shares leadership tools at each monthly meeting, at our annual planning meeting, and even at community celebrations!

In 2018, HNK joined with partner organizations serving the Kennebec Valley to scale up these leadership concepts and skills to even broader audiences, including the health, education, social service, business, economic development, labor, arts, and faith communities. Together with Waterville community members who have lived experience, we co-designed a series of three day-long leadership workshops that were free and open to the public. About 150 emerging leaders from our Central Maine region learned and practiced the leadership skills described below.

Healthy Northern Kennebec coalition members work in cross-sector partnerships.

Leading from Within

Leading from Within is your own inner journey as a leader, including the ability to:

• Know yourself
• Reflect and change as needed
• Believe in abundance, even in the midst of scarcity
• Value difference - "Habits of the Heart"

Scott McAdoo - Resident of Waterville's South End Neighborhood and Community Champion

- Interviewed by Matt Guy, SCALE Coach

Tina Chapman - Organizational Leader and Community Connector

- In her own words

Leading Together

The community is a dynamic network of people, organizations, and systems. We need to lead together with others to create effective, equitable change. Leading Together skills include:

• Developing trust and relationships
• Effective teamwork
  
• Collaboration (including people with lived experience)

Waterville residents listen riveted as Dr. Soma Stout shares stories of local leadership from around the world.

Positive change is possible when we all listen, learn, and lead together!

In June 2016, HNK planned a community event to bring together professionals, organization leaders, and Waterville residents living in poverty to celebrate the HNK coalition and development of the Healthy Waterville Action Team. The intent of the event was to create a space where about 100 diverse participants would bridge socioeconomic differences, talk, listen to music, eat dinner, recognize each other’s humanity, have fun, and plan to lead toward community solutions together. Dr. Soma Stout gave an electrifying presentation that inspired all that! 

At this event, leaders with power listened more than they spoke. Unexpected voices spoke clearly. All participants left with a greater sense of hope and possibility.

Change is possible when we work together! See the faces and hear the wisdom of our Waterville community members in this fabulous presentation by Dr. Soma Stout. (48 minutes)

Leading for Outcomes

Together, we created a theory of change, identified measures, tested the theory, and planned improvements that will grow and last. We used:

• Design Thinking – Using stories to understand the experience of people affected by change
• Improvement science – Developing aims, drivers, and measures, and testing our ideas to learn what works
• Implementation skills – Making what we do easier, more effective, and more joyful

Community Transformation is possible. Change is happening in the Greater Waterville region!

The Community Transformation Map (CTM) is a 40-question planning and assessment tool. It is designed to help communities make meaningful, measurable improvements in health, well-being and equity, to advance toward a Culture of Health. Section 1 (Blue) - How the community approaches the change process Section 2  (Red) - How members of the community relate to one another and create abundance Section 3 (Yellow) - How the community leads for social change and equity

From September 2017 through March 2019, Healthy Northern Kennebec (HNK) coalition members answered the 40 "Community Transformation" questions four times. Scores were averaged. Our group had fascinating discussions about our different opinions at HNK coalition meetings in the fall of 2018 and spring of 2019. 

HNK coalition members agreed that the Greater Waterville region has made progress in: Vision, Co-design, Applying improvement methods, Willingness to adopt change created by others, Sustainability and scale-up, Organization of the community collaboration, Communication and conflict resolution, Shared stewardship, Growing the leadership of those most affected by inequity, Distributed power and leadership, and Taking effective action to improve equity. 

As the graph shows, Community Transformation scores progressed every six months. Scores increased even more after the series of three regional Leadership Trainings, held in Waterville in the fall of 2018.

Leading for Equity

Equity considers justice and fairness for everyone. Leading for Equity is included in all the Community of Solutions skills:

• Leading from Within – Understanding implicit bias, power and privilege
  
• Leading Together – Building relationships across differences, Mapping assets by sharing stories
  
• Leading for Outcomes – Using data to understand who is not thriving, Testing improvements that could change unhealthy systems
  
• Leading for Sustainability – Using a mindset of abundance, Working strategically to make lasting changes 

Community Health Improvement Leadership Academy (Phoenix) Team (clockwise from top left): Dave Dawson, Kelly LaCasse, Kathryn Kelly, Beth Thomas, Fran Mullin

Our original aim in 2016 was to engage a total of 50 people in co-creating actions or activities to improve food security, with 25 people with lived experience (50%).

• In April 2017, the Healthy Waterville Action Team had engaged 71 people total, with about 38 actively involved, including 16 people with lived experience (42%). Active involvement means people participated in at least three activities or meetings in one year.
• At the end of 2018, there were 78 total active participants in the Action Team: 53 individual or organizational partners and 23 people with lived experience in poverty and/or hunger. 
• By July 2019, the Healthy Waterville Action Team included 25 people with lived experience. We achieved our aim!

We build bridges, create new relationships, and bring voices of experience together.

As a result of the Healthy Waterville initiative, we gained a deeper understanding of the power dynamics between social service professionals and recipients of services. We continue to strive to mitigate inequity, the dichotomy between “us and them.” The process of transforming the community to build a culture of health involves everyone. Those most harmed by poverty -- individuals with lived experience who know the issues best -- must receive special attention as expert consultants.

Organizational leaders on the Healthy Waterville steering committee led this effort, in the beginning. We wanted to build individual skills, leadership capacity, respect and trust among people experiencing poverty and those more privileged, through multiple opportunities to work, learn and have fun together. 

Diverse community representatives, including people with lived experience in poverty, formed the Healthy Waterville Action Team in 2016. This action-oriented group reviewed local health assessments, mapped assets, collected data, analyzed gaps, and created a comprehensive plan to address the community-identified priority issues of food security and community connectedness. 

The Healthy Waterville Action Team and steering committee co-created the Aim and action plan, then the Action Team designed tests of change to remove barriers in our food system. Individuals who rarely had a voice stepped into leadership, and organizational leaders supported the growth of this untapped potential.

Healthy Waterville Action Team members (Cynthia Muniz, Kelly LaCasse, Scott McAdoo, and Debbie Dornish) promote community food equity.

The process of transforming the community to build a culture of health involves everyone.

How did you recruit people with lived experience to join the Healthy Waterville Action Team? 

We asked participants of focus groups, clients of social service programs like General Assistance and the Homeless Shelter, parents of HeadStart kids, and volunteers for other community efforts. We reached out to clients of the food bank, soup kitchen and evening sandwich program.  Some early participants recruited their family members or friends to join them at our community planning meetings and celebrations. 

How did you find people to ask? 

We started by asking organizational leaders and partners in our coalition to identify Waterville residents who might have an interest in community health improvement. Once the Action Team started meeting regularly in 2016, we asked people who were engaged in our community health programs and events. People are not hard to find; there are potential leaders everywhere!

What made them say yes? 

Whether participants are organizational leaders like the director of the food bank, or a person who uses the food bank, one attraction is the opportunity to participate in a diverse group that is highly motivated to take constructive action at every meeting. The Action Team is a “safe space” where people recognize each other’s humanity. GEDs and PhDs each have valuable experience and improvement ideas to offer. Everyone is teaching and learning from one another. It is exciting for participants to see changes that they influenced actually improve food access in our community. Small successes attract new Action Team members and build momentum.

"Do nothing about us, without us."

Leading for Sustainability

Sustainability keeps positive changes going and growing. Change may happen in:

• Environment – Keep the physical, political, and cultural environment stable
  
• Resources – Maintain what is needed to keep and spread changes; Resources include people’s relationships, plus financial and other assets
  
• People – Cultivate leaders who continue to improve the community
  
• Process – Keep learning to move forward

"Abundance does not happen automatically. It is created when we have the sense to choose community, to come together to celebrate and share our common store. Whether the scarce resource is money or love or power or words, the true law of life is that we generate more of whatever seems scarce by trusting its supply and passing it around. Authentic abundance does not lie in secured stockpiles of food or cash or influence or affection, but in belonging to a community where we can give those goods to others who need them — and receive them from others when we are in need." — Parker Palmer, Let Your Life Speak

We turned around a negative shift with abundance thinking.

-- Notes from Fran Mullin, Healthy Northern Kennebec (HNK) Director and Local Improvement Advisor

I resisted the scarcity mindset and taught others about abundance, posting Parker Palmer’s quote in my office. In my staff photo, I held a sign that said, “We have everything we need here now.” I applied to two other private foundations for health equity grants, successfully making the case that we needed three years of funding to authentically engage community members with lived experience. To support our coalition work, our team applied for and received a 5-year federal grant for Drug Free Communities, which began October 1, 2016, the day after our federal funding from the Maine Center for Disease Control ended. 

The Community of Solutions skills of Leading from Within, Together, for Outcomes, for Equity, and for Sustainability gave me hope in the possibilities… and allowed others to believe, too.

"Invite in everybody who cares to work on what's possible. Acknowledge that everyone is an expert about something. Know that creative solutions come from new connections." - Margaret Wheatley, "Turning to One Another"

Healthy Waterville Open House June 30, 2016

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