Community of Solutions Framework: Skills for Change-Making

Photo by Enayet Raheem on Unsplash


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

The Community of Solutions Framework is a set of interconnected skills and behaviors divided into five domains: Leading from Within, Leading Together, Leading for Outcomes, Leading for Equity, and Leading for Sustainability. 


Developed and tested during the  SCALE initiative of 100 Million Healthier Lives (100MLives), this framework supports communities at all stages of readiness to acquire skills and apply them in practical ways to achieve meaningful community outcomes. 






When a community builds these skills and begins to apply them to the change process, they start to embrace a set of behaviors, systems, and processes that, over time, lead to sustainable transformation and improved health, well-being, and equity.


A three-sided leadership team begins to emerge, made up of groups of institutional leaders, community connectors, and community residents affected by inequity. Change becomes dynamic, situated at kitchen tables as well as coalition tables, with more freedom for community members to rapidly improve coalition-building skills, and clearer roles for formal leaders to ensure that resources and structures support transformation. An engine for social change develops that powers the leadership of hundreds of people. 


Improvements tested at the local level can be spread and scaled up because there is growing trust and an atmosphere of teamwork. The community is able to use its assets in traditional and nontraditional ways to effect transformation in policy, systems, and environmental change over time to address the root causes of poor health and inequity.

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100 Million Healthier Lives Case Studies from Around the Globe
Resource - Case Study
Brought to you by IHI
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Overview of SCALE and a Community of Solutions
Resource - Report
Brought to you by 100MHL
Published on 07/01/2017
Cover of Foundations of a Community of Solutions
Foundations of a Community of Solutions
Resource - Report
Brought to you by 100MHL
Published on 07/01/2017

Leading from Within

Leading from Within skills involve one’s inner journey as a leader, including the ability to:

  • Know oneself and what brings one to leadership
  • Reflect, “fail forward,” and change as needed 
  • See and commit oneself to unlocking the leadership of others, especially those with lived experience of inequity
  • Approach change from a place of abundance, even in the midst of scarcity
  • Value differences as reflected in the Habits of the Heart model: understand that we’re all in this together, appreciate the value of difference, hold tension in life-giving ways, have a sense of personal voice and agency, and seek capacity to create community

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Healthy Monadnock: A Homegrown Community Health Improvement Journey
Story - Written
Brought to you by Community Commons
Published on 06/10/2020
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Parker J. Palmer’s Five Habits of the Heart
Resource - Website/webpage
Brought to you by Center for Courage & Renewal
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Kershaw County: Youth on Fire to Build a Healthier Today
Story - Written
Brought to you by 100MHL
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Leadership Skills that Create Communities of Solutions
Story - Written
Brought to you by 100MHL

Leading Together

Leading Together skills are grounded in a perception of the community as a dynamic network of interacting people, organizations, structures, and systems that are related to a place.  It is vital to lead together with others in a community to create effective, equitable change. 

Elements of Leading Together skills include:

  • Developing trust, relationships, and interconnectedness
  • Effective teamwork
  • Engaging in collaboration by creating a safe space, asking open, honest questions, being open to having difficult conversations, honing facilitation skills, and developing boundary-spanning leadership skills
  • Cultivating the leadership of others through community  organizing and integrating people with lived experience of inequity in your work
  • Growing abundance through power and stakeholder mapping

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Leveraging Community Partnerships to Navigate COVID-19
Story - Written
Brought to you by IHI
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Engaging People with Lived Experience Toolkit
Tool - Toolkit/toolbox
Brought to you by 100MHL
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Prescribe Safe: Combating Opioid Abuse
Story - Written
Brought to you by 100MHL
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Vital Village Network: Leading Together
Story - Written
Brought to you by 100MHL

Leading for Outcomes

Leading for Outcomes skills support communities in applying design skills to co-create a theory of change, identify measures, test the theory, plan for implementation and scale-up in a way that makes these tasks easier. Skills include:

  • Innovation/Design Thinking by using stories to understand the experience of people affected by a change 
  • Improvement science by developing aims, drivers, and measures, and running tests of change 
  • Implementation skills to help make the work easier, more effective, and more joyful

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Growing Together: Reimagining Health Care with CHWs
Story - Written
Brought to you by 100MHL
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Healthy Nevada Project
Story - Written
Brought to you by 100MHL
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The Daily Mile: An Implementation Guide
Tool - Toolkit/toolbox
Brought to you by 100MHL

Leading for Equity

Leading for Equity skills apply the three previous skills - Leading from Within, Leading Together, and Leading for Outcomes - to address equity at a population and structural level. A longer description of the 100MLives approach to equity is detailed here

The work to improve equity is everyone’s responsibility and helps people, organizations and communities apply the set of skills through an equity lens: 

  • Leading from Within means understanding implicit bias; applying Habits of the Heart; and understanding the core concepts of power, privilege, structure, and history
  • Leading Together helps one recognize interconnectedness; sharing leadership and owning the process of creating equity; fostering ownership and solutions by people with lived experience; and mapping assets to potential levers
  • Leading for Outcomes involves the use of data to identify those who may not be thriving; using stories to map systems that perpetuate inequities; identifying potentially replicable bright spots; and testing policy and programmatic changes that have the potential to disrupt systems perpetuating inequity

100MLives Equity Concept Paper
100 Million Healthier Lives Program Brief: Approach to Equity
Resource - Policy Brief
Brought to you by 100MHL
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Social Worker in the Library Chicago
Story - Written
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Housing is Health Care
Story - Written
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Leading for Sustainability

Leading for Sustainability skills facilitate an ongoing process of transformation in a community as opposed to maintaining programs as they are. Four key elements of sustainability are: 

  • Environmental sustainability – Stability of the physical, political, and cultural environment
  • Resource sustainability – Availability of intrinsic (will for change, relationships) and extrinsic (financial, in-kind) resources needed to maintain, spread, and scale changes
  • People sustainability – Cultivation of change leaders in a community 
  • Change sustainability – Growth and sustainability of the change process.

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Investing in Youth
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From the Ground Up: Improving Community Health Through Collaboration
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Brought to you by Community Commons
Published on 06/10/2020
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IHI Psychology of Change Framework
Resource - Guide/handbook
Brought to you by IHI
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Unlock Playgrounds To Unlock Health
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