A Systems Thinking Approach to "Collective Impact"; the Necessary Ingredients for a Paradigm Shift in Engaging Public Health Prevention and Corporate Wellness Programs

"General Systems Theory, a related modern concept [to holism], says that each variable in any system interacts with the other variables so thoroughly that cause and effect cannot be separated. A simple variable can be both cause and effect. Reality will not be still. And it cannot be taken apart! You cannot understand a cell, a rat, a brain structure, a family, a culture if you isolate it from its context. Relationship is everything [1]."

- Marilyn Ferguson, "The Aquarian Conspiracy"

Big Picture

We live in such a paradoxical time; technology, medicine and science have been advancing at a dizzying pace with the promise and hope of making our individual lives and collective social environments better and healthier. Yet we are seemingly more and more incapable of addressing some of our biggest social problems, such as obesity, substance abuse, underage drinking, drinking and driving, bullying in schools and the workplace, teen pregnancy and school and workplace violence.


New CDC data estimates that 42% of those living in the United States will be obese by 2030 [2], and another CDC study estimates the annual cost of obesity to be $147 billion [3]. Also, though drinking by persons under the age of 21 is illegal, people ages 12-20 drink 11% of all alcohol consumed in the United States and, on average, underage drinkers consume more drinks per drinking occasion than adult drinkers [4].  


The estimated monetary burden to society from alcohol problems alone is projected to be close to $200 billion annually [4]. By conservative estimates, additional societal costs for DUI, bullying, teen pregnancy and workplace violence total several hundred billions more annually. Clearly, the societal annual monetary costs are staggering.


Furthermore, when we factor in the collateral damage and added burden experienced by family and acquaintances due to injury, lost productivity capacity and loss of life on the part of their loved one, we are looking at perhaps the first clues as to how ill equipped we are at addressing these problems and why we are having such a dismal rate of success.


Looking at the magnitude of these problems offers us clues as to how complex and comprehensively ingrained and embedded they are into our individual, cultural and societal fabric. What is even more astounding and inexplicable than the incredible financial and physical costs these social problems carry is the fact that we are unwilling to try to prevent them by investing even a microscopic fraction of the almost $1 trillion annual price tag we are saddled with.


There are many factors going against the prevention and wellness field, from the economic global downturn to the lack of professional and sustainable workforce development to a lack of hard outcomes data supporting our efforts. However, I believe the biggest overarching factor working against us is the lack of a systems thinking approach to prevention and wellness.

Systems Thinking

As human beings we are educated to look at direct paths to cause and effect in order to solve problems; we also look at the micro level and try to understand the environment around us while working on individual problems in a linear fashion.


For example, according to recent national data the current problem facing individuals and communities is prescription drug abuse [5];  thus, the government is issuing grants to fight prescription drug abuse in communities all across America.


Once enough resources are pumped in to the local communities to fight prescription drug abuse, prevention folks, local leaders and the entire community will rejoice in the fact that their efforts have indeed produced a significant reduction in this area.


However, invariably and undoubtedly (as historical data bears out), another drug of choice will appear in the horizon and the vicious cycle will start again. The Feds will issue another round of grants to combat the new drug of choice and communities will once again prevail in reducing the use of the new drug, only to have it replaced by something else.  


Furthermore, alcohol and marijuana are always at the forefront of our societal problems, and they never go away. The reason these problems always show up in different forms (sometimes indefinitely) is because they are embedded in very large and complex systems.


Addressing only one symptom at a time is like using band-aids on a patient who needs surgery. Big systems (e.g., society and human beings) are multilayered and multidimensional, and need to be looked at broadly and collectively. Additionally, we need to understand that such large systems have a very long delay feedback loop [6] (a causal connection between everything that feeds into a system and its corresponding results), and by the time a problem becomes obvious it is very difficult to solve.


There are many more areas in systems thinking that we will explore together in future articles that will provide insights on how a system operates and how we can influence it to get desirable, sustainable health and wellness results. However, in order to predict what is influencing individual systems we have to take a hard look at all the main factors driving the system.


Once we have identified these factors we will need to determine if they are actually embedded in the system or are independent. The desired end result of all this is to have more than one organization, one workforce area, one public sector or one private sector work together to identify the system's dynamics and work on a set of comprehensive strategies to create a systemic collective impact.

Collective Impact

Collective impact is the implementation side of the systems thinking approach. Whereas the systems thinking looks at the technical components of the system, collective impact is where all the partners involved with the system get together and decide to put their individual agendas aside in order to address the system's shortcomings.


In a recent paper by John Kania and Mark Kramer in the Stanford Social Innovation Review titled "Collective Impact [7]", the authors describe in great detail the need for collaboration across traditional boundaries to enact change. They stress the importance of public and private partnerships as one of the keys to creating collective impact. Their research also showed that there are five conditions that need to be present for collective impact to work:

  1. Common agenda- everyone participating needs to have the same agreed upon vision.
  2. Shared measurements- measuring the same things using the same instruments.
  3. Mutually reinforcing activities- requiring each partner to implement programs that they have expertise in but also tying them into the big picture of the shared vision.
  4. Continuous communication- this develops trust, transparency, openness and honesty about the work and the challenges.
  5. Backbone support organization- an organization with the means and willingness to coordinate long term, collect data, be responsible for logistics and manage the entire system of partners. Kania and Kramer also point out that the lack of having a backbone organization is why many collaborative efforts fail.

When looking at the ingredients necessary to create collective impact, one comes to the realization that it is a herculean task; yet great things were never accomplished without taking huge risks and defying the odds. All we have to do is to keep reminding ourselves of the staggering financial and human burdens we are faced with if we stay with the status quo.

Conclusion

We have a $1 trillion annual preventable problem from obesity that leads to heart attacks and myriad other health problems (e.g., alcohol, tobacco and substance abuse, teen pregnancy, bullying and school and workplace violence).


To put this staggering number in perspective, it is more than what we are going to spend this year on national defense, Medicare or Social Security [8]. All these problems are interrelated; if they're left unchecked, they will continue to cause havoc in the workplace, at home and in every community across America.


However, we have solid research and theories on what works and practical knowledge of what hasn't. It seems that the key question we need to answer is this: Do we have leadership (and enough ground swell from entities in the public and private sectors) that can see the big picture and are willing to take sustainable steps to reach a tipping point in order for a paradigm shift to take place?


A systems thinking approach for collective impact is starting to happen; it is simply too profound and immeasurably cost effective a strategy to ignore. Given this, I'm very excited and hopeful about the future of our world; you should be, too.

References

  1. The Aquarian Conspiracy (J.P. Tarcher, 1980; 1987) ISBN 0-312-90418-5
  2. CDC Obesity is common, serious and costly, http://www.cdc.gov/obesity/data/adult.html
  3. CDC Study Estimates Medical Cost of Obesity May Be As High as $147 Billion Annually,
  4. http://www.cdc.gov/media/pressrel/2009/r090727.htm?s_cid=mediarel_r090727
  5. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (April 1, 2010). The NSDUH Report: State Estimates of Underage Alcohol Use and Self-Purchase of Alcohol. Rockville, MD.
  6. Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network: selected tables of national estimates of drug-related emergency department visits. Rockville, MD: Center for Behavioral Health Statistics and Quality, SAMHSA; 2010.
  7. MIT System Dynamics Group, http://sdg.scripts.mit.edu/Publications.html
  8. Kania, J., Kramer, M. Collective Impact, Stanford Social Innovation Review Journal, 2011.
  9. Office of Management and Budget (OMB), the Budget of the United States Government, http://www.gpo.gov/fdsys/browse/collectionGPO.action?collectionCode=BUDGET

About the Author

Frank G. Magourilos is a Sr. Certified Prevention Specialist with a Master's Degree in Prevention Science from Oklahoma University and Bachelor's Degrees in Cognitive Behavioral Psychology and Intercultural Communication from the University of New Mexico.


He is the Executive Director of the New Mexico Credentialing Board for Behavioral Health Professionals, www.NMCBBHP.org and he is also the Founder of the New Mexico Prevention Network, www.nmpreventionnetwork.org. Mr. Magourilos is also a Training Consultant for the Substance Abuse and Mental Health Services Administration (SAMHSA) SW- Collaborative for the Application of Prevention Technologies (CAPT).