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Funder’s Forum: Laura K. Landy, President/CEO, Fannie E. Rippel Foundation

May 20, 2011

The mission of the Morristown, New Jersey-based Fannie E. Rippel Foundationis to serve as a catalyst for new ways of thinking about the health system that lead to better health, better care, and lower costs. Recently, the Foundation Center spoke with the foundation's president and CEO, Laura K. Landy.

Laura_landy Foundation Center: With its emphasis on direct charitable activities (DCAs) and systems thinking, the Rippel Foundation takes an unusually proactive approach to health system challenges. Can you describe your approach and the kind of impact your efforts have had?

Laura Landy: Our own circumstances -- limited funds and ambitious goals -- mirror the challenges of our health system and require that we be innovative in our efforts and highly strategic in what we do.

We also know that most of the current efforts in health reform are designed to address the short-term challenges and symptoms that plague our health system, not the fundamental solutions that will result in a redesigned system that's sustainable over time. As a result, our approach is to actively engage leaders from in and outside the health sector who can help bring new insights to system redesign and change. With a belief that all health and health care is ultimately local, much of our work has a regional focus. Moreover, rather than believing we have all the answers, we work to enable those best positioned to lead change to explore and implement innovative initiatives in order to create sustainable new models of health and care.

ReThink Health, our key initiative, is both a way of thinking and a collaborative initiative we've developed over the last few years. In an environment that fosters exploration and encourages dialogue, we bring together leaders from diverse disciplines on a regular basis to think and talk about what health and healthcare change might look like and how it can be achieved. Those in the room have included health leaders like Don Berwick and Elliott Fisher, environmentalist Amory Lovins, system dynamics expert John Sterman, management guru Peter Senge, and others. Over time, those conversations led participants to ask questions others weren't asking and, eventually, to create a vision for health and care in America and develop guiding principles for fundamental change. Working with this core group, a leadership team of committed and talented project directors and a group of partnering organizations have launched a number of exciting and different efforts to test innovative approaches to regional change, most of which have been drawn from other industries and social movements.

Our role has been to promote the vision, convene key players, and support ideas and explorations that emerged from the group discussions. Through this process, ReThink Health has catalyzed or contributed to a number of developments, including:

  • a broader understanding of regional disparities in healthcare costs tracked by the Dartmouth Atlas of Health Care and disseminated through the national media;
  • critical understanding of the role of regional culture in system change;
  • greater awareness of healthcare systems that are providing high-quality care at lower costs;
  • a growing emphasis on the role of leadership and cross-boundary collaboration; and
  • the creation of a growing number of cross-boundary leadership teams across the country engaged in system thinking and redesign.

Some of our other key projects include:

Organizing for Health, an action-research initiative led by Marshall Ganz, acclaimed community organizer for Barack Obama and Cesar Chavez, that is aimed at exploring how American communities can act to simultaneously achieve better health, higher-quality care, improved access, and lower costs, as well as how diverse community members can organize themselves and develop the leadership capacity to effect change in their own systems. Columbia, South Carolina, has been selected to serve as a pilot site in which Ganz' community-organizing techniques will be applied to healthcare advancement.

Managing the Health Commons, another action-research initiative that is applying the groundbreaking work of Elinor Ostrom, winner of the 2009 Nobel Prize in Economics, to health care. Dr. Ostrom theorized that societies can identify and successfully manage their common pooled resources by developing a common vision, shared trust and respect, and a system of governance that ensures long-term sustainability of limited community resources. Over the course of eighteen months, Dr. Ostrom and her team at Indiana University’s Workshop in Political Theory and Policy Analysisare investigating and documenting the process, identifying and managing the "health commons" in four U.S. communities -- Cedar Rapids, Iowa; Grand Junction, Colorado; and Bloomington and Bedford, Indiana -- as well as developing tools for future community analysis.

Understanding Regional System Dynamics and Opportunities for Change: A Simulation Model and Gameis a project in which the Rippel Foundation is collaborating with three MIT-trained experts to develop a simulation game that will enable health and healthcare stakeholders to imagine, experience, and better shape the future. The first stages of the project are focused on the development of a system model that illustrates important regional and community-level health and healthcare dynamics. Eventually, an interactive simulation game based on the model will be developed that allows players from different sectors of a community, including healthcare, to better understand the complexities of the health system as well as the impact of various types of interventions and change.

Last but not least, Leading for Health is a collaborative effort with Society for Organizational Learning founder and chair Peter Senge, a legendary authority on organizational learning and leadership, and Sherry Immediato, founder and president of Heaven & Earth Incorporated and a current trustee and former president of SoL. Based on SoL's Foundation for Leadership program, ReThink Health is working with Sherry and Peter to develop a health leadership program and learning community. The goals are to help build a shared language, a set of common concepts, and new leadership capacity within the healthcare system, as well as to explore the profound connections between personal mastery and systems thinking that link deep change in our social systems and in one's self.

FC: Given the foundation's focus on and experience in rethinking the healthcare system, are there opportunities for other grantmakers working on healthcare issues to align their work with yours?

LL: What has been most exciting is the growing interest in ReThink Health's approach to change. New ideas such as conferences, distance-learning programs and a wider array of training programs are on the agenda, both as a way to reach more communities and to support leaders. In addition, we've identified a growing list of case studies and research projects to advance our collective learning and expand our reach. We're also exploring hands-on efforts in new regions across the country as well as deeper commitment in some of the communities in which we are currently engaged. One of the more effective strategies has been to partner with other foundations -- including the Peter G. Peterson Foundation, which helped support two national conferences, and the California HealthCare Foundation, which is partnering with us on the system dynamics model and game. We appreciate the importance of foundations as key players in the system of regional change and invite a broader conversation of how we can all look more systemically and strategically at the impact of our work in a way that leverages the intrinsic motivation in communities and respects regional and cultural variation. And we welcome the opportunity for collaboration with anyone who shares our values and interests.

FC: Is there anything else you want your colleagues in the field to know about the strategies the Rippel Foundation employs in its chosen program areas?

LL: Our work has evolved through a recognition that we don't have all the answers, that health and health care are local, that sustainable change must emerge from the community, and that new ideas can often be found in places people don’t think to look. As a result, we have sought to build an active learning organization that takes a cross-boundary approach to finding the best solutions to health and healthcare transformation. We recognize this won't be accomplished easily, or quickly, and so we have embraced a long-term vision for achieving change.

We also recognize the value of experimentation and failure, as well as the importance of committing to partners whom we believe can make a difference. As our first president, Julius A. Rippel, said, "We must have substantially new manners of thinking to enable mankind to bridge the gap between the things that have been and the things which will be." He also said that a foundation had the responsibility to take risk. We honor these words every day in the hope that we might contribute to the true innovation -- not just improvement -- required to improve health and health care in our country and to redesign our health system to meet the needs of our children and their children.

-- Foundation Center

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