The Weld County Department of Public Health & Environment (WCDPHE) has been an early adopter of the innovative practice of Zoomable Strategy Maps, a dynamic visual tool that facilitates the communication of a broad and multi-faceted strategy for community health improvement. Inspired by Collective Impact approaches that build strong consensus around a common agenda, WCDPHE engaged a wide range of stakeholders in a coalition to co-create this robust strategic framework, which became the structure for a community-wide shared measurement system. The powerful ability of the Zoomable Strategy Maps to communicate many levels of strategy information has dramatically improved the alignment, efficiency, and collaboration among a diverse group of community stakeholders. The Zoomable Strategy Maps are deployed in a cloud-based platform, InsightVision, through which coalition organizations and citizens of the county can easily monitor progress on priority health issues, improving equity, and key social factors that impact health.
Weld County Health Department of Public Health and Environment
Co-Creating A Common Agenda using Zoomable Strategy Maps
Description of the LHD
Weld County Department of Public Health and Environment (WCDPHE) is the public health authority for nearly 4,000 square miles in the northeast Colorado plains. Established in 1938, WCDPHE is a department of about 100 employees with an annual budget averaging $9.5 million. WCDPHE has two offices, four divisions, and serves approximately 275,000 people. Weld County's population is 27 percent of Hispanic or Latino and 12.5 percent of its population is below poverty level.
Need for Collaboration to Improve Community Health
No single organization can successfully address all the priority health issues and social determinants of health in Weld County. Like other counties, Weld has historically been challenged by problems of fragmentation, wasteful redundancy, and inefficiency in the Public Health sector because every organization was developing its own strategy, measurements, reporting, and communication structures. To counteract this problem, WCDPHE has been working with the North Colorado Health Alliance to engage a broad coalition in community health improvement efforts. However, although the coalition has a high level of engagement and passion for creating a healthier county, it was challenged with efficiently aligning the efforts of its many different organizations to execute a shared strategy.
Use of Zoomable Strategy Maps to Meet Objectives
WCDPHE developed a “Zoomable” set of interactive strategy maps with the goal of providing a framework through which stakeholders can become more effective by aligning their efforts, measures, and communication. The main objectives of the Zoomable Strategy Maps practice are to:
Provide an easy to understand structure for a co-created, shared strategy that serves as a common agenda for collective impact.
Create an enduring, but flexible, framework for a shared measurement system based on the common agenda.
Support community teamwork and mutually-reinforcing activities.
Simplify and enhance continuous communication while requiring fewer meetings.
Create shareable templates and techniques that simplify the role of providing backbone support.
The flexible, co-created, and enduring framework of the Zoomable Strategy Maps allows many different stakeholders to efficiently work as a team towards the vision of "Thriving Weld County."
How the Zoomable Strategy Maps Practice was Implemented
In the Fall of 2013, after an RFP process to solicit solutions, WCDPHE began working with a vendor, Insightformation Inc., to transform the content of their community health assessment, planning documents, and meeting notes into a set of draft strategy maps. They worked with the key stakeholders such as the WCDPHE, the local hospitals, the North Colorado Health Alliance, the Federally Qualified Health Center, and the United Way to get input and buy-in as the strategy maps were refined. The Zoomable Strategy Maps were then deployed in the vendor’s online platform to be used as the organizing structure for a robust set of information management, measurement, and communication capabilities. Click http://tinyurl.com/WCDPHE-HE to download an interactive PowerPoint presentation of the Zoomable Strategy Maps for Healthy Eating. View in Presentation mode and click on the + to zoom in and the - to zoom out.
Positive Outcomes of Zoomable Strategy Maps
The results of the adoption of Zoomable Strategy Maps has been dramatic. About a year into the process, Dr. Mark Wallace, Executive Director of WCDPHE and CEO of the North Colorado Health Alliance, described the impact of this practice in a presentation at the Public Health in the Rockies Conference:
"We’ve had a lot of energy and activity around becoming a healthy county for quite a few years. But in the past, it was like all the organizations were...people talking in a crowded restaurant. All the different conversations ended up creating a lot of noise. Now, with a shared strategy that is clearly communicated using the strategy maps, it is like being in a theater with surround sound."
Public Health Impact of Zoomable Strategy Maps
As more and more local health departments and coalitions strive to achieve the five conditions of Collective Impact—a common agenda, shared measurement, mutually-reinforcing activities, continuous communication, and backbone support—the work in Weld County will be an excellent model of specific techniques to achieve those conditions. The structure of Zoomable Strategy Maps allows for a much greater clarity in aligning actions and measurement than is offered by static documents such as a strategic plan or a community health improvement plan. The Zoomable Strategy Maps are easily accessible, interactive, and easily downloadable for use during community and organizational meetings and events.
Website for Program
A public facing website that houses the Zoomable Strategy Maps and other information about WCDPHE community initiatives can be found at www.thrivingweld.com.
Issue of the Lack of Effective Collaboration to Improve Community Health
Over the past 20 years, there have been thousands of attempts by communities to gather a cross-sector coalition of stakeholders to look at the data, prioritize issues, and take action to improve community health. In spite of the valuable techniques defined in the MAPP process and similar approaches followed by health departments, coalitions have consistently been challenged by the process of clearly implementing a coherent strategy with the alignment, teamwork, and shared measurement necessary to monitor its execution. There have certainly been examples of progress in many cases, but it is probably safe to say all of those communities have struggled greatly with implementing the kind of aligned, multi-sector, coordinated effort needed to achieve the big goals they defined for their community.
Target Population of Public Health Stakeholders Have Attempted to Collaborate
In recent years, the ACA and public health accreditation standards have pressured hospitals, health departments, philanthropies, and other stakeholders to collaborate. There are a growing number of examples where data is shared, surveys are coordinated, and community input is sought in ways that streamline the creation of the Community Health Needs Assessments by hospitals, health departments, and other organizations in a community. But, when it comes to co-creating and collaboratively implementing strategies to meet community health needs, there are far fewer examples of inspiring and effective teamwork.
Commonly-Used Techniques Were Designed for Programs, Not Coalitions
The typical static information structure used for community health improvement plans is not a good fit for supporting the alignment of many different stakeholders in community teamwork. The techniques commonly used by health improvement coalitions were developed and refined to manage the implementation of clearly defined and isolated programs—typically those funded by a grant-giver requiring evaluation and accountability for how funds were used. The commonly-used toolkit of techniques includes a theory of change, a logic model, SMART Objectives, work plans, tables and static reports at periodic times during the lifecycle of the project. These techniques are not well suited for the complex social and health issues selected by health departments as priority health issues after an assessment has been completed. The shortcomings of these commonly-used techniques are becoming more broadly recognized, but most health departments are still not familiar with alternatives.
An underlying challenge faced by coalitions addressing complex issues like chronic disease, infant mortality, or the social determinants of health is the sheer complexity of the strategies that could lead to significant improvements. There are no silver bullets. The multi-faceted mix of drivers and potential strategies surrounding these issues can quickly overwhelm the capacity of coalitions to manage information, plans, and progress. Without techniques and tools to manage this complexity, the “action teams” tend to lose traction and often resort to trying to focus on some isolated project in order to get something done. Even coalitions with generous funding still struggle with efficiently and effectively coordinating the multitude of changes and actions by the myriad actors. At best, we may see different organizations agree to take the lead on different issues. That is progress, but it is a far cry from optimally engaging the many different stakeholders in differentiated and mutually-reinforcing ways so they function as a high-performing multi-sector community team.
Zoomable Strategy Maps Practices Offer Potential Solutions
Since all that passion, time, and resources are leading to underwhelming success, it makes sense to look into the processes and techniques being used and determine if there is a better way. One of the main practices that WCDPHE is demonstrating is the use of Zoomable Strategy Maps to define and communicate details of a co-created community strategy. The practice of creating Zoomable Strategy Maps builds on techniques that have been refined for the past 25 years in the field of strategy management, but it also blends in state-of-the-art thinking on Collective Impact, Asset-Based Community Development, System Leadership, and capabilities enabled by Internet Technologies. The adoption and refinement of these techniques by WCDPHE has created a model that can help many other states and counties achieve breakthroughs in the success of their health improvement plans.
Important Innovations of Zoomable Strategy Maps
The specific strategy mapping practices used by WCDPHE build on this rich legacy of evidence-based techniques for developing strategy maps, but they also have key innovations that make them more appropriate, simpler and more effective than other attempts to use strategy maps for community health improvement. These key innovations include:
Three Perspectives Structure. Zoomable Strategy Maps uses Balanced Scorecards “perspectives” that each give a different view of the strategy. These perspectives are structured with a cause and effect logic that flows from the bottom up to the top. The traditional Strategy Map and Balanced Scorecard has four perspectives: Financial, Customer, Internal Process, and Learning and Growth. In contrast, Zoomable Strategy Maps use three perspectives: Outcomes, Strategies, Asset & Capacity Development.
“SMARTer” structure of OMTA. Most Community Health Improvement Plans define goals or objectives in a series of statements that are intended to include all the SMART elements—Specific, Measureable, Actionable, Relevant/Realistic, and Time-Bound. Weaving all these elements into statements may work for focused action plans for an isolated grant, but those statements don’t work well for creating manageable, emergent strategies for big complex issues. In the “SMARTer” approach used by WCDPHE, the typical SMART statement is replaced with information deconstructed into the Objectives, Measures, Targets and Actions (OMTA). This is essentially the same as the OMTI model that is at the heart of the Balanced Scorecard methodology, but the last term is switched from “Initiatives” to “Actions” to reduce the confusion in the social sector where the term “Initiative” often refers to a broader effort.
The Objectives, which are the building blocks of the Strategy Maps, clearly define the desired change without including the Measure, Target, or Actions in that Objective statement. This makes it easier for a coalition of diverse stakeholders to agree on elements of the Zoomable Strategy Maps. It also creates a structure that is valuable for fostering the ”reflective and generative conversations” that are essential for successful system leadership. Once the Objectives are defined, the coalition can agree on the definitions of Measures that will help the community monitor progress on each of those Objectives. Only then are the Targets and Actions defined. The process of developing Zoomable Strategy Maps is an ideal way for the “systems leader” to shift from reactive problem solving to co-creating the future. Because the Strategy Map does not include the specific actions of individual organizations, it is more stable (while still being flexible) and provides consistency while the strategy implementation is managed for the multiple years that it takes to make meaningful progress.
Zoomable Strategy Maps. In order to tame the complexity that usually causes strategic plans and action teams to bog down under the sheer amount of information, the Strategy Maps used by WCDPHE are “zoomable.” This term is a comparison to the functionality of a Google Map or GPS system that allows a person to look at a single map but zoom in or zoom out to see the details that they care about. This is very different from a document-centered approach. Having a zoomable framework allows many different stakeholders to be able to understand the big picture framework and then zoom in to multiple levels of details for any part of the strategy map. Just as no single view of a map in Google Maps is overwhelming, each view of the strategy map is easy to understand. This zoomability allows the system leader and other stakeholders to see the larger system as well as the more actionable details they choose to view.
Although the zoomablility is best understood when people access the richer information management capabilities in the InsightVision platform, the team working with WCDPHE has also created some innovative ways to use PowerPoint to make versions of these strategy maps. The Zoomable Strategy Maps can be clicked on in the presentation mode of PowerPoint, which allows them to be shared with many community organizations and easily used in the team's own presentations. Click HERE to download an example of the Zoomable Strategy Maps in a PowerPoint. View it in Presentation Mode and click on the pluses and minuses to navigate.
Structure for Additional Information. The value of Zoomable Strategy Maps is greatly enhanced when they are deployed in a strategy management system that allows people to access an interactive set of information with a single click. The specific information for each Objective can be structured using different templates, but the added information provides valuable clarity of the intent of the Objective (such as the gap between the current state and the desired state) and who the lead advocate or action team associated with it. The supporting information for each Objective becomes the place where the system leader is able to efficiently capture and share insights and highlights of the “generative conversations” by the various stakeholders.
Framework for a Shared Measurement System. One of the main ways that WCDPHE is benefiting from having a shared set of Zoomable Strategy Maps is that the Strategy Maps become the structure for the shared measurement system. The details of the Zoomable Strategy Maps creates a clear set of pathways for how the various community organizations can work together to implement the co-created strategy. Because the Strategy Maps lay out the many different Objectives that the community is working on to achieve the priority outcomes, the community has a predefined set of “driver measures” to monitor progress towards accomplishing the outcomes. When individual programs or the work of specific organizations is funded, the expectation is that the work will help move those pre-determined driver measures in the right direction. This is a fundamental shift from each organization or program developing its own measures to justify performance. Rather than each organization battling to prove their isolated impact with their own data and measures, aligning around driver measures in a shared measurement system creates a powerful incentive for teamwork
Evidence Base for the Success of Zoomable Strategy Maps
The evidence base for the value of Zoomable Strategy Maps is compelling. Many research reports have validated the positive impact that well-designed strategy maps bring to strategy execution in businesses. The Balanced Scorecard Hall of Fame contains dozens of case studies that document the positive value of strategy maps (when well done) in many sectors. After extensive research on performance management approaches in the government and non-profit sectors, Bernard Marr and James Creelman strongly endorsed strategy maps in their book, Doing More with Less: Measuring, Analyzing and Improving Performance in the Government and Not-for-Profit Sectors.
John M. Bryson, the McKnight Presidential Professor of Planning and Public Affairs at the Hubert H. Humphrey School of Public Affairs at the University of Minnesota and author of the best-selling & award-winning, Strategic Planning for Public and Nonprofit Organizations, 4th Edition (2011) is another proponent of Strategy Maps. Bryson wrote in his recent book, Visual Strategy, “Strategy Mapping is the most effective technique we know of for helping organizational leaders, managers and other stakeholders understand the challenges they face; develop mission, goals, strategies, and actions to address them; and do so in a quick and effective way.”
The Objectives of WCDPHE's Zoomable Strategy Maps
WCDPHE embraced the evidence-based Collective Impact approach to achieve better alignment and outcomes in their coalition's community health improvement efforts. Since the Collective Impact approach is not specific on who to achieve success within the five conditions it describes for achieving the improved collaboration and results, WCDPHE searched for the most promising and relevant practices to achieve those conditions. WCDPHE determined that the use of Strategy Maps--especially Zoomable Strategy Maps--would best support their journey to become a national model for successful Collective Impact. WCDPHE's Zoomable Strategy Maps practice focuses on five key objectives:
Provide an Easy to Understand Structure for a Co-Created, Shared Strategy that Serves as a Common Agenda for Collective Impact. Instead of having a fragmented mix of strategies and measures, one of WCDPHE's key goals was to co-create a shared strategy that would be owned by the broader community rather than any one organization. The Zoomable Strategy Maps approach helps communicate that shared strategy in a visual and easy-to-understand manner. Once people understand the technique, it becomes easy to communicate a strategy for any issue.
Create an Enduring but Flexible Framework for a Shared Measurement System Based on the Common Agenda. Instead of having each organization or grantee develop their own measures to make themselves look good, WCDPHE aimed to create a shared measurement system that identified the priority measures for the community—including the shorter-term “driver” measures as well as longer-term outcome measures. In order to have agreed upon driver measures, a shared strategy needs to be clearly articulated through Zoomable Strategy Maps.
Support Community Teamwork and Mutually-Reinforcing Activities. The real power of Collective Impact is not just measuring the performance of various organizations, but aligning the work of many organizations and then tapping into other community resources in mutually-reinforcing ways. The process of creating and using the Zoomable Strategy Maps helps make this happen.
Simplify and Enhance Continuous Communication While Requiring Fewer Meetings. Without the zoomable structure that a strategy map provides, typical action teams working on a priority health issue consistently struggle with two communication obstacles. First, they will have meetings and discussions on their topics but quickly get overwhelmed because gathering ideas and trying to cluster them into sensible groupings lacks the strategy execution-focused discipline that goes into the design of a Strategy Map. And when people try to bring up many different sub-topics, the meetings tend to get difficult to manage. Even if the details of a multi-faceted strategy start to take shape, just getting an update of who is working on what will require a long meeting. It is very common that these groups then decide to focus on a small number of actions--not enough to achieve the desired impact. The structure of the Zoomable Strategy Maps allows meetings and communication to be much more efficient. The appropriate stakeholders can talk about the details of their specific Objective and know that others will be talking, in parallel, about the other issues that make up the Strategy Map. The second communication obstacle is the use of linear, static documents. To capture the details, documents tend to get long and difficult to read. And because a document structure is linear, it can be challenging for different people to find the information they care about. Some people need the big picture and others need details in specific area. The , like Google Maps, allows different people to navigate through the information in different ways with different levels of detail. When powered by a system like InsightVision, the ability to manage large amounts of information is even more powerful because, unlike a linear, static document, the information in the Zoomable Strategy Maps is dynamic and easily updated.
Develop Shareable Templates and Techniques that simplify the role of providing backbone support. The leaders of Weld County and the North Colorado Health Alliance don’t just want their county or region to be healthier. They want to accelerate health improvements across the State of Colorado and the rest of the country. When strategic plans are structured in the typical way—with logic models that list inputs and activities and with the action plans that are specific to the organizations in a community—and when the plans are developed as big documents with static reports, it is difficult for other communities to leverage that work for their own use. But, because the Zoomable Strategy Maps are built in a way that allows different communities to use the same (or slightly modified) framework by aligning it to their own organizations, assets, and actions, this approach can be spread to other counties or alliances much more easily. And the use of Zoomable Strategy Maps templates among many counties can greatly simplify strategic communication for the entire state and the sharing ideas among local health departments.
Achieving the Zoomable Strategy Maps Objectives Through "Emergence"
WCDPHE's approach emulated the influential work of John Kania, Mark Kramer, and Fay Hanley Brown who, in their writings on Collective Impact, emphasize the need to allow for “emergence” in the journey to address complex social issues. After co-authoring an article in the SSIR on “Embracing Emergence: How Collective Impact Addresses Complexity,” John Kania spoke at a conference put on by the Aspen Institute. In that conference, he stated an important concept of Collective Impact: “Let’s get clear on our common intent and what our goals are. And then let’s structure this work for others to come to this…and take advantage of emergence.”
One of the key benefits of Zoomable Strategy Maps is they begin by creating a consensus on the high level aspects of the strategic framework, organizing communication and serving as a catalyst to engage others in the community. Then, as the insights, assets, and choices of the community become clear, evidence-based and promising practices will be explored and the next level of details for the strategy can "emerge" and be refined. The information structure of the Zoomable Strategy Maps, especially when supported by an online platform like InsightVision, allows a community to efficiently collaborate and take advantage of "emergence." Other options, like meetings, emails, spreadsheets or even online documents are not nearly as effective for managing the information in a way that allows for "emergence."
Steps Taken to Implement Zoomable Strategy Maps
Actionable steps to implement the Zoomable Strategy Maps practice include:
Referencing Existing Documents. While there are a variety of useful pathways to develop co-created Zoomable Strategy Maps, WCDPHE started by gathering the content from their existing community health improvement plan document. In addition, they referenced the meeting notes from the action teams that had been discussing the priority actions and possible plans for the health issues that had risen to the top during their Community Health Assessment—Healthy Eating, Active Living, and Healthy Mind and Spirit. Because these documents had been created with the input of many different organizations, the content of the initial draft strategy maps already had a good start in alignment with the priorities of the various community organizations.
Simplifying the Approach Through Stakeholder Input. In the early process, the various stakeholders were trained on the techniques and terminology of the strategy maps and the OMTA structure. During that time, the dialogue between the health department team, the Insightformation consultants (who were helping to facilitate the process), and other stakeholders led to some simplifications that have helped improve the overall technique. These simplifications included reducing the perspectives in the Balanced Scorecard approach from four to three (combining what had been the “Community Implementation” and “Community Process” perspective into just the “Strategies” perspective). This reduction eliminated much of the confusion about what to put in each perspective.
Clarifying Language and Visual Appearance. Further clarity was added when the bottom perspective was renamed from the “Community Assets” perspective to the “Asset and Capacity Development” perspective, The purpose of the bottom perspective is not just to list assets (as is often done with the input column of a logic model) but rather to describe the Objectives for developing the assets and improving the capacity to be able to successfully implement the strategy Objectives and achieve the outcome Objectives. It took several iterations to refine the wording, balance the desire for simplicity and detail, and get a visual appearance that enhanced understanding. The selection of colors went through a few iterations, but ultimately, the focus on the colors was to differentiate between the Objectives that were on the top level strategy maps (the interstate highways in the Google Maps metaphor) and the added level of detailed Objectives that were only visible on the zoomed in maps (the secondary highways).
Adding Additional Zoomable Strategy Maps. Once the techniques were better understood based on a few iterations of the Healthy Eating and Active Living strategy maps, people in Weld County who were working on other issues were able to develop strategy maps for those topics—including Healthy Mind and Spirit, Access to Care, Education and Livelihood. While there is an initial learning curve to understand how to design and use strategy maps, once the basic techniques are understood, it becomes much easier to work on any other issue that requires collaboration to develop and implement a strategy.
Building and Sharing the Shared Measurement System with the Public. The Strategy Maps become the structure for the Shared Measurement System. Once the Objectives of the strategy were defined (the O of the OMTA structure), the appropriate Measures could be gathered to be able to see historical trends and monitor progress on achieving those Objectives. This resulted in the Thriving Weld Data Dashboard that was shared with the public, initially on the Make Today Count Website (www.maketodaycount.org) but now on the Thriving Weld Website (www.thrivingweld.com). Much of the value comes from the fact that the Measures are not just focusing on individual program or organizational performance. They are Measures that monitor the county’s progress on the strategy that they all own. So, if a Measure is indicating that some Objective is not making sufficient progress, it is up to the community to work on a solution. By gaining agreement on the structure of the strategy and the general causal logic, the community has the ability to monitor progress on some of the driver Objectives in the strategy that should change more quickly than the outcome Objectives which often take a long time to significantly change. As various community organizations work to move a pre-determined set of driver Measures in the right direction, there is improved alignment and also an enhanced ability to evaluate the contributions of the different stakeholders.
Cascading the Strategy to Multiple Organizations. Another important benefit and part of the strategy implementation journey is the “cascading” of the strategy to the work of the many different community organizations. The term “cascading” was popularized to describe this process in the Balanced Scorecard methodology as part of aligning an organization to implement the many elements of a sophisticated strategy. For WCDPHE the cascading process is where the efforts of those various community stakeholders are aligned with the detailed community strategy. This process also helps promote mutually reinforcing activities where different stakeholders explore how they can combine their efforts to achieve things that could not be accomplished on their own.
Timeframe for Zoomable Strategy Maps Practice
The initial training and drafting of the first two Zoomable Strategy Maps, "Healthy Eating" and "Active Living," was done over a three-month time period through a series of web-based conference calls. These calls educated the participants on key concepts, provided examples of existing strategy maps, and allowed participants to work together during those sessions to create the Zoomable Strategy Maps. During that process, different stakeholders would provide input, ask questions, recommend suggestions, and agree to changes. After the initial three months, the community members could begin to align around the strategies and begin to work on some of the measures and underlying information. Over the next three months, minor changes were made to the zoomed in layers of the strategy maps and scorecards were deployed in InsightVision based on the structure of the Zoomable Strategy Maps.
Six months into the project, the strategy maps began to be used more broadly as a communication tool and the focus shifted to creating the versions of the scorecards that would be shared with the public. With the focus on how the public might react to viewing the strategy map, it became a priority to look for ways to simplify the wording and structure to make it less intimidating to people unfamiliar with the concepts of strategy management or the language of public health. It was during this time that the number of Balanced Scorecard perspectives was reduced form four to three and the wording of some of the objectives was simplified. For example, "Decrease the Consumption of Sugar-Sweetened Beverages" was changed to "Decrease the Consumption of Sugary Drinks."
As the first two Zoomable Strategy Maps were being used to shape conversations, measurement, and plans, the WCDPHE team began working on the next of the Zoomable Strategy Maps, "For Healthy Mind and Spirit." This time, they did most of the work by themselves, with minimal coaching from the Insightformation consultants. Their experience with using and refining the first two Strategy Maps had given them sufficient understanding to create additional Zoomable Strategy Maps.
During the second year, apart from minor refinements, most of the work shifted from creating the Zoomable Strategy Maps to using them to align the efforts of the many community partners. The development of Objectives and Measures for the many partner organizations was done with the help of the staff person who had been hired by the North County Health Alliance to support this process and the use of InsightVision. As the value of aligning the efforts of different organizations around the Zoomable Strategy Maps became clear, the United Way of Weld County decided to align their funding with the Strategy Maps and have their grantees report their progress and outcomes using InsightVision. This led to an expanded use of InsightVision in the third year.
Engaging Stakeholders to Develop the Zoomable Strategy Maps
Much of the value of WCDPHE’s innovative use of Zoomable Strategy Maps is based on the way that this practice enhances the engagement of a broad range of stakeholders in the community. WCDPHE was well positioned to demonstrate the value of this practice because we had already done a good job of engaging a wide range of organizations in the journey to improve community health. The relationships that WCDPHE had previously established with stakeholders contributed to the success of the Zoomable Strategy Maps effort. However, it is important to note that even if a community is early on in the process of developing a coalition and fostering the relationships that help the coalition to function, this practice of using Zoomable Strategy Maps will be valuable to their process.
Fostering Stakeholder Collaboration Through Simplified Communication
While there is an initial investment in learning the concepts of Zoomable Strategy Maps and creating the Zoomable strategic framework, once the framework is in place, it simplifies and streamlines communication. Instead of a large group of stakeholders holding an inefficient meeting on a broad topic like "Improving the Built Environment for Active Living"—which is likely to end up with everyone feeling frustrating that they didn’t get to make progress on their specific concern—more appropriate groups can meet individually to discuss details and action steps for one of the cascaded objectives that contributes to the broad topic.
Because the structure is agreed on and clearly communicated, stakeholders working on one part are aware that others are making progress in refining, implementing, and measuring other parts of the strategy that will contribute to the common agenda. Since WCDPHE is using the InsightVision software to manage the details, each group that is working on specific Objectives can update the relevant information on the centralized platform so others can see it. And when a group reconvenes to continue to work on their specific objective, they can easily pick up where they last left off, even if some people are not at all the meetings.
Start-Up Costs and Investment Required
Embracing the approach of Zoomable Strategy Maps and the supporting technology requires a few different investments. The investment can be considered in four main categories:
1) Training on the concepts and techniques
2) Facilitation and coaching on building Zoomable Strategy Maps
3) Technology to support the strategy management and scorecard capabilities
4) Staff to support the scorecard building, data maintenance, and training of partners
The amount of investment can vary based on many factors, but the investment by WCDPHE was as follows:
1) First year investment.
Professional services to help develop the strategy maps and build the local capacity to use these new tools typically range from $5,000 to $20,000 ($16,300 for WCDPHE).InsightVision software: Software licensing depends on the licensing type (rent vs. buy) and the number of users. The per-user cost decreases with the number of users and typically ranges from $5,000 to $25,000. ($15,600 for 10 users for WCDPHE) plus $8,000 for the first year of Website Embed & Publish services to allow the dynamic scorecards to be embedded in multiple Websites. InsightVision "Fast Start" package for configuration, training and scorecard building: $9,500
2) Second Year Investment
$2,600 for annual hosting, maintenance and support. $8,000 Annual fee for Website Embed and Publish service (shared, public measurement system)One of the factors that is demonstrating the power and improving the value of this practice is how funders are beginning to align their grant-giving practices with the strategy as communicated through the Zoomable Strategy Maps. Funders are also leveraging the shared measurement system to simplify and enhance the reporting and evaluation of the many different not-for-profit organizations in the community. The United Way was the first major funder to embrace this.
Objectives Achieved and Collaborative Processes Improved
The use of the Zoomable Strategy Maps practice is improving the efficiency of the collaborative process on many issues in Weld County. The fact that each of the major organizations that might otherwise have a separate strategy written up in a static document is now working together on a shared, dynamic strategy is a positive change that should lead to improved outcomes in a wide variety of issues. WCDPHE achieved its objectives to:
Provide an easy to understand structure a co-created, shared strategy that serves as a common agenda for collective impact.
Create an enduring, but flexible, framework for a shared measurement system based on the common agenda.
Support community teamwork and mutually-reinforcing activities.
Simplify and enhance continuous communication while requiring fewer meetings.
Create shareable templates and techniques that simplify the role of providing backbone support.
Evaluating the Practice Based on Indicators of Success
One important process milestone that is a strong indicator of success and future alignment is the fact that the United Way of Weld County decided to use the Zoomable Strategy Maps and the InsightVision software to organize and align their grant-giving and requested that grant recipients update their progress using the InsightVision system. The use of this practice was a primary focus of the application to be a pacesetter community for the 100 Million Healthier Lives' SCALE initiative, and WCDPHE and the North Colorado Health Alliance were selected as one of 20 pacesetter communities out of over 150 applicants. That is evidence that evaluators looking to find replicable "bright spots" saw the value in the process of creating Zoomable Strategy Maps and in the ways that the strategy maps are being used to enhance alignment and strategy implementation.
Another indicator of the success and value of this practice is that Dr. Mark Wallace, the Executive Director of the WCDPHE and the CEO of the North Colorado Health Alliance, is recommending the use of this practice as he gives presentations to other public health departments in Colorado. Vincent Atchity, the COO of the North Colorado Health Alliance, stated the following in his presentation during Insightformation's summer training session:
In talking to other communities about adopting InsightVision [and the Zoomable Strategy Maps practice] I’ve said that they should not think they need to be at as advanced of stage as the North Colorado Health Alliance has become. Just start where you are with [a] few organizations [who] come to the table and start building out the mechanism. Even with just two organizations and ten measures in the mechanism, it is so graphically valuable that you build it and they will come. It is the classic representation of that. Show what it can do with as little as you’ve got going and others will come to it because it makes so much sense and is so easy to use.
The Colorado Network of Health Alliances is also recommending that the various health alliances in Colorado adopt this practice.
Evidence of the Impact of Zoomable Strategy Maps
The use of Zoomable Strategy Maps creates a broad set of measures for a wide range of topics. One example of the way that the use of Zoomable Strategy Maps impacted a measure is with the Greeley Farmers' Market. This farmers' market had declining vendor sales for four consecutive years. In the process of developing and refining the Zoomable Strategy Maps, many stakeholders shifted their mindset and began to view that decline in sales as a community issue, not just an issue of the performance of the Greeley Farmers' Market. Zoomable Strategy Maps communicated the understanding that the strategy for healthy eating included an objective to "Collaborate to Strengthen Farmers' Markets and Community Gardens." As a result, multiple organizations took steps to rally around the Greeley Farmers' Market, and vendor sales increased significantly the following year.
Feedback from Others Learning Zoomable Strategy Map Techniques
Another form of evaluation comes from the feedback interviews on the 2015 Summer Training Program in Zoomable Strategy Maps conducted by Insightformation, Inc. This training program taught the same techniques used by WCDPHE and that used the Weld County Zoomable Strategy Maps as a primary example of using that technique. Vincent Atchity, an executive with the North Colorado Health Alliance who was a guest presenter for this course, shared the positive experience and value that the alliance in Weld County had experienced from this approach. The following are quotes taken from interviews on the value of that strategy management training course that specifically recognize the value of the practice of using Zoomable Strategy Maps:
"The community strategy management training by Insightformation provided us with a valuable tool to create a shared community strategy and align our partners’ efforts. The strategy map framework provides a common language to effectively engage new and existing partners in collective action while also allowing the coalition’s leadership to more easily manage the complexity of working on numerous objectives and initiatives targeting social change.”
- Virginia Hartmere, coalition director, Pelham PACT Coalition
“As a community, Colorado Springs has a very active food movement, but it needs a structure. The principles taught in this training will help our community systematically collaborate, which will help support the current efforts of passionate people in the Springs.”
- Sophie Javna, a senior at Colorado College
"As a decade long participant in sustainable food system transformation, I understand the need for cross sector, strategic partnerships. Yet, without appropriate structure and guidance, one or several organizations often become overburdened. Insightformation's Community Strategy Management Training Program provides principles for effectively organizing and strengthening broad coalitions necessary for effective collaborative efforts. ... I knew this was the missing link to creating and organizing the broad networks necessary for systemic positive social change. This course provided me with the theoretical and practical foundation of collective impact and system leadership. ... I truly feel that Collective Impact is the path forward for large scale systemic social change and Bill and his team through Insightformation are leading the way."
- Meghan Murphy, San Diego Food System Alliance Member, MPH student at San Diego State University
"Armed with the five principles of collective impact and improved strategy mapping skills, not only can the Public Health Department continue to work towards its public health accreditation requirements, but community partners can better align their goals and capacity to support Mason County’s community health initiatives.”
- Allie Perline, Community Health Education Specialist, Mason County Public Health & Human Services
Zoomable Strategy Maps are Sustainable Solutions
The sustainability of a shared Zoomable Strategy Maps framework is positively impacted by the way it is simplifying and streamlining the work of several organizations in Weld County. There is a growing number of organizations that are either aligning their funding or aligning their efforts with the Zoomable Strategy Maps framework. Because the Zoomable Strategy Maps were created with the input of multiple organizations, it is natural for the various organizations to want to use them to organize their own efforts. The more organizations that align their efforts around the Zoomable Strategy Maps framework, the more visible they become, the better they are understood and the greater the appeal will be for others to also embrace them. Some of the lessons learned in terms of using Zoomable Strategy Maps include:
Supporting Health Department Accreditation. Several requirements of PHAB accreditation are supported and enhanced by the use of Zoomable Strategy Maps and the InsightVision technology that powers the interactive shared measurement system. Rather than developing separate tools and techniques for the departmental strategic plan, the Quality Improvement plan, and the Public Health Performance Management System, the WCDPHE can extend their use of the Zoomable Strategy Maps techniques and shared measurement system. Because other alternatives would require a greater investment in time and money, the WCDPHE can achieve savings by continuing to support this strategy management practice.
Saving Time for Developing Strategic Plans. Since the Zoomable Strategy Maps are designed in a way that allows them to last for several years (with modifications as needed), many organizations will benefit from not having to reinvent a way to organize the complex issues that may be part of a strategic plan, Community Health Assessment, or Community Health Improvement Plan. Using the existing shared strategic framework saves them time and allows them to invest more time in the valuable work that helps to accelerate the implementation of their plan. It also allows each organization to more easily show how their work fits in with that of others.
Simplifying Hospitals’ IRS Reporting. Non-profit hospitals that do the ACA-required Community Health Needs Assessment need to explain to the IRS in their Implementation Plan how the needs in the community are being addressed, even if the hospital is not the one directly involved with meeting those needs. Having a shared strategic framework that is being used to organize multiple Weld County needs assessments and the actions being taken to meet those needs will greatly reduce the efforts of the hospitals to communicate to the IRS about how the various needs are being addressed. With each hospital having both a financial interest and a mission interest in using the shared Zoomable Strategy Maps framework, it is logical for them to allocate some resources to sustain the on-going use of this practice rather than let it fade away and having each hospital take on the full burden of developing their own way to organize a needs assessment report and implementation plan.
Leveraging Work in Other Communities. Another benefit of the ongoing use of the Zoomable Strategy Maps frameworks is the ease in which work on other topics done by other communities that use strategy maps can be leveraged. For example, if a county somewhere else in the U.S. develops a Strategy Map for addressing oral health, prisoner re-entry, or any other issue that becomes a priority for Weld County, it will be easy for the stakeholders in Weld County to use the other county’s Zoomable Strategy Maps as a template and implement it with any relevant modifications. The Weld County organizations may adjust some of the Objectives, modify the Measures, use different data sources and modify some of the Actions, but the structure of the information makes it much easier for a multi-stakeholder coalition to leverage the work of others—especially if many of the organizations are already comfortable with the using Zoomable Strategy Maps. The zoomability of the strategy map framework makes it relatively easy to integrate the new content with the existing strategy maps. In contrast, when strategies are defined in a typical document form without the structure used for Zoomable Strategy Maps, it is more difficult for other county to easily build on that content.
Aligning Grant-giving with the Zoomable Strategy Maps. The United Way of Weld County has communicated to their potential grantees that their funding will focus on projects that are aligned with the community Zoomable Strategy Maps. This creates a powerful incentive for many of the county’s non-profit organizations to invest the time to understand the Zoomable Strategy Maps and to begin to communicate their value in terms of how they support the strategic objectives in the strategy maps. Furthermore, United Way grantees will use the InsightVision platform (which powers the interactive strategy maps) as the shared measurement system to communicate their progress on grant-funded activities. This is creating a larger base of people in the community who understand the technology and makes it attractive for other funders to do the same thing, simplifying the funders’ access to information and reducing the burden on Weld County non-profit organizations in having to learn multiple grant monitoring systems. The greater the number of organizations that understand and align around the Zoomable Strategy Maps, the easier it will be to expand the use of the technique and to increase the amount of information that can be viewed in the context of a shared strategy.
Enhanced Ability to Win Competitive Grants. In the past few years, as most communities struggle with the implementation of their grant-funded work-plans, government and philanthropic funders are putting a growing emphasis on the track record of a community in managing the implementation of a multi-sector, multi-organization plan. It is likely that this emphasis will continue to grow. Since the practice of using shared Zoomable Strategy Maps is a clear way of demonstrating that capacity, Weld County and other counties that adopt this practice should find that it strengthens their applications. When a county uses a shared strategy management platform like InsightVision, they also need to allocate less of the budget for building or buying a way to track information and relevant performance and evaluation data.
Financial Sustainability and Leadership Commitment
All of the above factors should enhance the financial sustainability and the leadership commitment to using this practice. The ongoing costs of the InsightVision licensing are relatively low, and the platform can be used by many different groups in Weld County, each of which could potentially fund some of the licensing if needed. With the growing number of stakeholders understanding the Zoomable Strategy Maps practice, the need for additional training is also quite low, so having sufficient funding and skills for sustaining the effort should not be a major issue.
I am a previous Model Practices applicant|NACCHO website