For true system transformation to occur, those involved in the system must feel that their experiences and perspectives are listened to, valued, and utilized to promote change.
“Systems change” is an intentional process of transformation designed to address historic and complex root causes of social problems. Systems change aims to fundamentally alter the reasons a system behaves in certain ways. It requires innovation to modify the goals, structures, and mechanisms, which can include policies and procedures, resources, relationships and power structures, and values, of an identified system.
One driver of systems change and innovation in the public sector is the need to improve health equity; to remove the systematic disparities that create the conditions for some groups to prosper while lower income people, often those who are Black and Brown, continue to have worse health outcomes and more difficulty accessing care. To address these disparities requires significant changes in people’s perceptions, attitudes, and ways in which they work.
With more social service and public health organizations focusing on systems change using a multi-sector, collaborative approach, leaders are being asked to change not just policies and processes, but the culture, values, and norms of their organizations. Like all systems, organizations are composed of, influence, and are impacted by their smaller parts, including staff delivering services, consumers of services and their families, and local community members. Therefore, it is critical that these stakeholders be included in all phases of the systems change initiative.
At RDA, we approach such complex challenges by actively engaging individuals who have been historically excluded from the process of system design. To leverage their unique strengths and skills in the planning, implementation, and evaluation of a systems change effort, some critical steps can be taken.
1. Invite the right people to the table: It is not enough to bring together established leaders from multiple sectors and call the project diverse. For a project to be truly equitable and inclusive, leaders of change efforts can benefit and draw from existing efforts on the ground in the communities they are working with. This could mean including local spiritual or religious leaders, members of advocacy groups, and the individuals and family members who receive the services from the organizations taking part in the system change effort. Community outreach and engagement is a critical step to ensuring your collaboration is truly representative of the population you hope to impact.
2. Facilitate honest discussion with a focus on healing: Many of the individuals who will be impacted by change efforts have been excluded from positions of power and influence. Acknowledging the failings of existing structures and calling out ways to improve from the point of view of those negatively impacted by those failings can lead to a more open dialogue and can help to establish trust among the individuals engaging in the process. Leaders must actively make room for historically underrepresented voices to be heard and must be committed to co-creating solutions to the problems raised by those individuals.
3. Learn from one another and be open to new ideas: In a collaborative space, each stakeholder should be considered an expert in their own right. This means that leaders of change initiatives will be charged with creating an environment that allows for shared learning at the individual and organizational levels. Creating this space will allow for a shared understanding of the needs, hopes, pains, and desires of the people impacted by the change. Being open to a variety of perspectives will create room for new ways of thinking about how to approach problems. Innovative solutions to difficult problems emerge when creativity can flourish.
The onslaught of COVID-19 has created a demand for public systems to provide human services at unprecedented levels and speed, forcing them to rapidly adapt. Public agencies are likely to find greater success with their required systems changes if they involve diverse stakeholders in the planning and implementation of those changes. We encourage all public agencies to hear from those being affected by COVID-19 and utilize their experiences as assets to inform rapid decision making during these uncertain times.
 2018 National Healthcare Quality and Disparities Report. Rockville, MD: Agency for Healthcare Research and Quality; September 2019. AHRQ Pub. No. 19-0070-EF.