Session 1.2: Creating Opportunities to Improve Health Outcomes

Introduction

Working with partners across settings to improve maternal and child health systems can be a complex process, but one critical to advancing health outcomes at national, state, and local levels. There are several discussion guides that allow us to:

1. Reflect on priorities for what a well-functioning MCH system would look like
2. Share experiences of structural and system-based factors that impact health outcomes in your setting
3. Identify root causes and meaningful opportunities for improvement in your setting

The purpose of this is to identify opportunities to improve aspects of your MCH system to achieve better health outcomes. The process of developing an Opportunity Statement — a carefully-crafted one- or two-sentence summary to clarify the problem to be solved or opportunity at hand — follows a two-part process, beginning with individual brainstorming and moving to group discussion. It's important to include healthcare providers, family members, youth, and community members in this conversation to have a comprehensive and meaningful discussion.

MCHwork provides a jump start to developing Opportunity Statements through a Ready-Set-Go approach. Use the following resources to start your learning, dig deeper, and move from knowledge to practice.

READY: Creating Opportunities for System Improvement — Understanding Root Causes

Before writing Opportunity Statements, we need to understand the systems we want to improve and identify root causes of challenges.

Watch this video from the National MCH Workforce Development Center about the Iceberg Model of Systems Thinking: Identifying Leverage Under the Water Line.

Resources from the MCH Navigator. Use these resources to dig deeper and understand how to implement what you've learned:

1. Understanding Systems. First, we need to quickly refresh ourselves on what systems are.

• Systems Integration Resources. This portal page starts with a background on systems integration and then presents a number of tools and learning resources, including the Five-Minute Systems Mapping Series of microlearning videos.
• Systems Integration Spotlight. This resource provides a deep dive into systems integration, including trainings on terminology, problem identification, system solution methods, and evaluation. It frames systems integration as a new leverage point for change.
• Systems Integration Toolkit. This checklist provides tools to see your work in the context of the “big picture” and strengthen collaboration within agencies and across sectors.

2. Finding Root Causes.The Iceberg Model shows how underlying structures affect visible outcomes. Three key resources explain this approach:

• Iceberg. This two-minute video explains the Iceberg Model.
• The Iceberg and Systems Thinking. This seven-minute video emphasized the Iceberg (or Pyramid) in understanding behavior change on a systems level.
• The Iceberg. This twelve-minute video digs deeper into the model and provides multiple examples above and below the surface.

SET: Identifying Improvements for Your MCH System

An Opportunity Statement summarizes a problem or opportunity in one or two sentences. It helps focus on root causes rather than symptoms.

Watch this video from the National MCH Workforce Development Center to reflect on what a well-functioning MCH system would look like: What Needs to Chance in Your MCH System?

Resources from the MCH Navigator. Use these resources to dig deeper and understand how to implement what you've learned:

• Writing an Opportunity Statement. This one-page worksheet provides six questions and example responses to craft an opportunity statement.
• How to Write a Clear Opportunity Statement for Better Problem-Solving. This blog post provides background, examples, benefits, and helpful tips to develop opportunity statements.

GO: Brainstorming Actions to Transform Your System and Improve Health Outcomes

Combining the Iceberg Model with Opportunity Statements is a way to brainstorm ways to improve health outcomes. When we “flip the iceberg,” we can envision a different purpose for the structures we identified and begin to plan comprehensive solutions.

Watch this video from the National MCH Workforce Development Center: Brainstorming Actions to Transform Your System.

Resources from the MCH Navigator. Use these resources to dig deeper and understand how to implement what you've learned:

• Systems Thinking and The Iceberg Model Tool. This tool provides a one-page background of the Iceberg Model and a fillable two-page tool that can be filled out to “flip the iceberg” and start problem solving solutions that could shift one structure toward a desired purpose for the system.
• Iceberg Worksheet: What’s the Root Cause of the Problem. This webpage provides probing questions to explore the domains of the Iceberg Model. It also provides a downloadable tool to that helps to crosswalk questions raised to possible solutions that can be used individually or in a group.

PUTTING IT ALL TOGETHER: Creating a Discussion Guide

A Discussion Guide is a structured conversation guide you can use with partners and collaborators across settings to:

1. Analyze system factors affecting health outcomes
2. Develop clear opportunity statements
3. Create action plans for improvement

Key considerations before you begin:

• Use structured meeting techniques
• Include all relevant team perspectives
• Focus on concrete health outcomes
• Build on existing successful practices