By Michael R. Fraser, PhD CAE
Like putting the pieces of a puzzle together to form a complete image, systems building involves putting MCH services together within a state or community to create a unified whole of services geared toward protecting and promoting the health of women, children and families. Systems building is one of the unique features of the Title V MCH Services Block Grant. Unlike other funding streams with specific approaches and guidelines, the Title V MCH Block Grant allows states to tailor their programs to support state specific needs and create a system that works for that state. As such, the MCH system in one state may look very different from the MCH system in another. However, at the core of all state MCH programs, is the goal of improving the lives of women, children and families including children and youth with special health care needs and creating systems that effectively and efficiently provide needed services and programs.
When I first came to AMCHP, systems building was a term that I heard a lot. I remember a meeting I attended with Holly Grason from Johns Hopkins University. Holly provided a definition of a system that I still rely on today. In the definition she shared with me, systems have three components: focus on a shared goal, interrelated parts to meet that goal, and communication between the parts to assure that the shared goal is reached.
Focus on a Shared Goal
Every system has a goal, and for MCH programs that goal is very clear: develop systems that protect and promote health for women, children and families. A major role for MCH leaders within a state is to develop a shared goal that can bring together different kinds of programs and links diverse services providers. Getting agreement on a shared goal is an essential, though often difficult, role for Title V programs. I would posit that getting all MCH players within a state to contribute to a shared goal is one of the hardest parts of a Title V Director’s job! However, it is also one of the most important: without a shared goal, how do partners and collaborators fit their work into the larger MCH system within a state? What are all the players working toward?
One of the challenges of systems building is getting the various components involved in the system to see themselves as collaborators and partners in the work rather than individual entities providing specific services to segments of the population without the need to link to one another. A task for many MCH leaders is “herding cats” – getting various independent groups to work together toward the shared goal of improving the lives of women, children and families. For a system to function, interrelated parts must work together seamlessly and contribute to the shared goal.
Communication to Ensure Components Meet the Shared Goal
Communication is a constant challenge, and communications between components in an MCH system is no exception. How many meetings, e-mails, and phone calls take place between different organizations to assure that each is helping move forward the shared goal? In my experience there is always never enough communication between entities – this is an area for continued growth and development for almost all of us! But communication is essential to getting our work accomplished efficiently and effectively. How else do we know what each of us is going to meet our larger, shared goal and coordinate our work?
As you can see the elements of a system are straight forward, but the work of assuring that the systems is functioning takes some effort! As you work to build systems in your state, especially for children and youth with special health care needs and the new opportunities presented by the Maternal, Infant, and Early Childhood Home Visitation Program, keep this definition of system in mind. Let me know what else you think contributes to systems building in your state and how AMCHP may be of assistance moving your work forward.