The perils of trying to be everything to everyone

I was facilitating a coalition meeting recently and the conversation ended up going in circles for a bit - someone would propose an idea for a message or an activity and someone else would respond explaining why that wouldn’t resonate with or convince members of their community.

After a few rounds of this, someone interjected with a powerful idea - it’s one I’d heard before and you likely have too, but it bears repeating: Let’s say 20% of the community are strongly with us and 20% of the community will always be against us, no matter what we do. That leaves 60% - maybe we can focus on them instead of the 20% we’ll never be able to sway.

The percentages may change based on the issue, but the underlying concept does not: we can’t be everything to everyone. If we try to get to that 20% who will always be against us, we’ll either get stuck or put out a diluted message/program/policy in an attempt to appeal to everyone - but end up appealing to no one at all (including the 20% that was originally with us!).

Now, Reader, I know you might be thinking, “But it’s not just 20% at the far end of the spectrum!” Especially on politically charged topics, it might seem like almost everyone has a strong opinion, leaving hardly anyone “in the middle”. But what do we actually mean by people "in the middle”? One of my favorite thinkers/authors, Anand Giridharadas, has suggested that “moderates don’t exist”.

Moderation, he says, is about someone having a “less baked” or less certain viewpoint . It does not mean their view is exactly in the middle of the two extremes (I love Anand’s analogy for this – if I am undecided about whether I want a pizza or a burger, that doesn’t generally mean I want a pizzaburger.). Which is not to say that no one has a view exactly in the middle, some people do. But many others have “strong opinions, lightly held” – i.e., approached in the right ways, they can be persuaded.

So who is your 60%? Do they have “strong opinions, lightly held”? Can they be persuaded?

Of course, even within that 60%, not everyone is the same.

I studied health communications in grad school and taught an intro health communications course for several years - one of the key topics we covered was audience segmentation. This is something that commercial marketers (think cars and shoes and soda) do really well. They’re not trying to appeal to everyone with a particular message - their message is targeted and tailored to the particular values and perspectives of a narrow segment of the audience they’ve identified and spent a lot of time understanding. And if they want to appeal to a different segment of the audience, they’ll have a different message in a different channel.

Of course, the coalitions we work with and most public health organizations don’t have the resources that commercial marketers do.

But we can still think critically about who exactly our audience is and what segment of that audience we are trying to reach with a particular message or intervention.

As we often hear in the consulting world, there are “riches in the niches.” When you “niche down” and narrow your audience and services, you can speak to that very specific audience in a way that resonates deeply and makes people recognize that you understand and can address their specific needs.

It’s the same for any work or communication we undertake, whether as a coalition or an organization - we can’t be everything to everyone, but if we “niche down,” we might be surprised at just how effective we can be.

What is your favorite example of the power of “niching down” (or the perils of being everything to everyone)? Let me know!

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15% and 15x solutions

Do you ever feel powerless to tackle the big problems your community faces?

I often feel that way, and I think many of us do.

On the other hand, do you ever feel like our solutions aren’t enough - not big enough, not disruptive enough, not transformational enough?

Especially when trying to improve community health and well-being, it can often feel constraining to work within existing systems instead of thinking about how we dismantle and rebuild the systems themselves.

My colleague and I are facilitating a national convening next week, and the group will be brainstorming and prioritizing public health solutions to address dementia. We’ve tried to ensure each session incorporates a slightly different approach to brainstorming - to keep things interesting and make sure new ideas keep flowing.

In one of the sessions, I wanted to address both these struggles - sometimes we get stuck brainstorming because it feels like the only way to change things is big, huge, systems-level transformation and we feel powerless to make that happen. On the other hand, sometimes we get stuck brainstorming because all we can come up with are ideas that would make small changes on the margins, but nothing that feels big enough to create real change.

The reality is, we need to brainstorm and move forward on both fronts.

​15% Solutions, a type of Liberating Structure (i.e., alternatives to presentations, managed discussion, and other conventional structures that typically guide the way groups work together), invites those brainstorming to consider: “What is your 15 percent? Where do you have discretion and freedom to act? What can you do without more resources or authority?”

I love the way the Liberating Structures website describes what is made possible through this approach: “You can reveal the actions, however small, that everyone can do immediately. At a minimum, these will create momentum, and that may make a BIG difference. 15% Solutions show that there is no reason to wait around, feel powerless, or fearful. They help people pick it up a level. They get individuals and the group to focus on what is within their discretion instead of what they cannot change.”

I have found it works well to pair this 15% solution question with another question borrowed from Liberating Structures that’s about getting 10 times (or we’ll make it 15 times to make it parallel with 15%!) bolder - “If you were [fifteen] times bolder, what big idea would you recommend? What first step would you take to get started?”

What’s made possible through this approach is the flip side of what’s made possible via 15% solutions - there are bold, transformational things that would move us towards transforming community health (or whatever you’re trying to transform!) and while they may not be within our control, we can identify some initial steps to take towards them.

I think pairing these questions together is powerful. You can have participants brainstorm 15% solutions on one color of post-it note in the first part of a session and 15x solutions on another color in the second part of the session.

We can both be empowered by the things we can do fully within our circle of influence and inspired by the things that are more aspirational and transformational - which may take a lot longer (even generations) to accomplish but can still be pursued by starting with a first step.

​Let me know if you have tried this kind of brainstorming before or have other approaches that have worked well!

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The value of ONE right door

Have you heard the phrase "no wrong door" before?

A Google search didn't bring up a standard or formal definition, but the description I found that most aligns with my understanding of the concept is this:

"The vision for No Wrong Door is that every door in the region’s healthcare and human services system should be the right door with a range of services being accessible to everyone from multiple points of entry."

This is a lovely and logical idea in theory.

But I have come to question how well it works in practice.

I work closely with a school mental health collaborative in DC and at our meeting a couple weeks ago, one of the members shared with us results from an evaluation of DC's school behavioral health expansion. There were bright spots and progress to celebrate, but one thing that stood out to me in terms of challenges that remain was that about half of students reported still not knowing where to go for help in the school. We have heard our partners who lead parent advocacy in DC lament about this too - even parents who are deeply engaged in advocating for their children don’t know where to turn or what resources are available at their own schools. This is clearly not due to a lack of involvement on their part, so why is this happening?

Let me share a counterintuitive guess with you - I don’t think the problem is that there is nowhere for them to turn. I think the problem is there are too many places for them to turn.

This is a theme we heard repeatedly in community input gathering to inform the Fairfax Children's Behavioral Health Blueprint.

Imagine that you’re Kira - a mom with two elementary school aged kids, one of whom is in need of mental health supports. You reach out to various folks within the school and community for suggestions, and each person hands you a list of resources available for kids with mental health needs. There are so many resources that you’re overwhelmed about where to start and how to choose one. But you decide to just pick one at random and call them. Turns out they are no longer in business. You try another number. They don’t have any spots available. You move to the next number on the list. They do have availability starting next month but your income is too high for you to be eligible. The next place doesn’t have supports for the kind of mental health issue your child is struggling with. And on, and on, and on.

While the idea of "no wrong door" is great in theory, in practice, it often involves someone behind every door being equipped with a list of other places and people to point someone to. This would be fine if the lists were kept updated, limited to services that were currently available, categorized by eligibility, and tailored to specific needs - but they are rarely any of those things, much less all four.

What people most need is not a laundry list of generic resources that may or may not be available to or appropriate for them. What they need is a way to navigate to the right solution for them - whether that is by way of a person (like a navigator or case manager), an interactive database (imagine being Kira and having a website where you could type in your child’s age, their mental health needs, your family income, your insurance, etc. and receive a list of organizations that currently offer services that meet your specific needs and eligibility), or some other solution (Have an example or ideas? Email me!)

What people often need is one right door - someone or something to help them navigate through all that's available to find the right fit for them.

This is true for mental health support, for childcare, for any number of other needs people are seeking services for.

As anyone who’s ever been handed a laundry list of resources can vouch for, sometimes too many doors can actually leave us feeling lost. If we can shift more systems to create one right door, maybe we can connect far more people with the services and supports they need - not just in theory, but in reality.

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Just do it. Then iterate.

Whatever idea you’ve been mulling over, considering, planning for…just do it.

Now, I know it’s not that simple (in most cases).

Maybe you can’t "just do it” because you don’t have the authority. Or because you need to assess the potential consequences. Or any one of a dozen other perfectly valid reasons.

But there are also many cases when we could "just do it" and we let something stop us. Sometimes it's perfectionism. Sometimes it's fear.

Whatever the reason, it's getting in the way of the magic of just doing it, and then iterating.

As an engineering major in college, I was trained to "fail fast". Now, I don't love thinking about it as failure per se, but it's true that the first attempt is rarely going to be a home run. So just do it. Get it out of the way. Learn as much as you can from the experience and then revise, making it better each time.

Last year, as part of a volunteer team under the umbrella of the Partnership for a Healthier Fairfax, I helped organize the very first Healthy Together Fairfax, a fun, free, interactive community event focused on healthy and active living, with hands-on activities, fitness classes, access to community services and resources, etc.

The event was set to take place at an amazing county park that has a beautiful trail walk, amphitheater, treehouse, playground, carousel, and tons of green space. My co-volunteer who is a whiz at these things put together a thoughtful, color-coded layout for how all our exhibitors would be spread out throughout the park, organized into groups based on the health topics they addressed.

Then Hurricane Ian brought a storm our way and we had to move everything indoors. We were locked out of the iPads we planned to use for exit surveys. Someone whose proposal to participate we had not accepted showed up to exhibit anyway. The list goes on.

But you know what? Despite it all, we had a WONDERFUL event - exhibitors and community members were engaged and learning from one another, we had a number of local agency heads and policymakers come read children’s story books focused on social and emotional health, we had a steady stream of fitness classes and other interactive, community health-focused activities, and everyone - organizers, exhibitors, and attendees alike - expressed excitement about doing it again next year.

But that's not all. We recently held a community meeting to plan for this year's event and we had so many people show up with so many great ideas. When we tried to do something similar last year, we had almost no one show up.

What changed? We've done it once! That means…

• We got a broader coalition on board through partners that participated in the event last year.

• People saw it in action and understood our vision, so they got more excited about it themselves and shared it with others.

• We got some systems and templates built out, meaning we could start our planning earlier and stronger this year, all while putting in fewer hours.

• We learned from last year - this year, we have a rain date set that we’re publicizing from the start, we’ve moved our timeline up so we’ll have exhibitors identified early enough to be actively included in event promotion efforts, we’ll set the exit survey ipads up differently, and so on and so forth.

So my point is - if you can, just do it. Don’t worry about getting it all right or what might go wrong - you won't get everything right, things will go wrong, AND it will still be wonderful (or at the very least, you’ll get your “first pancake” out of the way - as a firstborn child, I feel like I get a pass to share this meme). Most importantly, you’ll learn from it, and be able to do something even better in the next iteration.
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What have you been thinking about or planning for that you're feeling ready to just do? Or, if something's stopping you, what is it? Let me know!

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A fish, an elephant, and an iceberg: Orienting community towards root causes and systems

When a community is trying to address a public health problem, the immediate causes are often the most apparent.

Too many youth aren't physically active. Why? They don't understand the value of physical activity or the consequences of not being active. What should we do? An education and mass communication campaign to help them understand this value and these consequences, so that they are motivated to be more active.

Not only are immediate causes often the most apparent, the solutions required to address them are often (relatively) non-controversial and don't require the upheaval of established systems.

But to truly transform health in communities, we need to move beyond the immediate. We need to 1) drill down to root causes and 2) fly up for a systems wide view.

On the first point -

WHY are too many youth not physically active? Do they have safe spaces to run and play in their neighborhood, and do their schedules allow them to do so? Are the costs of joining recreational sports leagues prohibitive? Are the apps on their phones designed to be addictive, so they have less time for everything else?

To get community members thinking about root causes, one exercise I have found quite helpful is a fishbone diagram (where you start with the problem, which is the "head" of the fish, and then brainstorm multiple causes, as well as causes of causes). This diagramming is often paired with the "5 whys" facilitation strategy (where you keep asking "why" five times to drill down to deeper root causes). The idea here is that this process can help identify countermeasures (things that prevent root causes) instead of merely solutions (things that might just put a bandaid on the problem by treating a symptom instead of a root cause).

On the second point -

HOW might systems be transformed to encourage more physical activity among youth?

First, we need to be able to take a step back and see the system as a whole. I find the elephant analogy an incredibly helpful way to remind ourselves and our communities to do this. It’s an ancient parable you may have heard before about blind/blindfolded individuals encountering an elephant for the first time. Each person feels only one part of the elephant and comes to a conclusion about what they are encountering based on that. It leads to a lot of misconceptions and no single person who has the full and accurate picture.

To take community thinking a step further, from recognizing there is a broader system to understanding how we can improve that system, I love using the iceberg model of systems thinking. It's a great way to reminder ourselves that what we can see of a problem is usually only the tip of the iceberg. "We know that an iceberg has only 10 percent of its total mass above the water while 90 percent is underwater. But that 90 percent is what the ocean currents act on, and what creates the iceberg’s behavior at its tip." Most public health issues are like this as well! I especially appreciate the way this model helps community members walk through the process of identifying trends, underlying structures, and ultimately mental models.

I've often had clients point to a fairly surface-level approach or solution and say, "This is what our community said they want to see." This may be true, and I'm 100% on board with community-driven approaches. However, we also need to ask ourselves if we've walked ourselves and our communities through the kind of tools above to make sure that the solutions we're brainstorming are oriented towards root causes and systems.

Have you had success with setting the stage to approach problems in a way that is focused on root causes or systems? Or have you tried using any of the tools mentioned above? Please share your experience with me!

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Too many partners, too little time, one nifty tool

Public health problems live at the intersection of many different sectors and issues.

You can’t help kids in schools do and feel better without also making sure their teachers are well, that school policies don’t kick them out of class, that their communities are safe, and so on.

So any community health improvement effort worth its salt is going to involve multiple components led by multiple partners.

But it can be really hard for those involved in a joint effort to truly understand the work of other partners. Heck, as anyone who has worked at a large corporation or agency can attest to, it's really hard to understand the work of different departments and teams within the same organization, let alone partner organizations!

Yes, we have logic models and summary descriptions and annual reports, but we often don't have the time to read those things and even when we do, they often fail to give us a true understanding of how the work looks, sounds, and feels on the ground where it's happening.
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We were grappling with just this problem as part of a multi-partner effort to help kids in DC schools thrive. We were bringing various partners together for an in-person convening and many of them had expressed a desire to know more about the activities others were leading. How could we create the space for this without taking up the entire day and while keeping things engaging and interesting?
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One of my colleagues on the project suggested using the Ignite Talks format - “20 slides, 15 seconds a slide, 5 minutes on stage, just you and the audience”. The emphasis in this format is on highly visual slides with interesting imagery. It’s similar to the PechaKucha format, which originated in Japan, and involves 20 slides, each for 20 seconds.

We were a little worried about asking our partners to put together a new presentation just for this convening, but decided it was worth the risk.

And it definitely was! We used these talks to open our convening and it was lively, engaging, interesting, and everyone learned a lot about the different elements of this joint effort we were engaging in.

• By emphasizing visuals, we got to see what the work looked like in action.

• By forcing everyone into a new presentation format, we escaped the boilerplate slides and explanations we otherwise would have gotten.

• Perhaps most surprisingly, by providing a tiny bit of extra structure (“20 slides, 15 seconds each” - instead of just saying “no more than 5 minutes, please”), we actually had everyone stay within the time limit - every single person. (Who else has tried the “no more than X minutes, please” route before, only to find that no one listened to you? Turns out, a little extra structure is the answer!)

All in all, it was a wonderful experience, and one I’ll be looking for opportunities to replicate in other settings and with other groups! I think it’s a great tool for community coalitions and collaboratives to have in their pocket - if you use it, please share how it goes, and if you have questions about how we used it, please reach out.

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