10-Year Evaluation of Connecticut Health Foundation's Leadership Program
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The evaluation of the Connecticut Health Foundation's Health Leadership Fellows Program, stemming from class years 2006 to 2015, assesses the program's impact on leadership and health equity. Key findings show that 70% of fellows are people of color, with the program meeting its goals for skill development and inclusion but lacking significant success in achieving large-scale system or policy changes. Recommendations include strengthening the program's structure and increasing engagement within the fellows network to enhance its effectiveness in promoting health equity.
10-Year Evaluation of Connecticut Health Foundation's Leadership Program
- 1. Evaluation of the Health Leadership Fellows Program Class Years 2006 through 2015 Connecticut Health Foundation Health Leadership Fellows Program Fellows Network July 16, 2015 1
- 2. Evaluation QuestionsResearch Design Purpose Understand the difference made by the Health Leadership Fellows Program Collect and develop feedback from comparable programs, Fellows, CT Health staff, and HLFP faculty 2
- 3. Evaluation QuestionsResearch Design Report Data Sources CT Health Staff and HLFP Faculty: the perspectives and feedback of at least six Foundation staff and HLFP Faculty HLFP Alumni Fellows: perspectives and feedback of 135 Fellows (70% of all Fellows) from interview and survey data External Experts on Health and Health Equity in CT: the perspectives of five external experts Comparative Leadership Program Data: data from 13 comparable leadership programs 3
- 4. Evaluation QuestionsResearch Design Triangulation & Mixed Methods Document review Surveys Interviews CT Health Staff & HLFP Faculty Fellows External experts Triangulation Mixed methods 4
- 5. Evaluation QuestionsAbout HLFP & Fellows About the Program • The Health Leadership Fellows Program (HLFP) was founded in 2005 • 10 class years (2006 to 2015) have graduated from the program to become Fellows • The ten-month HLFP curriculum covers both leadership development and health equity • Upon graduation, participants become Fellows and join the Fellows Network 5
- 6. Evaluation QuestionsAbout HLFP & Fellows About Fellows 42% 27% 18% 8% 1% 4% 70% of Fellows are People of Color (n = 194, CT Health Database) African-American White Hispanic Asian Other/Unknown Native American 93% live in CT 86%contribute to health equity 42% 24% 10% 9% 14% Two-thirds of Fellows Reside in Hartford and New Haven (n = 194, CT Health Database) Hartford New Haven Unknown Fairfield CountyEastern Connecticut 6
- 7. Evaluation QuestionsHealth Equity, defined by Fellows 7
- 8. Evaluation QuestionsFindings CT Health Goals for HLFP 1 Develop the knowledge and skills of individuals in the areas of health equity and leadership, and for individuals to apply these assets to their professional development. 2 Increase the number of people of color who are at the table when decisions or policies are made that impact health. (The decisions/policies may be broader than health—e.g., housing—but in some way impact health.) 3 Provide Fellows with the knowledge and skills to change systems and policies through Fellows’ primary place of employment, other professional roles, and/or volunteer activities. 8
- 9. Evaluation QuestionsFindings Goal 1: Knowledge and skills • This goal has been met. • The Program has developed Fellows’ knowledge and skills in the areas of health equity and leadership 79% of Fellows Report that HLFP Made a Strong or Very Strong Contribution to Their Leadership (n = 37, Fellows Interviews) 3% 3% 16% 30% 49%Very strong contribution No contribution Little contribution Some contribution Strong contribution 9
- 10. Evaluation QuestionsFindings Goal 1: Knowledge and skills • The vast majority of Fellows are applying these assets to their professional development 10 Most Fellows (89%) Work on Health Equity through a Professional Role (n = 109, Fellows Survey) Professional role Other Personal life Volunteer role 3% 37% 45% 89%
- 11. Evaluation QuestionsFindings Goal 1: Knowledge and skills • What does it look like for Fellows to work on health equity? 11 Health Equity Teaching and training about health equity Improving health literacy in underserved communities Promoting access to health services in underserved communities Advocacy, policy, and systems change Improving direct services Health insurance Health research
- 12. Evaluation QuestionsFindings Goal 2: People of color are at the table • This goal has been met. • 70 percent of all Fellows are people of color • 82 percent of Fellows of color report contributing to improving health equity in Connecticut • Professional, personal, and volunteer activity of Fellows of Color 12 Universities & research institutions (4) Community health centers (8) Nonprofits (6) Workgroups & committees (5) Public health departments (4) Fellows’ activities drawn from interview data and are illustrative, not representative, of all Fellows’ activities.
- 13. Evaluation QuestionsFindings Goal 2: People of color are at the table • CT Health connects Fellows to projects and professional opportunities • CT Health connected Fellows to the State Innovation Model (SIM) Initiative and now at least three Fellows sit on the State Innovation Model Consumer Advisory Board or workgroups • Through the Program and CT Health, several Fellows mentioned working with or volunteering with the CT Multicultural Health Partnership and/or Health Justice CT • More recently, some Fellows noted being involved in the outreach and the roll-out of the open enrollment process for health insurance through Access Health CT 13
- 14. Evaluation QuestionsFindings Goal 3: Systems and policy change • This goal has not been met. • There are a few promising but early results, but there has not been a big, noticeable win with a major system or policy that improves health equity at scale. • Advocacy, policy, and systems change was discussed by Fellows who were interviewed, but was significantly less prevalent than other types of work in support of health equity. 14
- 15. Evaluation QuestionsFindings Goal 3: Systems and policy change Examples of Fellows’ efforts in this area: • Removing barriers to healthcare services or health care information for underserved populations, including language barriers and housing; • Influencing health insurance policies to provide expanded or improved coverage, for example, to HIV+ individuals and other underserved populations; • Engaging in legislative advocacy on public health topics, in support of aging populations to be able to age in place, and for health equity in business practices; and • Advocating for healthcare reform 15
- 16. Evaluation QuestionsFindings Program/Network Design & Strategy • The Program and Network is in need of additional design and strategy to match its current maturity and future ambitions. • CT Health has already started down this path, but more infrastructure and purposeful cultivation is necessary now that the Strategy has matured from an experiment to a core Foundation investment and a Network of nearly 200 health equity leaders. • There are five areas that the Foundation (and Fellows) could strengthen so that the Network can better impact health equity: 1)Shared vision for health equity impact 2) Communication, 3) Ongoing professional development and capacity building, 4) Structure of Fellows Network, and 5) Fellows tracking. 16
- 17. Evaluation QuestionsFindings Strategic Alignment • The Health Leadership Fellows Program is most robust as the incubator program—not a Fellows Network—though the longer- term ambitions of the Fellows Network yield more promise to Fellows and CT Health. • The Fellows Network has not been effectively engaged to have long-term impact. • The Fellows Network and the Foundation’s hopes for the Network have grown organically over the years, and expectations for the Network are much higher now than ten years ago. 17
- 18. Evaluation QuestionsFindings Program Reputation and Visibility • The Program is regarded well by those who know of it—but the reputation and visibility of the Program could be improved within Connecticut. • There are still many people in important health-focused positions and related fields that do not know about the Program, understand the importance of being a Fellow, or know to draw on the Program or Fellows as resources. • The visibility of the Program is strongest in the Hartford and New Haven areas. • The reputation of the Fellowship is tied to the positive, visible reputation of the Foundation. The stand-alone reputation of the Fellowship is less well known than CT Health. 18
- 19. Evaluation QuestionsRecommendations 1. Clarify the contribution of the Program to the Foundation’s strategic plan 19 2. Strengthen the “incubator” program 3. Strategize on how to increase active engagement from Fellows Network.
- 20. 1. Assess the Situation: The evaluation report will deliver the necessary information to assess the outcome and functioning of HFLP and the Fellows Network. 2. Identify Range of Options: The recommendations from the report and recommendations from CT Health staff will present CT Health with a range of options. 3. Refine & Select Top Options: CT Health staff will refine the list of recommendations to select those that will best contribute to a strengthened Health Leadership Fellows Program to align with the Foundation’s priorities. 4. Plan & Implement: CT Health staff will plan and implement new designs and strategies into the Health Leadership Fellows Program. Next Steps 20
- 21. Evaluation of the Health Leadership Fellows Program Class Years 2006 through 2015 Connecticut Health Foundation Health Leadership Fellows Program Fellows Network July 16, 2015 21
Editor's Notes
- #3: The purpose of this evaluation project was to evaluate the first ten years of CT Health’s Health Leadership Fellows Program so that CT Health can develop a program that will continue to further the Foundation’s mission in the current transformative health reform environment. The evaluation focused on documenting the changes that CT Health and the Health Leadership Fellows Program (HLFP) brought about in the past ten years, and collecting feedback from a variety of sources to serve as a starting point for CT Health to work from as they lead a process to further develop the program.
- #4: Additionally: Innovation Network’s past knowledge: we have been the evaluation partner to CT Health generally for the last few years, as well as we have evaluated the last few HLFP classes (midterm and end-of-term) We reviewed the 5 year evaluation of the Health Leadership Fellows Program Program documentation, e.g., curriculum plans We drew on the CT Health database as possible
- #8: ***Consider if we should delete this slide?*** YCD & TD suggest deleting but leave it up to us [word cloud of the HE definitions given by Fellows in interviews] The definition of health equity that most Fellows were using was along the lines of “Health equity is having equal access to fair and affordable health care services across different populations, and ensuring all people, regardless of their social, ethnic, racial or economic background, have fair health outcomes. “ When fellows mentioned “equal access to health care services”, they referred to not just primary care or physician services, but also equal access to mental health care services, behavioral health care services, and social services. That no matter what type of health services it is, there should be a fair and equal access to it by everyone. Fellows placed a heavy racial and economic justice lens to their definitions of health equity. And a great quote from a Fellow: “Health equity is the ability to enjoy the best health opportunities for themselves in terms of outcomes, treatment, access that they can possibly have. That will be equal across socio, economic, racial, and educational lines.”
- #9: Third goal added later
- #12: [present content on slide, and:] In addition to these specific actions, Fellows also discussed a more general orientation to incorporating a health equity lens into how they see the world, their professions, and conversations they engage in professionally and personally. More than one Fellow expressed that health equity was not in their formal job description or role, but that he/she is able to be a “friendly reminder” or raise questions to address health equity in meetings or decisions. Through the Program, CT Health has supported the development of 194 individuals—most of whom live and work in Connecticut—to have the language and concepts to advance health equity in small but powerful ways on a daily basis.
- #13: Fellows of color have demonstrated a wide variety of professional, personal, and volunteer activity in support of health equity. From interview data, 22 Fellows of color were identified as holding 40 professional, personal, and/or volunteer roles that in some way can be leveraged to impact health equity across 11 types of organizations. Fellows of color were also working with Coverage providers, Hospitals, Philanthropy, Other service providers, and Community based organizations
- #17: 1. Communication: There is a need for more frequent communication among the Foundation and the Fellows generally about health equity information and opportunities in the field. 2. Ongoing professional development and capacity building: Fellows would be better positioned to be allies in the fight for systems change if they continue to grow as leaders and develop their skills after the incubator program. 3. Shared vision for health equity impact: It’s clear that the Foundation and Fellows share the same long-term vision for health equity in Connecticut, but the Foundation and the Fellows actions could be better aligned if there was a purposeful conversation between the Foundation and Fellows regarding roles, opportunities, and intended impacts. 4. Structure of Fellows Network: The Fellows Network has grown organically over the past ten years and has reached a size where Fellows would benefit from more structure and organization among themselves for improved communication and an increased ability to be coordinated in their actions. 5. Fellows tracking: The Foundation would benefit from a fully fleshed out database of Fellows, their interests, their professional roles, and their health-equity related skills and competencies.