Elevating Best Practices and Building Evidence

The Nicholson Foundation worked to advance meaningful change in New Jersey’s safety net service systems. Its journey is described in Changing Systems, Changing Lives: Reflecting on 20 Years.

We knew that our grantmaking had to be grounded in evidence and needed to take advantage of the best practice models that research, advocacy, and policy organizations all over the country were developing and promoting. We actively sought out these models to inform our work.

Beginning in 2010, The Foundation substantially increased its investments in health, principally to strengthen the primary care component of the “safety net” healthcare system. Using models from outside as well as within New Jersey allowed us to benefit from a broad array of experience. It also gave our grantees an opportunity to import inspiration from elsewhere. Importantly, such replications provided proof-of-concept evidence for New Jersey, which was helpful in convincing payers to support the new efforts—ultimately facilitating systems change.

Government action also can create a context where opportunities for investment can emerge and all can join in to ride a wave of change. Our work with government was integrally linked to partnerships we formed with nonprofits and ultimately, with other foundations. In some cases, government agencies assumed responsibility for projects when Foundation support ended.

Our experiences in elevating best practices and building evidence generated a few key takeaways that might be useful to others who are engaged in similar work:

• Adopt and adapt. Find what works elsewhere and identify ways to use it or adapt it to specific contexts and circumstances. This is a smart way to facilitate improved, sustainable services and build evidence.
• Be willing to commit to providing resources over a long period. Patience is necessary to ensure that the right people, opportunity, mechanism, and other elements come together to make a project succeed. It also helps in dealing with the inevitable bumps in the road along the way.
• Make sure that potential partners understand that the science behind an initiative is what makes it a priority. Recognition by the partners that the project is a way to disseminate best practices and build evidence is important to generating enthusiasm and commitment by all.
• Capitalize on experiences grantees gain from funded projects. Help them spread their good ideas and new expertise to other local organizations. This approach to building home-grown capacity can accelerate the dissemination of best practices and ensure durable systems change.
• Understand that changing organizational culture takes time. It can be done only with engaged leaders and champions who are invested in building a team that is committed to the initiative for the long haul.
• Recognize that people who are closest to a problem often have the best ideas on how to address it. Partnering with local groups, such as community-based health organizations, can help them highlight the role that health related social needs play in health and other outcomes. These partnerships also can help them accelerate efforts to reduce inequities in care and services.
• Remember that evidence evolves over time. Research may bring unexpected results—positive or negative. Be open and transparent about the results and their impact. Remember that the goal is not to enact a specific model, but to find out what really works to improve the lives of those you seek to help.

Learn More

• Read the other blogs in this Key Takeaways series:
  — Engaging with Government for Systems Change
  — Finding and Nurturing Effective Partnerships
  — Investing in Organizational Nuts and Bolts
  — Tackling Complex Problems with Multiple and Complementary Solutions
  — Developing Future Leaders
• Read “A Framework for Creating Systems Change,” a paper by Drs. William Brown and Wynn Rosser. The paper presents a model for systems change that adapts and expands the Foundation’s approach, making it easily accessible to a broad audience and grounding it in the growing literature in this area. [Brown W, Rosser W. A Framework for Creating Systems Change. The Foundation Review, 2023;15(4):50-6.
• Receive or download a free copy of Changing Systems, Changing Lives: Reflecting on 20 Years. This book describes the 20-year journey of The Nicholson Foundation. Chapter 3 illustrates what’s possible by elevating best practices and building evidence. It describes how the Foundation:
  — Funded a multi-component initiative to integrate behavioral health into primary care for adults as well as children and to change the regulatory and licensing environment to make this service integration possible.
  — Supported Project ECHO, a national tele-mentoring model that connects primary care providers with specialists, as a strategy for improving care for complex health conditions.