Community of Solutions Framework

The Community of Solutions Framework, developed by the Institution for Healthcare Improvement, is a model of community change and transformation in communities at all stages of readiness. Community of Solutions represents a dynamic approach, not a static designation; it requires that communities continue to practice these skills and behaviors and make structural changes over time.

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Community of Solutions Skills are a set of interconnected skills in five domains: Leading from Within, Leading Together, Leading for Outcomes, Leading for Equity, and Leading for Sustainability.

Leading from Within (LW) skills involve one’s inner journey as a leader, including the ability to:

  • Know oneself and what brings one to leadership
  • Reflect, “fail forward,” and change as needed
  • See and commit oneself to unlocking the leadership of others, especially those with lived
    experience of inequity
  • Approach change from a place of abundance, even in the midst of scarcity
  • Value difference – Habits of the Heart: (Palmer P. , 2000)
    • An understanding that we’re all in this together
    • An appreciation of the value of difference
    • An ability to hold tension in life-giving ways
    • A sense of personal voice and agency
    • A capacity to create community

Leading Together (LT) skills are grounded in a perception of the community as a dynamic
network of interacting people, organizations, structures, and systems that are related to a place. It
is necessary to lead together with others in a community to create effective, equitable change.
Elements of Leading Together skills include:

  • Developing trust, relationships, and interconnectedness
  • Effective teamwork
  • Collaboration:
    • Creating a safe space for collaboration
    • Asking open, honest questions
    • Ability to have difficult conversations
    • Facilitation skills
    • Boundary-spanning leadership skills
  • Cultivating the leadership of others, including those with lived experience of inequity
    • Community organizing
    • Integrating people with lived experience in your work
  • Growing abundance through collaboration
    •  Power and stakeholder mapping

Leading for Outcomes (LO) skills support communities in applying design skills to co-create a
theory of change, identify measures, test the theory, and plan for implementation and scaling up
in a way that makes these tasks easier.

  • Innovation/Design Thinking – Using stories and experience to understand the experience of people affected by a change
  • Improvement science – Developing aims, drivers, and measures, and running tests of changes
  • Implementation skills – Making implementation easier, more effective, and more joyful

Leading for Equity (LE) skills apply Leading from Within, Leading Together, and Leading for Outcomes skills to address equity at a population and structural level. A longer description of the 100MLives approach to equity is detailed elsewhere. The work on equity is everyone’s responsibility and helps people, organizations and communities apply the prior three Community of Solutions set of skills through an equity lens:

  • Leading from Within – Understanding implicit bias, understanding power and privilege; applying Habits of the Heart; understanding core concepts of power, privilege, structure, and history
  • Leading Together – Recognizing interconnectedness; everyone leading and owning the
    process of creating equity; fostering ownership and solutions by people with lived experience;
    mapping assets to potential levers
  • Leading for Outcomes – Using data to identify those who may not be thriving; using stories to map systems that perpetuate inequity; identifying potentially replicable bright spots; testing policy and programmatic changes that have the potential to disrupt systems perpetuating inequity

Leading for Sustainability (LS) skills facilitate an ongoing process of transformation in a
community (generative sustainability) as opposed to maintaining programs as they are. Four key
elements of sustainability are:

  • Environmental sustainability – Stability of the physical, political, and cultural environment
  • Resource sustainability – Availability of intrinsic (will for change, relationships) and extrinsic (financial, in-kind) resources needed to maintain, spread, and scale changes
  • People sustainability – Cultivation of change leaders in a community
  • Change sustainability – Growth and sustainability of the change process.

When a community builds these skills and begins to apply them to the change process, they begin to
embrace a set of behaviors, systems, and processes (Community of Solutions Behaviors) that, over time, lead to sustainable transformation and improved health, well-being, and equity. A tripod leadership/improvement team (made up of groups of formal/institutional leaders, community connectors, and community residents affected by inequity) begins to emerge. Change becomes dynamic, situated at kitchen tables as well as coalition tables, with more freedom for community members to rapidly improve and clearer roles for formal leaders to ensure that resources and structures support transformation. An engine for social change develops that powers the leadership of hundreds of people. Improvements tested at the local level can be spread and scaled up because there is growing trust and an atmosphere of teamwork. The community is able to use its assets in traditional and nontraditional ways to effect transformation in policy, systems, and structural and environmental change over time to address the root causes of poor health and inequity.

These behaviors consist of three interacting elements cross-walked with the Community of Solutions Skills:
1) How people relate to themselves, each other, and those most affected by inequity
2) How the community creates abundance
3) How the community approaches the change process



Stout S. Overview of SCALE and a Community of Solutions. SCALE 1.0 Synthesis Reports. Cambridge, Massachusetts: Institute for Healthcare Improvement, 2017