The California Improvement Network (CIN), a project of the California Health Care Foundation that is managed by Healthforce Center at UCSF, is a community of health care professionals that has been striving since 2005 to identify and spread ideas to improve health care delivery in California. CIN’s most recent cycle — the last two and a half years — was especially challenging due to the pandemic. Despite making its activities entirely virtual, CIN sustained and strengthened relationships across health care silos and inspired actions to improve care in California.

CIN’s collective efforts resulted in several outstanding resources and built connections across sectors, developed leading edge ideas and practices, and put these ideas into action to improve care. CIN programming is developed collaboratively by active representatives from 20 CIN partner organizations, and could not have been possible without the devotion of time and energy by many folks at these organizations.

Feedback for the California Improvement Network is consistently positive and enthusiastic. Said one partner, “There are too many things to stay abreast of, so I look to CIN as a trusted source for what is important. I trust that what I get from CIN I can then distill and bring to my members. There’s a million places saying this is a best practice, but I think CIN, because it’s unique to California, because it knows the safety net, it really is tailored for the needs that we have.”

In addition to supporting broad efforts across the network, CIN helped individual partner organizations to:

• Introduce equity-specific goals into organizational program goals.
• Add a staff role dedicated to equity.
• Start a diversity, equity, and including (DEI) committee across departments.
• Review internal operations through an equity lens, such as hiring practices.
• Create a train-the-trainer program for collaboration and leading change in virtual environments.

Key Offerings from CIN’s Recent Cycle

The focus areas that the network had determined in advance of 2020 retained tremendous relevance during the pandemic twists and turns. CIN assembled a collection of online resources for three priority areas with these goals:

1. Resilient Leadership: To establish and maintain a network of strong, resilient health care leaders and organizations able to drive continuous improvement efforts, including building anti-racist organizations and cultivating a culture of wellness.
2. Addressing Social Needs that Impact Health: To understand, create, and implement effective methods for addressing all factors that influence health and wellbeing, including intentionally advancing equity into social needs efforts, and aligning with CBOs to address social needs, and aligning social needs work with CalAIM.
3. Providing Care Differently: To improve care outcomes, increase access and reduce costs by considering and expanding the modes, methods, sites, and the roles in care delivery, including managing rapid change and leveraging technology.

Within the above framework, CIN hosted an amazing 20 webinars, workshops, partner meetings, and discussion forums on subjects including reducing health care worker burnout, dismantling racism, preparing for Medi-Cal changes and CalAIM, and leading with empathy.

In all, these events featured 52 leaders, faculty, subject matter experts, and consultants hand-picked from across nation, including posts at the White House, New York City, states such as Oregon and North Carolina, and all types of organization throughout California. Most event recordings are available for replaying.

Partners Gathered to Dive Deep into Salient Concerns

The cornerstone of CIN programming is partner meetings, which are one- or two-day events that are codesigned for the common needs of commercial and safety-net providers, quality improvement organizations, and health plan communities. These hot-topic discussions are later distilled into publications to disseminate the key takeaways:

• CIN Connections, Spring 2020 — Foundations for Health: Provides tips on how to be a resilient leader and make strategic decisions around social needs interventions, as well as lessons on building partnerships across the health care landscape.
• CIN Connections, Fall 2020 — Emerging Innovations: Health Care During a Pandemic: Features Dr. Mitch Katz on adapting the delivery model of a large public health care system and lessons learned in the surge of the pandemic in New York City.
• CIN Connections, Spring 2021 — Addressing Racism to Improve Health: Contains strategies for how to abolish racism to improve health and remove roadblocks to real health equity.
• CIN Connections, Summer 2021 — Caring and Sharing: Supporting the Primary Care Workforce: Discusses strategies for managing increased levels of burnout, trauma, and moral injury among the primary care workforce because of the pandemic.
• CIN Connections, Winter 2022 — Centering Equity in Health Care Improvement: Offers tools for quality improvement efforts to identify health disparities and advance health equity in primary care.

CIN Pivoted to Focus More Closely on Racial Health Equity

As the pandemic progressed, greater focus was given to the shocking racial health inequities witnessed in the headlines, in the data of cases and deaths, and in communities. The story of Dr. Susan Moore was especially poignant, as the physician died of COVID-19 after repeatedly voicing that she was receiving substandard care as a Black woman.

CIN partners jump started a Racial Health Equity Workgroup. The group’s centerpiece was the development of A Toolkit to Advance Racial Health Equity in Primary Care Improvement. Just released in April, this practical toolkit is designed to help health care organizations — including those that provide, pay for, or support primary care — to increase the primary care improvement efforts that center racial equity.

“We plan to apply this toolkit to a cancer screening project. Our organization really needed a tool to help guide us in making our programs more equitable and anti-racist,” shared a CIN partner.

CIN’s most recent technical assistance offering was a 2.5-hour workshop on dismantling racism with Dr. Camara Phyllis Jones. Over 125 people gathered to learn how naming racism is an essential tool for moving to action to advance racial health equity.

What’s Next: Partnering with Community-Based Organizations on Social Needs

CIN remains a unique network in California due, in large part, to the diversity of perspectives that are brought together along with the fact that it addresses relevant and complex topics. Collectively, partner organizations serve more than 25 million patients across the state — more than half the population of California.

The California Health Care Foundation (CHCF), CIN’s funder, continues to prioritize building leadership capacity in health care organization through programs like CIN, and is working closely with the CIN program office at Healthforce Center to evolve the network. The next funding cycle of the California Improvement Network will be remarkable: CIN will welcome community-based organizations as partners in improvement.

Look for details in July and August to learn more about the next iteration of CIN and how you can participate. Thank you for considering getting involved and sharing CIN outreach with your networks so that CIN can do more to improve the health of our communities! Meanwhile, be sure to leverage the resources available now through the links above.

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