On January 1, 2015, recently reelected Michigan Governor Rick Snyder ascended the steps of the state capitol, took the oath of office, and delivered an inaugural address with a stirring vision. More concretely, he argued that the state needed to reorient its approach to social services. “We’ve tried to solve problems by creating new programs, segmenting programs, and adding layers of government,” he explained. “Each program focuses on a finite segment of someone’s life without looking at the whole person and understanding what’s holding them back from success.”

In 2007, the board of directors at Four Oaks—a non-profit child welfare, juvenile justice, and behavioral health agency in Iowa—was excited and concerned. Founded in 1973 to serve ten children in Cedar Rapids, a city in eastern Iowa, the agency was enjoying a decade in which its budget nearly doubled, and it was serving almost 14,000 clients in more than a dozen cities across the state. Nevertheless, the board was troubled by something more foundational: it had no way of knowing whether the organization was fulfilling its mission of “assur[ing] that children become successful adults.”

In 2011, Finland’s healthcare and social services leaders faced an extremely challenging set of circumstances.  To begin with, there were a number of troubling trends—including the aging of the Finnish population and an increase in the prevalence of chronic diseases—that portended a surge in demand for their services. At the same time, providers were dealing with increasingly complex cases—a difficulty that stemmed from the numerous clients and patients who had multiple conditions and were oscillating between the health and social services systems. 

As we move deeper into a digital world, health and human services leaders have more and more data at their fingertips. When this data can be shared across agencies in real-time and is structured in a user-friendly, objective, and informative way, it can play a critical role in seeding breakthrough innovations. In particular, health and human services leaders can identify new opportunities to improve the client experience, reduce costs, enable population health management, enhance care, provide greater equity, and focus on interventions for clients who touch multiple health and human services systems. 

In late 2015, four leaders—William Hazel, the Secretary of Health and Human Resources for the Commonwealth of Virginia; Dr. Craig Ramey, a professor at Virginia Tech; and Accenture’s Howard Hendrick and Gary Glickman—began dissecting a simple but critical question. “What,” Glickman recalled, “are we trying to do for kids?”

In 2011, officials from the State of Ohio performed a cost-benefit analysis of the state’s spending on health and human services, and the results were alarming. On the one hand, per capita healthcare spending in Ohio was higher than all but 17 other states. On the other hand, Ohio had one of the least healthy workforces in the country. As dismaying as this situation was, newly-elected Governor John Kasich also realized that the state’s limited return on its health and human services investment created a powerful case for change. 

In fall 2014, Mark Stutrud was fishing for salmon in Michigan’s Pere Marquette River when a colleague introduced an intriguing but fraught proposition: interviewing to become the CEO of Lutheran Social Services of Illinois (LSSI), the largest statewide social service agency in the state. As Stutrud cast his line, he considered the challenges: low morale, a looming state fiscal crisis that could imperil LSSI’s funding, and a litigious environment that had led to 80 consent decrees. “My first question,” recalled Stutrud, then the President and CEO of Lutheran Social Services of Michigan, “was, ‘Why, God, would you ever call me to this situation?’” 

In 2008, Walt Ekard, the Chief Administrative Officer for San Diego County, asked Nick Macchione, the newly-promoted director of the county’s Health and Human Services Agency, to address a complex and significant question: “How do we help San Diego become a healthier region for the entire county, representing more than three million residents?”  Macchione responded by engaging his staff and an array of county, city, and community partners to develop a health strategy, which elected officials used as a launching point for what would become Live Well San Diego, a multi-pronged “vision for a region that is building better health, living safely, and thriving.”  To achieve these goals, the county team planned to employ a variety of core strategies, including strengthening the service delivery system, effecting policy and environmental change, supporting positive choices, and improving the culture from within one’s organization. They also identified areas of influence (e.g., health and knowledge) to be measured by a set of key indicators. Above all, the fate of this initiative would hinge on the ability of the county team to establish trust and build an ecosystem that spanned organizational and jurisdictional boundaries, moving beyond politics. Macchione emphasized, “It’s about relationships. It’s about beliefs. It’s about integrity. It’s about legitimacy. It’s all about improving lives.”

In 2015, 1,307 people died from opioid overdoses in Kentucky, resulting in Kentucky having the third-highest overdose mortality rate in the country. What’s more, of the approximately 50,000 babies delivered in Kentucky that year, more than 1,000 had Neonatal Abstinence Syndrome. ,   As Kentucky Governor Matt Bevin said, “We don’t have the luxury of pretending there isn’t a problem. Every life is worth saving. There is not a person we would not want to see redeemed and removed from this addiction, and it is up to all of us to work together and find solutions.”  

In the late 2000s, Henry “Hank” P. Stawinski III, then a senior official in the Prince George’s County (MD) Police Department, identified a troubling trend. Before the start of the millennium, his jurisdiction had had consistently high crime, most notably an average of 126 homicides per year. This was disturbing in part because it signaled to residents and visitors that they were often in danger (as a local radio station reported, the county’s homicide rate “dwarfed its suburban neighbors.”)  In addition, the dangerous durability of violent crime indicated that the county—which, as Stawinski noted, was spending significant sums on law enforcement—was not getting an appropriate return on its investment. “We were renting public safety,” argued Stawinski, who in 2016 became the Chief of the Prince George’s County Police Department. “I refer to it as renting public safety because we accrued no public safety equity. We were spending dollars, and we never saw any lasting return on that investment.”