Systems change occurs when the “underlying structures and supporting mechanisms that operate within a system are altered, such as the policies, routines, relationships, resources, power structures, and values.”⁴⁹

“Aligning across sectors emphasizes coordination that extends beyond working together on a single project. Aligned systems require that sectors think and work together in fundamentally new ways to improve the health and well-being of the people and communities they serve in ways that are built to last.”⁵⁰

“If you get the partners in a room, somebody talks about what they’re doing or what they need, and some other partner jumps in. I think that’s cross sector alignment…a lot of the cross-sector alignment follows from being in the right rooms. So if you’ve got a county project supporting their homeless housing initiative, and the county thinks you’re doing okay, and they invite you to participate in a broad initiative to have around child welfare. You now have that intersectional position.”

– ACH Staff, CA

Key Takeaways

MSCs can change systems by aligning diverse people and groups around a shared vision and accountability for community health.
By aligning cross-sector partners, MSCs are positioned to facilitate a response to the upstream causes of adverse health conditions.
Systems change and alignment may happen through ideas, actions, investments, or other approaches to joining forces across sectors.
Changing systems and aligning takes time, energy, and investment. Providing MSCs with adequate financial investment will increase their chances of successful aligning.

Survey Findings

89% of respondents agreed that their MSC helps align resources and activities across community, clinical, & tribal partners (n=463).
89% of respondents agreed that their MSC helps community, clinical, & tribal partners work together more effectively (n=451).
91% of respondents agreed that, as a whole, their MSC gets things done (n=466).
80% of respondents agreed that their MSC helps reduce duplication of efforts by forming linkages between clinical, community, & tribal partners in our community (n=394).
95% of respondents agreed that their MSC effectively provides support for collaboration among community, clinical, & tribal partners (n=453).

“We talked about this work as being health systems reform, I would argue we’ve never had a health system…We had a lot of actors in a health economy that were doing business and sometimes also making people healthy, which is great, but not actually acting in a way that was systemic or connected or intentional…That’s the vision sort of that we’re working more towards: let’s actually take a look at every everybody who’s working on this, play to our strengths, figure out how we can connect in the most efficient way.”

– ACH Staff, WA

Perceptions of Systems Change and Aligning

As evidenced by survey results, MSC participants had mixed feelings about their MSC’s progress toward systems change and aligning. Perceptions varied by different local contexts and participant backgrounds. We found that:

Not every MSC’s efforts to create systems change and aligning were seen as equally effective.
MSCs that served larger geographic areas tended to have better perceptions of systems change and aligning.
MSCs with public funding tended to have better perceptions of systems change and aligning.
People from tribal communities and nations tended to have better perceptions of systems change and aligning in their MSC, while people who worked in public health tended to have worse perceptions.

Influencing Systems Change and Aligning

Perceived progress toward systems change and aligning was most strongly influenced by perceptions of power dynamics, equitable processes, and shared purpose, with these three factors having a positive association with participant perceptions of systems change and aligning.

“All of these things we couldn’t have done unless the partners were willing come to the table and imagine themselves working together in new ways. Instead of competing for these grants, instead of competing for these contracts, they were willing to imagine what it would look like if we did this together. And what we could achieve. New, different, bigger, better together.”

– ACH Staff, CA

Related Resources

Creating Positive Systems Change Through Multisector Collaboration, a Population Health Innovation Lab (PHIL) research brief (2023)
Powering Change Curriculum: Building Healthy, Equitable Communities Together, a Population Health Innovation Lab (PHIL) and California Accountable Community for Health Initiative (CACHI) curriculum for multisector collaboratives (2021)

View all references for the Data Walk.