Why It Matters
To paraphrase the Equitable Evaluation Initiative, “What might be possible if improvement was conceptualized, implemented, and utilized in a manner that promotes equity?”
As improvers, how might we untangle the longstanding drivers and root causes of inequity so that our work transforms systems to reflect equity, dismantle racism, and produce equitable results?
I’ve been considering these questions for a few years, and I was doing so in March when I was in Jackson, Mississippi, on my last work trip just days before COVID-19 shut everything down. I was attending a conference sponsored by the Robert Wood Johnson Foundation, soaking up every word during the lunchtime session called Methods in Action to Advance Social Change. Methods plus social change? Sign me up.
I came to improvement work with a background in public health, social policy, and evaluation research. As a white woman on my own racial equity journey — in my family and community, in my work at IHI, and in my heart — when I heard Jara Dean-Coffey, Founder and Director of the Equitable Evaluation Initiative, say that we need to be about something to be clear on the value of our work and how we do it, I felt like she was calling me into this work in a deeper way. It felt like a scene from a movie where you’re in a big crowd in a dark room, and a spotlight suddenly exposes you.
In fact, I think Jara Dean-Coffey is calling all of us to dismantle racism and advance equity by interrogating, and then transforming, our mindsets and our methods. We need to question the beliefs and practices that are hidden in the “orthodoxies” of our practice. As Dean-Coffey says in the Equitable Evaluation Framing Paper, which started with the philanthropic evaluation research community, these orthodoxies are “often invisible, masquerading as ‘common sense.’”
In a recent email, Dean-Coffey asserted that “if we want something different, we must push back and be different from the start.” Borrowing from writer Wendell Berry, she goes on to say, “Acknowledging that we are ‘complicit in the things we may be trying to oppose,’ we must continue to explore how we use our influence to change policies and processes that undermine our ability to get someplace new.”
So, improvers, how will we know if a change is an improvement? How might we begin to act, together, to uncover our orthodoxies and get to someplace new?
When creating the Equitable Evaluation Initiative, Dean-Coffey and her colleagues developed three Equitable Evaluation Principles to help foundations and non-profit organizations reimagine their evaluation efforts (Figure 1).
What might it look like to adapt these principles to improvement? Together with Dean-Coffey and building off the Equitable Evaluation Framework, I propose the following:
- Improvement work should be in service of equity. Production, consumption, and management of improvement work should hold at its core a responsibility to advance progress towards equity. This deeply aligns with how IHI President and CEO Kedar Mate and other leaders have said that there can be no quality without equity. This requires addressing equity at multiple levels, including in our systems and culture, interpersonally, and individually.
- Improvement work can and should answer critical questions about the
- Ways in which historical and structural decisions have contributed to the condition to be addressed;
- Effect on strategy of the underlying systemic drivers of inequity;
- Ways in which cultural context is tangled up in both the structural conditions and the change initiative itself.
- Improvement work should be designed and implemented commensurate with the values underlying equity work. It should be multiculturally valid and oriented toward participant ownership. This means co-designing and co-producing improvement and sharing power with those most affected by current inequities in the system. For example, partners in the 100 Million Healthier Lives initiative have developed resources for co-designing improvement and systems change with people most affected by inequity.
We are not starting from scratch. Our discipline is rich with approaches, practices, and tools that might help us make improvement work more equitable. We have an opportunity and a responsibility to recalibrate and align with greater focus grounded in equity. The possibilities for how our collective efforts to transform our work and the world are only limited by our hearts and minds. Join us.
Marianne McPherson, PhD, is an IHI Senior Director. Jara Dean-Coffey, MPH, is Founder and Director of the Equitable Evaluation Initiative.
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