Considering Individual & Collective Responsibility in Creating Change

In this episode, Heather Gates and Meg Koepke explore the power of individual and collective responsibility in creating systemic change, especially within healthcare and collaborative improvement. They discuss how small groups, agency, and curiosity can drive meaningful progress despite large systemic challenges and share some of their own experiences about things that we can do or seek to help us get there.

Disclaimer: The views and opinions shared in this episode belong solely to the host and the guest and do not necessarily reflect those of their employees, clients, or affiliated organizations.

Host: Heather Gates, MPH, Owner & Strategy Partner, Human-Centered Strategy, LLC
Guest: Meg Koepke, Co-Founder, Coral Health Advisors 

Resources
Coral Health Advisors
Pop Health Podcast 

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Transcript

Technical Note: Show notes are created with the help of Riverside.FM AI and thoughtfully reviewed by us. They’re meant to capture the spirit of the conversation, though they may not reflect every word exactly.

Heather 
Hello, this is Heather Gates, and I welcome you to the Stand in the And podcast, where we have honest conversations about the messy complexity of the human experience, where we get stuck, and how we find forward in the and of it all where many things are true at once. This podcast is designed especially for those of us who want to make things more beautiful and better for everyone, and sometimes need reminding that we are human too. I'm so glad you're here. 

Welcome back to the podcast, y'all. I'm joined today by small business founder and pop health expert, Meg Koepke. Meg, thanks so much for standing in the and with me today. Thanks for being here.

Meg
I'm so excited to be here with you, Heather. Thanks for having me.

Heather
Yeah, of course. I want to talk about how our paths cross, but first, why don't you go ahead and introduce yourself to folks in whatever way feels meaningful to you and we'll start there.

Meg 
Fantastic. So I think right now I'm a gloriously happy middle aged woman. This is my favorite age. I'm just really loving it. And I'm a small business owner. So I'm I'm busy like everybody, right? And I'm a small business owner in a firm that works at the intersection of healthcare transformation and healthcare policy.

Heather 
Yes. Awesome.

Meg 
So we work with government agencies, we work with hospitals and health systems, we work with tech forward and tech native companies that are trying to bring the best of new ideas forward into helping patients and providers connect and make better health. And so that's always busy and crazy. and then add to that this season, my youngest is graduating from high school and heading off to college. So I think today, as we meet, I'm sitting at thirty-one more days of him in the house before he's a free agent. And I'm really excited about that. So those are the ways that feel meaningful to me to introduce myself today.

Heather 
Just love gloriously happy, if I've heard you correctly. So just like the energy of midlife being framed in that way of like I am loving this phase. I appreciate we must be in similar time spans. My I have a kiddo who's about to leave also. so it is an interesting chapter. And I think I've said on the podcast before, there's been a lot of grief for me in that transition and the leaving.

And I am approaching the excitement side of it. Right. I'm seeing the other side, I think, of I have one more to go. So we're not empty nests like you are. But I do, I'm like, what is Q three of my I'm thinking of like Q three of my life. What's Q three gonna look like? with this time freed up differently and my attention and my focus freed up differently. So I'm starting to imagine, you know, a different.

chapter that it sounds like you're a little bit closer to. But you and I met, I'm trying to think, Mag, you and I've never actually met in real life, but a shared, probably friend, colleague, and client of ours just was sent one of those emails of like, you should know each other. And we got on a call and said, I agree. and so it's been fun just to stay connected a little bit over the years and see what y'all are up to with Coral and small business growth and and all the things. So I appreciate you being up to be in here. 

And actually I'm now reminded that you were on this podcast episode specifically because you responded to my request on LinkedIn for listener feedback on episode topics. Little did you know that suggesting a topic I was going to say, how about you come talk about it?

Meg 
Right. I thought that was a really clever it it surprised me. And when it did, I had to chuckle because I was like, Well, I you know, if I paid attention, I could have seen it coming. But I love your podcast and I I think the reason we were introduced was because I even though the work that we do in pop health spaces and community health spaces can have overlap and intersection, I actually think it was when we launched Coral, sort of looking at our network.

my co-founder and I Melissa Cohen said, Hey, like we know a lot of the people that we probably need to know from an industry connection, future clients, projects, where the trends are going. We don't know anybody who runs a small business. And we wanna part well. We wanna do that thoughtfully. And

And we'd wanna avoid making mistakes that other people have stubbed their toes on. You know, I we'll make our own mistakes. But but and that couldn't have been more true. I think some of our early conversations and connections, I think we found ourselves just really finding kinship in what it is to dream and and put work together and partner with people to try to advance change.

Heather 
And in this model, I've I've realized today as I was preparing to talk with you that I have I have a string here of episodes. We're about to release another one that's with this kind of small business. I have really small business I'm doing a lot of talking on LinkedIn about small business, a very small business focus right now. I think just the longer I'm in it, the more and watching the context around us, the more you just realize what kind of the specialness and the unique challenging, the unique opportunity and closeness and humanity that comes from small.

And often I think in business we're talking about bigger and bigger. so I love the opportunity to shine a light, to support each other. I think the small business ecosystem is such a lovely supportive place. So I'm glad that I mean I certainly see you as a, you know, small business badassery in the works over there. So I'm excited to learn with you every chance that I get.

Before we tell folks, so the topic that you dropped in LinkedIn for us that you want to think about is related to the and of individual and collective. But before I have you tee that up, if you're listener to the podcast, you know we're gonna and stand first. you did a little bit of anding in your intro, but you may have something else that you want to name. Just a kind of a two word check in about how you're showing up today. And I'm happy to go first if you want me to, or you can share.

Meg 
Why don’t you go first.

Heather 
Okay. I confess that mine changed about thirty seconds before I jumped on this call with you because I was coming into this with a very kind of quiet, rainy day. You know, I think it's like kind of quiet and curious. It's quiet in the house this week. I'm in the a lot of our clients are at a conference. It's kind of a slow time. I was feel feeling very settled. And then we got an email from the US PTO, so the US Patent and Trademark Office.

That our stand in the and trademark registration just came through today. Nice. And so I am just so excited if anybody has ever been part of the tediousness and the back and forth and the are we gonna have to pay a jillion dollars to like do we anyway, it's been a journey. so now as of July 14th, stand in the and is a registered trademark.

Heather 
Feels really exciting. About a year after we launched the podcast. So I think I'm just sitting in a lot of lessons about that of like, yep, you start it and eventually you get the rest of the pieces together. sometimes it goes through, sometimes it doesn't, but just that like boring behind the scenes stuff that happens that's not the glossy like new big client or fun thing that you're gonna do. But these little big little big wins. on the back end of especially small business, right? There's not a legal team. it's us. It's a little bit of AI support and a support from a high schooler and myself and just patching it together. But yeah. So now we have registered trademark for the podcast, for the mugs, all the things. Thank you. So I feel

Meg 
Amazing.

Heather 
relieved that that process is done. I feel excited and proud on top of my otherwise like rainy day quiet. So like a little lightning bolt of excitement right before this started. What's up for what's up for you?

Meg 
So excited to get to share in that celebration with you. That's really fun. And I love the like celebrating the small wins. I mean, wins are wins, and it's so important to celebrate them. to your format and the question of what additional ands. it's 90 here, so there's no an oppressive heat energy that I feel like I'm bringing, you know. And and it's maybe the well.

Heather 
Thank you.

Meg 
The calm before the storm, so thirty one days to to marching the kid off to college. You know, my office to the side of us here that you don't see, you know, is like the college staging ground. And if I could just tell all the internet algorithms that I have a mattress topper, you can all back off like

Heather 
Back off. I do not need another mattress topper or organizer.

Meg 
Yeah, I think there's a little bit of of that. Like I don't know exactly what these next thirty one days and the thirty one after that hold. I've never experienced this before. And so, there's a the bit of that that I'm bringing in and it's with me today 'cause it's it's it's barreling in on my my home office environment and

Heather 
So present.

Meg 
Yep, so present.

Heather 
It's an interesting unknown. You know, I did an episode where someone we were talking about transitions and how oftentime we're in a transition and you don't know that you're in in a transition, right? When you lose a loved one, when sometimes loss happens and it's you know, but these graduations feels like like we know. You know it's coming, but it doesn't change like I know

Technically I understand the date on the calendar, but the uncertainty still remains of what is it gonna be like and until you're in it, you don't know. So I haven't found that knowing it's coming changes very much. but yeah, it's a lot to to hold and be present with. And with summer, it's all kind of physically in our space. You may see said teenager walk by the window here as we have our conversation. So we're just gonna let all of that be with us and whatever happened.

happen as we dig in. So, Meg, tell me a little bit more, just kind of frame the conversation up. When you dropped in LinkedIn around, I want to hear this conversation around the and of indiv individual, I think it's individual and collective responsibility, but that might not be the right third word. You can just paint the picture for us about what this and looks like for you.

Meg 
Yeah, I think so I think I commented on LinkedIn back in winter. And winter was a particular moment in the twin cities of Minnesota where I'm based. And what was happening for us as a community was drawing a lot of light to how we are connected j as citizens and and across the neighborhoods and across cities and

It was maybe a moment where I was asking myself some questions around how do I individually want to show up in this moment and what what what parts of it from a community standpoint will I show up in. But in the context that you and I know each other, I was thinking about how present that dialogue is in my head. What is collective action and collective responsibility and community responsibility? And what is the thing that, you know, people need to own on their side of the street just as individuals.

And how different that is from sort of how I grew up in healthcare, where it was all about systems. And it was all about systems theories of changes. And it was, you know, the the books and the names that we all know. And and we still I still believe in systems theories of change. I just believe they're wholly insufficient. And I I do not believe that we get out.

comes by changing systems alone. I don't know that any of the writers or or thinkers believed that either, but I think over time, with how persistent the challenges remain in healthcare, I'm perhaps

Embracing a little system skepticism. And and maybe even the better side of system skepticism is a hope, a wonder, and a delight in the power of individuals and the power of smaller groups of people to make difference even when the system is going to stay challenging. because the system of healthcare is gonna stay challenging.

Meg 
Like we're not going to solve that with AI. It's not, you know, we didn't solve it with the last bill. We're not going to solve it with the next bill. It it it is so that is really what was running around in my head. And I was I was thinking, gosh, if there was space to sort of unpack, what does this look like to think more about

Heather 
Yeah.

Meg 
small groups and individuals or communities and individuals and the change that they can make and think about it relative to the space where I spend my life work, which is in health care and health outcomes.

Heather 
I can't stop thinking about I'm such a visual person, Meg, that the what comes to mind for me, I think it's even on our website as a part of when I think of a human centered appro so our business name is human centered strategy. So I'm often thinking about what do I mean by that? And when I'm working with leaders teams and multi agency partnerships, kind of what is the frame of reference, I think, for this? Where where does improvement come from?

Cause I think we talk sometimes about change and I'm like, we're not really trying to make it different, we're trying to make it better. So I try to remind myself this is about improvement. I think of what I would call from like a public health background is the social ecological model. So for folks not at from that nerdery, like a dartboard with the concentric circles, like circle in the middle, ring, ring, ring, ring. It's hard for me not to like just both and all of it. Like

individual, interpersonal, family, community, system policy, all of it feels also interconnected. So sometimes when we're thinking about so that model, we're thinking more about an individual community member situated within the larger context. I think of it too in our work as an individual like me the leader situated

I am influenced by all of the rungs around and I I'm influenced by them and I can influence them. So to me it's more I think of it as

What is happening at all of those levels? What are the the impacts and the opportunities? And then what role do I play within that? So when it writes kind of system skepticism versus individual kind of, you know, how do we hold the and of it? So my curiosity for you, when you think about systems thinking and the way that you're using with a healthcare background.

Heather 
Is is the skeptici is is that framing in more where they're really just looking at the outer rungs and we're just not thinking about the individual at all? And you're saying we gotta think about the individual too?

Meg 
Yes. And and I think that to your framework and the way that you have thought about it and worked with your clients, I agree. And lots of health systems will say we're, you know, we're patient focused and we're patient centered and they'll have committees for it and they'll have practices for it or they'll use elements of human centered design to to try to really bring and b and bake that in. I think the piece that I was

I think the system versus the individual is is it is one where oftentimes in healthcare I don't think we have d agency as individuals as much as we need it. I mean even an individual working in a health system doesn't necessarily have as much agency to change

to make different decisions and to and to change things. as we have if we really think about our own individual agency. If we just think about our own individual agency, I think that's I'm not doing a great job of this. I hope this part we can edit out a little bit. But I think I was thinking a lot about also this small group and individual I hadn't spent much time on that. I've spent time thinking about the individual versus the system.

Heather 
No, I think it's great.

Meg 
I haven't spent as much time thinking about the smaller collection versus the individual and how that shows up even within these health systems that we operate in. And the fact is there are organizations, teams, people, provider groups that are getting differentiated outcomes from their peers. And they're working with in the context of all the same system trappings, right?

they're often working with the same electronic health records, they're often working under the same payment models, they're often working within the same constellation of where are you recruiting your doctors from? What are your nursing shortages? Like they're facing all those same barriers and yet they're getting something different. And I'm wondering if that's really where is the individual showing up and how they're getting what's different there, and where are the smaller teams or the communities? doing something different? How are they embracing those challenges and those moments? I think that's sort of what I was thinking about. Much time thinking about

Heather 
Yeah. But I think I'm inspect before. Yeah, good. Well, welcome to the pondering podcast where we just like noodle on things that we're thinking about. Yeah, we're not here. PS everybody, if you're new to the podcast, this is not the place to come to get all the answers. We are here to wade into the messiness and see what we can find in it. And folks other folks will have have thoughts too. One thing I think that's really stands out for me about what you just said, is the word agency.

Meg 
Together.

Heather 
Right. The you know, and maybe even the reminder and the remembering. Because I do think sometimes in big systems, whatever the big system is, there is this sense of it creates the structures and the rules and the way and we can get I think we can forget the agency and the power that we do have already. so there's there's some almost reclamation of power in the remembering of the agency that we do have within.

Meg 
I love that.

Heather 
I was just last thing I think I was gonna say is I think sometimes we like what is the system? When we say the system, like what even it's to me it's 'cause I'm off often working in community or organizations and we still want to talk about like it is it's a separate thing. I'm like, y'all, community is a bunch of people together added up. Like it's individuals added up make the collective. So

So often I think we forget sometimes that not only do we have agency, we are also part of the ecosystem. So there's it's even this kind of and I just think culturally this is it in our country anyway, this kind of individual sometimes we this separateness that we feel. This aloneness outside of system, outside of the other thing. So part of it not only, I guess to me, what's coming up is this remembering of the agency and the power that we are and that we have and the interconnection that we have and are with the bigger thing. 

Like we are always part of the ecosystem in which we are operating. And we are always an individual within it. It's just a both and for me all the time. So with that frame then what? Right? What can

What can we do if we remember we always have some choice? what can we do when we remember the power of the collective also? I think it's really is a powerful place for just the reminder of the and. Yeah. Of of what jenga blocks can we push individually? Which ones need collective?

What barriers can be removed in the collective? Where does all of that live? So I think those are the two things that are coming up for me is this reminder about agency that you mentioned, which is certainly not I don't I don't want that to come across as seeming that I'm not aware that that's n has inequitable distribution.

Heather 
And I do I just believe deeply that I think sometimes we may have culturally been positioned to think that the power is outside of us. And just yeah. So

Meg 
Yeah. I love that. I want to pick up and run with that. I think blaming the system for everything that's not right also gave us that that power to kind of like disembowel our own individual role in it or like the good we can achieve if we work together in small groups, even if we're not gonna change this overall system. And I love this idea of remembering, remembering that we have agency and also practicing. So.

I don't know about you, but I feel like growing up in healthcare when I did, I got a lot of practice at systems theories of change, right? How do you break down the problem into understanding what its components are and how do you build back together something better? And but where was the practice for thinking about what is my individual role?

What permission do I need to give myself to speak this curiosity out loud? What safety do I need created in the room to be able to do so? What other containers or spaces or forums need to exist to be able to foster that, demonstrate it, see it, and then be able to do it or teach it yourself? and also the the small groups, sort of what what time and attention do we give to the whether it's the community or the collective action or

just this smaller entity of of change making that can happen with groups of people together that is sub full system and more than my individual effort. And I think that a lot of the practice reps that at least that I have had have come where it is about that small group, but then like in service of the system, of changing the system. And I think I think

Meg
I think there's something to hold about um…

Meg 
I think there's a space to hold for learning and practicing our work within smaller groups to advance change, even within the constraints that exist. And for really leaning into my role, our role, system roles, with like no abdication of responsibility, right? Responsibility was the right word for me. I know you and I went over email about it back and forth. Yeah. And I don't know if it felt

I wanted to ask you if it felt like too prescriptive or too judgmental. Like did responsibility

Heather 
Well, I got itchy about responsibility. No, I don't think I'm itchy about it. I have so much. I think there's a longstanding narrative around individual responsibility and blame the c like who's responsible who's responsible for what? And anytime I feel like

Used to talk about the shame, blame, guilt, fault, food fight. We're just kind of throwing energy at each other and blaming everything else. So I just I want to be thoughtful about thinking about collective responsibility. And yeah, responsibility I think just kind of can mean a lot of things to a lot of people. So I I mean, I like the word. It wasn't more about what I meant by it.

Meg 
Fair. No, that that's fair.That's really fair. And I I wasn't taking into account sometimes the debate about healthcare and healthcare spending can go to like what's individual responsibility, right? Like stop smoking. It's it so I I wasn't invoking that. I think maybe what I what I mean, maybe the better word for what I was thinking about was is change. Is your systems change, there's group and collective action type change, and there's individual change.

Heather 
Yeah, yeah, yeah.

Meg 
And and maybe that even puts a finer point on it because it's not just what you do. It's not just how you deploy your leadership individually in healthcare that that I'm interested in. It's like how how do we change how we're individually showing up?

Heather 
And I think Meg truly when I think about what you're digging into here, I'm like, this is why I in my consulting practice now am also an executive coach. Yeah. I think after after years of working and I do think 'cause I want to talk about your small group making collective change with kind of what they can, 'cause I've spent a lot of time in that space too.

Meg 
Yes, yes, yes, yes, yes. Yeah.

Heather 
But even after right, a career in collaboration and collective work, in small and large contexts of various collaborative types, some of what you were just saying a minute ago about where things get stuck, I think do come back to individual, like years ago, somebody asked me, we were doing in the region, a bunch of work around community health assessment, health improvement.

We were talking about our data at the time and they said if you could change one thing in the re like one thing about any of this or to to impact health in the region, what would you change? And I'd never thought about it this way before, but I'm it still feels true to me. It's probably been ten years. But I said, What I would change is our ability and willingness to have difficult conversations. That to me is an individual skill that impacts everything that's possible. 

Right. It impacts, cause you said our I don't remember the list, but these, you know, when I'm thinking about what do I need, what action am I gonna take? How am I going to as a leader create supported space for other people to ask brave questions? How am I gonna challenge silence? How am I gonna challenge what feels outside of values?

Right, these individual pieces of change that are are bigger and how do we wrestle with that? And I do think to your point, it's those things are skills. You said you're learning about collective systems change and how do we unpack the problem. Are we also learning about how to have difficult conversations? Are we learning about how to facilitate conflict? Are we learning about how to help?

settle our nervous systems in times of tension. Like these are individual pieces. And I think people, you know, in as I've been paying attention to the kind of ecosystem around me, you see folks kind of

Heather 
You know, that maybe maybe originally I was a therapist only working on individual, and then I realized that they are big systems lenses to this, and now I want to work on the system side. And then you pe see systems people realizing that it's not just systems that we have to look at. We need to dig into the on the individual side. So I think we're all kind of trying to figure out like where do you lean in and where do you push on this? But I think it's an important call out as far as the recognition of…

Especially so I think right now we can kind of talk about individual in the middle of that framework in two ways. When individual me, I go to work every day as somebody who is trying to make the system better. Right. It's my job at some level to try to make the system better and how am I situated as an individual within that. And then we're talking about individual that is a patient, a community member in a larger thing. So in this example, I'm talking about more like me as leader.

situated in the ecosystem of change. there are some individual skill change pieces there and we always can influence

something. I don't know if you want to respond to that, but I do have some thoughts about the you are referring to it as small groups, kind of how we make change within constraint. I feel like I'm often facilitating in that space. So I do have some thoughts there too. I want to dig around in and see what they are. Yeah, absolutely. But I'm curious if you had thoughts about the if that's what when we think about the individual piece of it is some of the

You know, is it really around what can we do? When we think about not just what the tension is, but what do we do about it? Mm-hmm. You know, kind of what the call is. Is it a call to remember? Yeah. the role of individual, the skill that comes with that, seeking those, creating those for others. Yeah.

Meg 
And the change you may individually need to make in how you're showing up. In how you're showing up in those work positions. And yeah. And I think this I love the notion of remembering and I and I want to press again the notion of practicing. Because I I think that when we learn something new, and this might have happened in some of our you know, diversity equity spaces, when we started talking a lot about and

Drawing awareness to what we needed to do about those things. I think that was an example of a lot of people, a lot of professionals taking courageous moves, trying to create space for conversation. But we, I think we sort of learned that we were not as used to doing that on any topic. And so then we weren't as practiced at, okay, how do I bring this consideration that might derail.

you know, the topic today, how do I hold in tension, you know, the thing that we need to achieve that's on the table? And hey, did we make enough space for patient voice in this? Did we make enough space for diverse patient voice in this? Did we make enough space for holding our our health equity considerations, you know, prominent? What additional data do we need? How do we balance those tensions of of keeping the work moving while while actually

Braving what you're talking about, Heather, in terms of having courageous and difficult conversation. And I think as leaders, having to judge sort of how much am I willing to slow this conversation down and take it where it needs to go and feel like I can bring it through with a group, with time, with intention, or how much do I need to make those trade-offs of judging how much still just needs to advance today?

And or was this the right space for that conversation, or is that conversation needing to happen elsewhere? I actually think some of my own living through that over the last 10 years maybe brings some light as I look back to like how much I didn't learn about my own individual role in advancing the change as opposed to just serving the the system of it all and and the system change of it all.

Heather 
Uh-huh.

Meg 
so I that's that's what I would add to our discussion of of our individuals. I I really think there are skills to practice there. and I think there are lessons left to learn.

Heather 
And it occurs it occurs to me, and I remember thinking about this when I was kind of on my soapbox about our ability and willingness to have difficult conversations as because I have in in my leadership journey, I just realized that was a place where I did not have the tools I needed. Just to to give a a personal example. You know, as I kind of grew up through work in leadership, I think I came out of this

as a young professional out of a frame of more perfectionism and probably in a context of keep everything comfy and nice. And so building the capacity and tools and skills to have the conversations that I knew that I needed to and wanted to have was a journey on the learning side.

So again, there's the remembering is one piece when we remember that we have agency. And what we're saying is that doesn't mean I'm gonna have the tools and the skills I need to know how to go about that. Right. So how do we go about that? And I'll just again, I'll keep talking about experience here is I've found some great books. But again, you're talking about the difference in learning and practice. Cause what we're trying to get to is like learning, practice, skill ability.

You know, or you know, in theory, like knowledge, awareness, behave whatever, just gonna get us to actual behavior and skill to accomplish, you know, whatever it is that we're the results that we're trying to get to. Right. And so I do think, you know, places where so for a while I was like, we need a learning lab. Like in clinical settings, you go learn how to give shots. You learn like there are places where you learn and practice skills.

Unfortunately, I think in leadership, you learn them maybe in a book or something, and then you practice IRL. Right? Like in your actual next meeting, in your actual next conversation, you're just having to practice in real life and sometimes high stakes situations. Yeah. So I don't and I think there are certain trainings. I think a well-designed training does have an element of like

Meg 
Right.

Heather 
role play and places where you can practice. But I think this is a great space for things like coaches who can role play with you and you can build some of these skills, small group kind of peer networks, or even within organizations, leadership teams, supervise like other teams of peers who can come together to practice having the conversations that matter.

Yeah. and I think unfortunately a lot of times it's kind of trial and error, you're just figuring your way through it. But I think we can create supported spaces for the kind of practicing for the deep skills that we do need and as individuals. And then I'll say again, last thing for me is on my side, there's just some work. Like we get we start when we start talking about individual, like we can get deep underneath the like what my issues are that come up.

And that's separate. Like, then I'm talking about my therapist and my somatic therapist and how do I help settle my own nervous system? Like, there's a whole bag of tricks that come with to me the work that is showing up in space with intention the way that I want to for the conversations that I want to have. If I am taking on that individual piece of the flourishing that I want to create and what my role is is in it. just when I think about kind of what helps with this holding the me as part of the ecosystem. having other support, I guess. So me learning is one thing, but having support and thought partnership, it's not exactly practice. There's not going to be anything quite like being in the the context, but I think we can create supported space. For ourselves.

Meg 
I want to give it a big yes and like yes, I think this like practicing with scenarios and creating space to kind of, you know, role play it out and and and it's maybe one of the surprises of middle age that I've that I've embraced role playing as much as I have 'cause I I mean loathe not nothing more than role play at like age twenty five as a young professional, you know, like just couldn't

really embrace it. but also creating learning environments where practice is permitted in the day-to-day work. Yep. You know, where we recog and I and I l I love I love the notion and the nomenclature we have as medicine being a practice. Like it is changing all the time. You have to keep practicing at it. You can't you can't learn medicine once and be done. I I've learned healthcare. I've learned medicine. I am I'm forever done now. It is a lifelong learning process and especially at the rate

that information is changing now. And I think so too for, you know, whether it's healthcare administrators or public health administrators or or organizers of some kind or consultants like us. I think we are we are we are in the practice of it. And I think creating environments, I love what you said about in your own work that executive coaching has become a big part of it. I mean that's that's that is recognition that it's like there are there are things that as individuals we do have to change.

As we are also influencing the change of the system in order to get the results that we're looking for. And I think creating a foundational environment where that learning is permitted in the moment. and and there there just are real specific things that you can do in how you talk, in how you set up somebody who's coming forward to speak, and how you bring a perspective forward that I think show up in environments that are learning environments more so than in ones that are are closed to it. And and I think We we have a duty, we have an opportunity to create more of those learning

Heather 
Love that. I'm having flesh. Gosh, I wish I remembered the author. But back kind of early career, I'm like, we did a whole like book club thing around it being a learning organization. I don't hear that language anymore.

Meg 
Right. We're done with it. We learnt

Heather 
Yeah, we moved on. We learned it, Chick. But yeah, it's it's interesting to me, even as we ponder around the individual piece of this, how much it still is collect you know, it's it's it's and still it's it's individual and it's collective. so maybe we just kind of tag that as an invitation to consider.

I think a lot of folks listening may maybe are in leadership positions and roles where not only are they reflecting on their own, you know, how what are my areas that I want to be grow growing in and around so that I can show up in the the ways that are aligned with my values and what I'm up to. How do I all and how do I create a space for learning and growth in other, in other people as an important part?

of what we're up to. I also wanted I want to take in a little bit, Meg, I think, to come back to your cause the when you're talking about the system, kind of the big system and, you know, architecture of structures and and policies and these things that feel kind of bigger than all of us. And talking about the power of small group, right? And what we can do

Meg 
Yep.

Heather 
And you're you know saying that you spent a lot of time thinking about big system. I think I have spent a lot of my consulting time, for sure, in this space of how do we push the jingle blocks that we can. Right. Given the pieces that are on the table. And so often, you know, when you think about where do we want to be, where are we now? How do we bridge the gap? So often I think

Whether you're in community or in organizations.

As you start getting into action planning or strategic planning, you bump up against these things that you wish were different and you can't control. Right. Like these are some things that are forces that are impacting us that we don't have control over. So there is a sorting. There is a sorting of what is impacting you know, the future that or the kind of current state that we can imagine, what is not in our control, what is? There's always something.

And then I think remembering that there are different types of action and that influence is a type of action. Because just because we can't control it doesn't mean we've lost our influence over it.

So teams are often thinking about, I think in small groups and in community, what can we do? Right? Asset based, what do we have? What resources do we have? I'm from rural. I would do a lot of work with rural, I think in particular. Lots of assets, lots of real creativity about how do we work with what we have to get to where we can. And for these other things that somebody else has say over.

Heather 
What is our potentially? What is our role? Do we want to have a role in trying to influence that? Take action where we can and get clear about where we want to try to influence a policy or a funding stream or a behavior of somebody else that impacts what's impacting us. So

Meg 
So and not I love that having a couple of different levers that you can pull and I

Heather 
Yeah, different lever levers of change.

Meg 
Yeah, and it like right. So where is their action? Where is their influence? Where is their monitoring? Where is their where is their supporting? I I think I think one of the community so thinking of smaller group or community or collective that's short of system, I think too there's a lot of different players in that space. there's leaders, there's actors, there's supporters, there's information,

there's ideation and you may not show up in a collective space the way that you show up in your individual way that you lead. Like it it may be something else you can give. And I I guess that question of when I move to collective or to small group, that taking a pause, is there a place I can join? Is there already a space where this challenge is is being

encountered and worked that needs something that I can offer, or do I need to create another space? And this this is true for small teams in in systems, in health systems, in organizations, right? Is this is this my work to own or is this my work to champion or support or provide data to, or to follow? followership is really important in community action and in and in smaller group action.

It's not all about leadership. And I think I I think about that tension. when I think about the and of individual action or collective, individual action or small group, I think about some of those tensions and that need for pausing for the cause, sort of what is the next layer of larger that can address this challenge? Does it already exist? Does it need my help? If it needs my help, what of my help?

Does it need and how? And I think taking that moment is something that I think can help us as we try to.

Meg 
Stand in that space.

Heather 
You probably know by now that I'm obsessed obsessed with pause in the first place. So pause for a cause, I just am gonna like tattoo on my brain for life. and you said like pause for a cause and what's the next level of larger? I love that. And I wish, you know, y'all, I don't want this to be a visual podcast, but at moments like this, I'm like, I really wish it was because I'm still thinking about my like social ecological model here that the target dartboard.

Yeah. And wherever you are situated, if you're individual, what's the next level of larger and where might I have influence or impact? It's just an interesting curiosity to hold.

Meg 
Yeah. Or support again, supporting

Heather 
Right. And so when we say w Go ahead.

Meg 
What's the next level of larger and how do I show up in it? And how might that be different than the way that I'm showing up every moment of the rest of my day job?

Heather 
I have a whole podcast and a half of things to say about this specifically, I think. Because so right, so much of when we start getting into the work of collective impact and collective action and collaboration and all of that. It's a really important point that you just made is not only what's the next level of larger, but what is my role. Sometimes the my is me and individual. Sometimes it's I'm coming with the

capacity of my whole organization, right? I am the hospital coming to the community table. I am the health department. I am the school system coming to the community table. Or I as an individual, I'm used to being the leader and now I'm going to come to the table and I'm not the boss of this thing. Right. I'm a participant. The triage that is probably the most simple that I've used there as far as roles is what is our role in lead, collaborate or support.

Because to your point, it's not always lead. yeah, what are our roles there? And I think I just I love the reminder, because if if system feels like kind of this thing that is just starting to feel bigger than all of us, maybe when I talk about remembering, it's true for me both for the individual agency and the a the agency and the possibility that comes from collective. Right.

Every day over and over and over for the past twenty years, I feel like I get to see and experience the possibility that comes when a handful or more of people come together around something they collectively care about and bring whatever resources they have to the table to figure out what they can do about what they care about with what they have. Yes. Jingle blocks can they can they move right now? So I think

Meg 
Yes.

Heather 
Again, sometimes w it does feel like the problem is bigger than all of us, but and it probably is, right? Some of the problems are bigger than any of us can solve individually or even with other own organizations. And that's where I think these collaborative and collective impact solutions do come. It's humbling and messy, and there's role clarification and there's a lot to figure out in there. And all of that individual that we talked about, how am I showing up in space? What do I need to check about what I'm used to?

you know, yeah, how do I how do I show up in a way that's gonna be aligned with the result that we have in mind here? And there are lots of tools there.

Meg 
And right, what are the tools and skills that support, you know, being I love the trifecta that you offered, the lead collaborator support. what it what how do the skills look different? How do I practice in the role of supporting? How do I practice in the role of collaborating? How do I practice in the role of leading in that next larger space? I think is this is exactly the conversation I hoped for that I didn't know. because

What I find so deeply hopeful about it is there's so much room for individual improvement and small group community collective action improvement and how we approach that, how we support it, how we take those opportunities, how we leverage them. And that's sort of what you need, yes, when we're in a moment where the large systems and institutions just feel a little unruly.

You know, I and I don't I don't mean to point to any diff any specific political reason they feel unruly. I I think we can just talk about it on the level of like the volume of information and the pace of change right now is taking large systems and exponentially blowing them up larger. And our collective problems in healthcare, you know, the fact that we spend more and we don't get the outcomes and the outcomes are disparate across reasons that we really wouldn't stand by, that we don't want to stand by.

they're not getting easier. And so if we only think about the systems change, I think we can get discouraged pretty fast. And given how isolated we are, whether it's with our screens or in this day and age or but there's hope and there's opportunity. There has to be. Maybe it's the middle age of us, Heather, but you know, we're sending kids off to college and we're saying there's a reason to fight, there's a reason to

To go out and learn the hard things and do the hard things and try and grow and come into this world of adulting that we're occupying because it's the water's warm. Come on in, you know? That that's our job right now. And I think to find the hope in that for me right now is not coming from what is the next great system redesign. Like it's just not. And maybe it will again. Like I've been in this industry for 30 years. So like it there are cycles.

Meg 
But this time that we've been able to spend sort of kicking around these concepts of what can we change about how we're individually taking action? What can and how can we do so as community and small group? There there's just there's just tons. There's tons of we have not solved it, you know, like that we've not we've not we know some tools that work, we have some skills that we can practice, but it's not like everybody's unlocked.

Those opportunities, the opportunities of your own action and your action in collection with smaller groups of people. I loved what you said. I wrote it down. It's probably too much for a tattoo. But if you get paused for the cause, I'll get what can we do with what we have about the thing we care about? Like that, that skill and that pr practicing at that is really exciting to me.

Heather 
Yeah, I have chills right now because I think I'm just settling into deep gratitude that I get to show up with people every day who are trying to do this. Yeah. And and and it does I think, you know, when you run into me on the street and I am a joyful what did you say in the very beginning? Gloriously like happy and joyful, like I am continuously inspired.

Meg 
Gloriously joyful.

Heather 
by people that are leading in this way and bringing people together to do just this. And so maybe the invitation is if you are feeling disconnected from these kinds of conversations, is you said something, Meg, important that we didn't really tap into a minute ago, which was sometimes we don't need to make a new conversation. We need to find where they're happening. Right? Where is the conversation happening?

How can I be part of it? and there's a humbleness, right? There's both a courage and a humbleness. There is grit and there's grace in realizing that we're gonna show up with what we've got and some of what we don't, and knowing that there are opportunities. I think that's one of my my takeaways here is like, what are the areas of growth that we just need to acknowledge in ourselves and in our teams?

Right. Back to lead, collaborate and support. If we're like really good at leading, but we don't really know what it means to support.

What it you're really teasing back even some of the words and some of the intentions. And I think anytime we get very granular about what we're trying to do, it's helpful. Because I know for sure that sometimes we get in rooms and we use words like partnership and collaboration and whatever, and it w it it doesn't necess it it's all kind of amorphous and doesn't mean anything. So just having the intention.

Meg 
Yeah.

Heather 
To get really practical about some of this? Yeah. Like, even s even when you say lead, collaborate, support, I'm like, okay, Meg, when you say support, if I'm going to support your effort or we're going to work together on this, what does support mean to you? What would that a question that I love is what would that look like if it was happening? Right. What would it look like if if we were support if I was supporting you as a partner, what would that look like if it was happening? And then if we talk about it and I realize like, I don't know that my team

Like we might need to work on some skill building, like the always-ness, and it's exhausting, but I'm gonna say it anyway. The always-ness of the skill building and not just around like how do I turn this new tech into some different tech? So I think there's a lot of training around that. But these how these humaning how things are not going away, friends. Yeah. Right. They may get even more important.

But how we human together, how we understand our roles, in individual in small groups, I just, you know, I think you've shined a light on to me, I feel really excited about this conversation. I think maybe sp coming from somebody who's such a big system thinker, you know, almost like reminder, y'all, all that stuff you're doing, no matter how small it feels.

It is necessary because we have to do what is possible.

Meg 
Yes. Do you say that a lot? Is that like one of your catchphrases?

Heather 
I don't know. I don't think so. I mean, I talk a lot about I talk a lot about possibility. I mean, I think just in the like in the nature of the work, we're talking about how do we find the jingle blocks we can push. Time changes it, energy changes it, context changes it, but there's usually something that we can do. Yeah. and I think true like communities do this and know this. Yeah.

Meg 
I like it a lot.

Heather 
So this is a place where I think sometimes it isn't a remembering. Yeah. Right. We know how to figure it out. I mean, you before we started recording, you mentioned that you and I haven't really chatted much since the hurricane here and like events like that show you that we know how to come together and figure out what we can do. We know how to find possibility with what we have. Right. I think sometimes we we get distracted and we turn away from each other. So

Yeah, I think this conversation for me today really is just an exclamation point on the turning toward it's almost like who whoever's we called it a level larger, but it's almost like whoever's around. Sometimes I think we can overthink it.

Meg 
Yeah. Dance with the ones you're with. Dance with the ones you're with. Yeah. I think that too. And I I loved I it's going backwards to go forwards, but you said something a moment ago that I don't want to miss and it'll help my neurons in the back to say it out loud. the asking what would support look like? And I don't mean to bring everything back to the fact that we've got kids, you know, graduating and whatever's coming next for them, but it's amazing when you ask an 18 year old and how do you want me to support that?

You get the pretty fast look on their face. Like, I'm not sure there is, like, you're good. You just stand back, like, stand back, create space. And and knowing what's not ours, knowing what next larger we don't have to recreate, and we're also not needed there. Like, go to where the water needs bailing, you know, go to where there isn't energy. And and I think that's part of this sort of discovery that can happen when we're focused on the individual or collective, you know, action duty, responsibility change. so I just wanted to pick that up because the because the not doing is important.

Heather 
And and I'm just like sitting here biting my tongue. I think the not doing is one of the most challenging things that we actually encounter. Because as I find I feel it in myself and I in collective work. And I don't know if it's my tendency to just like try to do and fix and go to resolve the tension in my own system. But

To your point, when you say what does support look like and your teenager's like, I'm good, I don't actually want you to come to orientation with me. Thank you very much. Like the I am not needed here is here's what support looks like is you is trust is like be there when I get back. Like

Meg 
Trusting me.

Heather 
It's a very different and that's where 'cause I think when you really probe, which is why I love the question, is what would that look like for you? It's not gonna be necessarily what you think. Right. And that not doing is another probably skill that takes practice.

Meg 
Yeah, especially for drivers, doers, and small business owners, right? Like we created companies to fill voids.

Heather 
Yeah, I'm telling you, like the hardest, maybe that's why I made these pause buttons. Cause one of my biggest challenges is the not doing, is the patience. It's the stepping back. It's the allowing. It's and it's humbling to check that that part of us. So I love I love the addition of that.

that with curios with deep curiosity. Cause I think we haven't said that word, but I think back to these questions of like, what role can I play? What level of action is needed? do I need to take action or not? Like the the continued curiosity, what would that look like? it's just it's all these layers of curiosity that I think maybe the starting point of that domino chain has to be the awareness that we don't know all that we think we know or that we should know. Because you have to right, to be curious there has to be some reflection around you know, I have an intention and I know that I don't know everything about what it's gonna take to get there. So what is this journey of curiosity? Yep.

Meg 
To your point of you have to do what's possible, you have to you possibility is endless. And so you have to discover it, you have to scratch at it, you have to ask questions to really learn what are its limits, what are its edges, what are its what are the best opportunities within the possibility. And I think, yes, all of that requires deep curiosity.

Heather 
All right. Well cheers to curiosity. I feel like I'm like, my gosh, an hour just passed of me noodling around in curiosity and I told you that I would try to keep this to an hour today. What's I wonder what and, as you settle into the conversation, what are you taking away that's really kind of sticking with you today?

Meg 
Oh such hope, and … Well, this is a long pause you'll have to edit out.

Heather 
Uh-uh. I'm keeping it. Everybody just like take a deep breath and drink some coffee. Meg's just humaning. Y'all carry on. She's thinking it's a good life skill.

Meg 
It's around um…

Meg 
When we can no longer see the things that need improvement that don't already have actions in place. Like I we can we can look in the systems of healthcare and we can see lots of needs for improvement, but there's like and there's lots of solutions that are already available. But when we look in this individual space and this collective action space and we see the challenges and the opportunities and the solutions are endless because they're very individual.

The solutions are endless because every group of two or three people that comes together is a new type of next larger. I get very hopeful because there's just so much possibility laying in all of that. The solutions are not all known. The challenges and the gaps between where and what we would need to be doing and what we're doing are there. And so it just seems like fertile ground. And there's so much reason to hope. And that is what is sticking. And I

I think when I said to you, I'd love to hear you have a conversation with someone about individual and small group. I think somewhere in me, my bones knew there is hope there. There is, there is possibility there that is not yet fully tapped, or we don't understand everything about how to tap it. You understand how there are a lot about how to tap you know, community action in the spaces that you have worked in.

I think there's it's still largely I think an area that, you know, not every health system, not every agency has unlocked. And so there's just so much potential. There's like there's lives to save from it. And there's and there's quality to improve and there's there's just there's real human good that can come out of it. That's what's sticking with me.

Heather 
And just my tag to that, I think, is if for you that feels like this renewed hopefulness about the fertile opportunity and possibility of all that's happening, I think for me it's this reminder of all that is already. Yeah. Right. That is people are coming together in small and large groups. So how do we help that and make you know, it's folks like how do we help connect? Because sometimes the solutions aren't known, you said, and sometimes they are. Right.

It's just we're out of resource. We've duct tape everything we can together to cover what we can and we need a different infusion of funds. So how do we connect right the funding to the known solution? Sometimes it's not we gotta come figure out the new thing. It's we gotta figure out how to lift up the known of what's there and what's figured out, either by, you know, individually and collective. So I I think hope hopefulness and enthusi kind of this energy.

is standing out for me too and just the reminder about this model, about this social ecological model, and the remembering that wherever you are working in, there is a layer usually above and below it.

Meg 
And there is change to do within it.

Heather 
There's change to do at every level of it. It all influences each other. So I think, you know, just my reminder to everybody about the interconnectivity of it all, sometimes that can feel like it makes it overwhelming. I think for me it feels more like, great, there are a lot of options about how to go about it and there are a lot of different levels of action. How do we figure that out? we can't solve for the whole thing.

Yes, we can't solve for the whole thing at once, but I think we do need to zoom out and see the whole picture and then zoom in and focus on the piece that we want to influence. and there are a lot of folks, so you know, just when you think about how do you get unstuck in that space, you know, connect to other people who care about that and find out what's already happening. I think I would say on the collective action side is assuming that most of the challenges on the table right now are not new.

And so somebody somewhere has been coming together to talk about Yeah. and how do we or has experience with them? So how do we get curious about what's already there? And then how do we make space? Yeah, for learning organizations, for learning communities to get curious together. Yeah. To get curious together, to get curious in ourselves about ways that we can can grow. And there are a lot of people out there that want to help.

make that happen. You know, there are conveners and facilitators and there are coaches and there are a lot of kind of on the edge in the periphery helping make these things happen. I hope we can continue talking about this, Meg. I think you and I interestingly maybe have deep experience on different pieces of the target board. And so I love seeing how those overlap and and come together.

Is there anything that you want to leave with people so plug? You didn't mention that you also have a podcast. How how can people learn more about the work that you all do if they're interested? How do how do we send folks your way?

Meg 
Yeah.

Meg 
Absolutely. You can check out the Pop Health podcast where we talk a lot about active healthcare transformation and policy and the where the two bump up against each other and how people navigate through that. And then our firm is Coral Health Advisors, so Coral HealthAdvisors.com.

And I'm on LinkedIn, so people can find me there.

Heather 
Awesome. Yeah. And people should when they are encountering what problem should they reach out to you at Coral Health Advisors?

Meg
if people are wondering how to get in touch with us or who we help, we really have two sides of our business right now. One is government programs. So we are directly supporting agencies, federal and state, with RHTP implementation, with payment model implementation, with the dis with the design of new payment models, and how to recruit participation to them. On the private sector side, we're supporting all the ways that health systems and tech organizations and clinicians are coming together to transform care under payment models that hold them accountable for those outcomes. So if you're thinking about which program, if you're thinking about how to engage or how to contract, if you're thinking about how to get the lift in in health improvement outcomes inside a healthcare delivery or private center organization, those are the types of questions and the types of challenges that we Help clients.

Heather 
Whew. Big system tangly challenges that you are navigating there that operate at all levels of technical, operational, strategic, political, cultural, all of it.

Meg 
All of it.

Heather 
Well, congratulations to your small biz as it is getting bigger and bigger over time. It's exciting to see what y'all are up to. And I really appreciate your curiosity. Curiosity brought this topic to the table and I think it's where I landed at least on the remember yeah, to stay curious and and keep growing and learning.

Meg 
Thank you so much for having me.

Heather
You're welcome. Thank you so much for being here. Thanks everybody. Share it with somebody you know if you thought this conversation was helpful. It's how this conversation keeps going and growing too. See you next time. 

The Stand in the And podcast is supported by Human Centered Strategy, where we help leaders and teams build connection and strategy and complexity so that everyone can flourish. To learn more or to work with us, please visit us online at humancenteredstrategy.com. Or message me on LinkedIn.