Outset and Origin Story

The challenge Camber Collective faces, as a consultancy for an equitable and regenerative world, is how to build a project delivery model that reflects its equity-forward values. The firm’s journey began nearly a decade ago, when one of the founding Partners, Hope Neighbor, collaborated with the Hewlett Foundation to understand how women and families in Niger make decisions about, and access, family planning services and products.

Working with local partners, the Camber team interviewed local stakeholders: women, providers, and other community members to assemble a broad prism into 1) what was needed by the community and 2) how to design for holistic, sustainable, and community-relevant outcomes. This first-of-its-kind project led to a segmentation analysis and design of new programs enabling local community health workers and the Ministry of Health to better meet the needs of people and communities.

From this initial foray into equitable design, Camber’s approaches and methods have deepened. A central tenet of Camber’s evolving theory of impact is to build upon the opportunity — and indeed, necessity — to instill localization and co-creation while elevating the constituents and communities most impacted.

Key Principles and Considerations

Positioning constituents and communities as key thought partners and participants would allow Camber to engender deeper, more authentic, and sustainable practices, and further its progress towards key equity-forward principles first adopted by the firm in 2021.

Among these considerations were:

• What is Camber’s role, as change-agents, or at least indirect purveyors of social impact, in integrating equity into project delivery?
• What nuances or contexts regarding cultural, community, geographical, racial, or other differences and distinctions risk being overlooked or unconsidered?
• How could the firm, from its advisory role, continue to lift up the voices and ideas of those whom our clients and we intend to serve?
• In what ways could models for research, analysis, and project conceptualization and design be more inclusive of differences (culture, community, class, race, income, education, etc.)?

These were just a few of the top-line considerations that fueled a series of team-wide conversations that began in earnest in September, 2022.  Camber sought to consider how, as a consultancy, the firm could live up to its aspirations and effectively assess, catalogue, normalize, incorporate, and amplify equity in project design, delivery, and dissemination. In so doing, the firm also identified opportunities to continue its deeply collaborative, trust-based, and non-extractive partnership approach.

Applying the Model to the Consultancy Sector

As a B-Corp consultancy committed to continued internal growth and learning in anti-racist and equitable practices, Camber also sought to integrate equity into its business model. The team embraced the mission-alignment around addressing injustice and systemic oppression that is deeply ingrained across societies, while recognizing the importance of developing strong client delivery.

Successfully partnering with community stakeholders while delivering upon client requirements, Camber Collective was able to successfully insert these new organizing frameworks and methods and tools under the moniker of Equitable Project Design.

Basics of EPD

Equitable Project Design (EPD) has its basis in the concept of Liberatory Project Design, a concept of the National Equity Project which seeks to apply an equity-focused lens to traditional Design Thinking principles.

In contrast to the mission of product designers, social movement organizations, or community-based organizations working towards direct service goals, Camber embraced the opportunity to refine the lens to more closely adhere with its purview and impact theses as a strategic advisory firm.

Equitable Project Design has five concentric spheres of activation:

Camber’s role as a consultancy requires approaching client work with curiosity, and using the talented staff’s capabilities to influence how clients consider and integrate equity into their research, analysis, strategy formulation, decision-making, and partnerships. Camber’s Director of Impact and Equity, Rozella Kennedy wrote about this aspiration in late 2022, as EPD was taking shape as an organizing principle:

As in all facets of the world and life, a 100% purity attainment goal is unrealistic. Not all clients and contexts will align with Equitable Design principles in uniform ways, and the journey is also iterative. To keep us anchored in our own values and vision of social impact and systemic change, we are establishing a team playbook of considerations across the entire project cycle that will help us execute the work with honesty, confidence, and equitable influence.

The ”MVP” of EPD

Camber Collective’s full Equitable Project Design framework includes over 130 questions and considerations across a typical project lifecycle. Distilling them down to ten top tenets, or an “MVP,” (minimally viable project) reaped these considerations.

Understanding the equity context and project parameters

1. Do we understand the context and equity issues at play within their field or those faced by their constituents? What do we want to change? Who can help us? Who/what stands in the way?
2. How much can we really influence, where/when do we agree to ease up? How does this flow fit into our overarching or long-term theory of influence and impact?
3. What do we know about where the client is in their equity journey? How will we push them or how might they push us? What’s the “give and take” we need to map between immediate impact and long-term influence?

Preempting potential equity “blindspots”

1. How are we aware of and ensuring we do not perpetuate white saviordom and the white, colonial, or male gaze in this project? How can we proactively discuss, codify, and navigate scope boundaries so we avoid becoming “white saviors”—even if we are asked (directly or indirectly) to play that role?
2. How will we avoid forcing or assuming a Global North (Western/US/EU) mentality into the project? What local power systems, brokers, influencers, and situations must we learn?

Navigating power dynamics

1. What balance can we strike between “capacity building” (which implies we know everything already) and “collaborative convening and co-design” (which is less assumptive)?
2. Who holds power and should/can cede some? Who holds power and is not in the room, and how can we bring them in?

Continuous learning and sustainability planning

1. To what extent can we ensure the work and our learnings are most accessible to the field, including communities who will most benefit? (publications, budgets, conferences, etc.)
2. What tactics, resources, and connections can we put in place to ensure that the relationships and levers we build do not shut down forever once our project is complete? What’s the “sustainability” plan for the project and the partnership?
3. What will we learn/measure/report out to the team at the end of the project that furthers our learning and growth in equity, and how?

Progress at the End of Year One

Over the course of 2023, Camber Collective integrated many of these constucts into client work, and continues to leverage EPD as its value and brand differential. A lookback, as the firm approaches the two-year mark of this concerted phase of its equity project delivery plan, illuminates several high-water marks of success, with tangible organizational tools and resources that anchor this continued work:

• A curated set of over 130 equity considerations and markers, sorted project phase, that can be incorporated into the full project lifecycle, from scoping to delivery to closeout
• Revised set of internal project tools with a focused embedding of equity considerations into the work
• In-progress library of resources, frameworks, and learnings for all of client serving sectors that incorporate equitable principles overall, and by sector
• Application of EPD into the firm’s own internal ways of working: learning, celebrating, building belonging, and leadership at all levels

Next Priorities for Equitable Project Design

The work continues for Camber Collective, with an attenuated focus in 2024 on developing a deeper focus on factors, both personal, interpersonal, sectoral, and societal that impact how “equity” is, and at times, is not integral to project and program design. This builds upon the Equitable Project Design mindset the firm had already been utilizing unofficially since its formation a decade ago. Some of these factors include:

• Consideration of historical/colonial contexts
• Removing barriers that marginalize or de-center “the voice” of the affected
• Valuing and centering local experts for their participation, including through compensation
• Deepening the application of cross-sectoral/intersectional framing
• Employing equitable sampling and data analysis
• Continually relying on storytelling and visual narrative, to underscore that narrative is a key component of systems change and collaboration, particularly across cultural, geographical, and other divides.

Camber Collective’s broader goal is to see ongoing and future work leverage EPD in ways that encourage innovation, equity, and co-creation—such that Equitable Project outcomes becomes the norm. In the words of CEO Brian Leslie and Director of Impact and Equity, Rozella Kennedy:

“As our firm becomes more deeply adept at authentically and systematically embedding and delivering equitable strategies and solutions for our clients, we can collectively galvanize equitable, transformative outcomes in constituent communities our clients serve. In so doing, Camber can meaningfully contribute to redressing the systemic injustices and oppressions that are so deeply ingrained in our society. This is our Grand Vision, and we are grateful to our clients, partners, associates, friends, and even strangers with critical voice, who help us continue to advance in this direction.”

Read more about EPD in action in Camber Collective’s 2023 Impact Report, published in February, 2024.

The post Equitable Project Design: Anchoring the Practice, Deepening the Impact appeared first on Camber Collective.

Introduction: Camber’s 2023 Impact Report

2023 was a year of growth, impact, and learnings at Camber. We’re excited to share this report as we look back on our work with clients and partner organizations around the world.

Our mission is to drive impact and develop talent in an economically sustainable model. In 2023, our first as a B-Corporation, we doubled the size of our organization with amazing new talent and seeded the social sector with Camber alumni taking on new roles in organizations driving equitable outcomes in health, prosperity, and climate. We worked closely with our clients and partner organizations to influence and amplify impact. This Impact Report highlights a select set of projects across our priority sectors and issues, and we welcome your feedback and input on how we can continue to improve our work and partnerships.

As we look to the future, we can all do more to drive equitable outcomes, processes, and policies. Camber is proud to launch Equitable Project Design and our Gender Equality Sector. Equitable Project Design integrates equity into every aspect of our work, from project scoping and design to methods and deliverables. Our Gender Equality Sector represents a formalization of over a decade of our work tackling the barriers to equality for women, girls, and sex and gender minorities.

Camber is a consultancy for an equitable and regenerative world. We are grateful for your partnership as we continue to grow, learn, and influence impactful programs globally and locally.

Wishing you an impactful and growth filled 2024.

Brian Leslie

CEO and Co-Founder

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Equitable Project Design Origin Story

The concept of Equitable Project Design was instigated from a puzzle: how could Camber Collective authentically elevate the voices, ideas, and power of those whom we mean to serve? A little over 10 years ago, one of our founding Partners, Hope Neighbor, worked with the Hewlett Foundation to design an effort to understand how women and families in Niger make decisions about, and access, family planning services and products. We worked with local partners, surveyed and interviewed women, providers, and local stakeholders. This first of its kind project led to a segmentation analysis and design of new programs to enable local community health workers and the Ministry of Health to better meet the needs of people and communities.

Our approaches and methods have evolved as we progressed on our equity journey. We saw an opportunity, and indeed, a necessity to instil localization and co-creation, elevating the constituents and communities most impacted as key thought partners and participants in strategy formation.

As professionals driven to advance the greater public good globally and locally across health, shared prosperity, gender equality, and climate, we wanted to push ourselves to a deeper, more authentic, and sustainable practice centering the equity promise that we had adopted as an organizing principle in 2021.

What was our role, as change-agents, or at least indirect purveyors of social impact, in integrating equity into our project delivery? What cultural relativisms were we overlooking? How could we, as the advisers and “helpers”, continue to lift up the voices and ideas of those we mean to serve in how we researched and analyzed, conceptualized and designed, and supported execution of  social impact programs?

Pondering answers to these existential considerations evolved into a series of team-wide conversations about our evolving approach to client engagements and delivery. What were our aspirations and values around racial, gender, and social equity, really? And how could we effectively assess, catalogue, normalize, incorporate, and amplify these in our project design, delivery, and dissemination? And if we succeeded at all that, how might it support both processes and outcomes that are more collaborative, trust-based, and non-extractive?

Whatever conveyances lay ahead for Camber, we determined, would be underlain by a commitment to continuing our growth and learning in anti-racist and equitable practices, and our collective agreement to address the injustice and systemic oppression deeply ingrained across societies. Our stance would need to incorporate ongoing, focused learning, and pinpoint a few key guideposts and deliverables. And as our efforts cannot succeed in isolation, we would have to identify ways to both guide and learn from our clients, project delivery partners, and community stakeholders along this journey toward elevated equity. We also knew that as consultants, we needed an organizing framework with supporting methods and tools, and we gave our framework a name: Equitable Project Design.

Refining and Defining Our Concept

Equitable Project Design (EPD) has its basis in the concept of Liberatory Project Design, a concept of the National Equity Project which seeks to apply an equity-focused lens to traditional Design Thinking principles. In contrast to the mission of product designers, social movement organizations, or community-based organizations working towards direct service goals, we embraced the opportunity to refine the lens to more closely adhere with our purview and impact theses as a strategic advisory firm.

Emanating outward, from the existentially essential level of personal bias, mindset, and growth, all the way to systemic change, our theory of impact around Equitable Project Design has five concentric spheres of activation:

As visionary as this concept is, we enshrined a realistic mindset into EPD from the start. As we said in our November, 2022 article:

As in all facets of the world and life, a 100% purity attainment goal is unrealistic. Not

all clients and contexts will align with Equitable Design principles in uniform ways,

and the journey is also iterative. To keep us anchored in our own values and vision

of social impact and systemic change, we are establishing a team playbook of

considerations across the entire project cycle that will help us execute the work with

honesty, confidence, and equitable influence.

With determination, we envision that employing this lens and approach will allow the firm to grow and evolve to a place where all team members will have the tools and competency to guide our teams and clients through issues of equity that affect their organizations, industries, and stakeholders. Ultimately, we aspire that our equity lens becomes a key aspect of our brand promise as well as a touchstone for client confidence and trust, centered on values alignment.

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EPD MVP: Key Tenets of Equitable Project Design

A year and a half after our initial conversations, we can celebrate some of the many important marks we’ve made along this journey, with tangible organizational tools and resources that anchor this continued work:

• We have built curated set of equity considerations by project phase, over 130 questions and markers we can incorporate into the full project lifecycle, from scoping to delivery to closeout
• We have built and revised our internal project tools with a focused embedding of equity considerations into our work
• We have begun building a library of resources, frameworks, and learnings for all of our client serving sectors that incorporate equitable principles overall, and by sector
• Having socialized the framework and elements with the team, we are now applying EPD into our own internal ways of working: learning, celebrating, building belonging, and leadership at all levels

Having a definitional framework has provided an anchor and organizing principle to scale the implementation and impact. This trajectory was already evident in a 2022 blog post in which we said:

As we build out this values alignment in our practice and demonstrate a deeper focus on equity and sustainability, we are even finding that new partners who were skeptical of the consulting sector writ large are eager to engage with our services. We are gratified to see this development, for we do believe that, by integrating equity into our theories of influence and client work, Camber Collective can help disrupt and dismantle the collective history of racist, exclusive, extractive, and colonial practices in the humanitarian and philanthropic sectors.

This report highlights some of the project work and sector impact that we are pleased to have driven in 2023. In addition to the client work, of which just a few illustrative examples are included, we also have leveraged this framework for how we define and position our internal progress and brand promise. Some of our major considerations include:

Please peruse some of the highlights from 2023 that incorporate Equitable Project Design principles. (Full report pdf is here.) Equitable Project Design-inspired elements are bolded in the below case studies.

• Gender Equality: The Women’s Health Innovation Opportunity Map
• US Health: Including Fathers in Family Care: WA Fatherhood Council         
• US Health: Broadening Access to Crucial Health Care
• Global Health: Task Force for Global Health Campaign Effectiveness Coalition       
• Climate: Building Bridges Across Intersections         
• Shared Prosperity: Finding Prosperity for More: What Contributes to Lifetime Income?    

Priorities for Further Expansion

Building upon not only these project outcomes, but our EPD approaches that were “hiding in plain sight,” we recognize a few key deliverables that will help us scale and broaden this approach. Above, we share our in-progress “EPD MVP” (minimally viable product) universal guidelines for our projects, determining, when possible, how to incorporate key equitable practices (many of which we had been employing for quite some time) such as:

• Application of historical/colonial context
• Centering the voice of the affected, and compensating our local experts for their participation
• Applying cross-sectoral/intersectional framing
• Employing equitable sampling and data analysis
• Continually relying on storytelling and visual narrative (as you will read in this report)

This report serves both as a sample lookback to some of our progress in EPD work, but it also helps pave the way that we wish to continue evolving the practice. It is our hope that our ongoing and future work will leverage EPD to encourage innovation, equity, co-creation, and norm-shifting. We want Equitable Project outcomes to become the norm.

As our firm becomes more deeply adept at authentically and systematically embedding and delivering equitable strategies and solutions for our clients, we can collectively galvanize equitable, transformative outcomes in constituent communities our clients serve. In so doing, Camber can meaningfully contribute to redressing the systemic injustices and oppressions that are so deeply ingrained in our society. This is our Grand Vision, and we are grateful to our clients, partners, associates, friends, and even strangers with critical voice, who help us continue to advance in this direction.

The post 2023 Report: Forging Impact appeared first on Camber Collective.

Around the world, over 5,000 Certified B Corporations in over 70 countries receive this designation, demonstrating they have met the highest verified standards of social and environmental performance, transparency, and accountability to all their stakeholders. While many corporations state a commitment and actions to ESG (environmental, sustainable, governance) best-practices and positive social impact, B Corps are legally required to consider the impact of their decisions on all stakeholders: customers, workers, communities, and the environment.

While there are B Corps represented across more than 150 industries worldwide, there are but a handful of strategic advisory firms in the mix. Camber Collective is elated to have become a certified B Corporation at the end of 2022, receiving a score of 100.9 points on the B Impact Assessment, a rigorous measurement of a company’s overall impact on its workers, community, customers, and environment. (The minimum performance score required to meet the requirement is 80.)

I recently talked with our co-founders Brian Leslie and Ted Schneider about what Camber Collective hopes to both gain and model by being a Benefit Corporation. This article has been edited for length and clarity.

Q: The B Corps has been around since 2007 and many of us recognize their “circle-with-the-letter-B-inside’ as a seal of approval. Not everyone knows what’s behind the logo though—a commitment to using the power of business to solve our most pressing global challenges. B Corps certification provides an immensely powerful way for corporations to build credibility, trust, and added value in the marketplace. Is this why you sought to pursue B Corps certification for Camber Collective?

A: One of the primary motivators for our pursuit of certification was to show our commitment to social impact. Camber, as a strategy consulting organization, strives to address today’s most urgent challenges, systemically, sustainably, and equitably. Our values aligned strongly with the principles of B Corps, and we saw many further benefits to becoming affiliated.

We would not only have proof, as it were, that we are committed to positive social impact goals, but we would also be accountable, in a transparent and public fashion, to measure and sustain that commitment.

Q: Yes, because certification has to be renewed every three years. So, certification creates a built-in requirement, making sure that we walk the talk.

A: Another element of being a B Corp is there is a measure of transparency insofar as B Labs publishes a summary version of every B Corp’s Impact Report, so that the public can see how the company compares to other businesses in their industry or sector across a variety of social impact measures.

How to Walk the Talk

Q: This is an interesting point. There are not a lot of consultancy firms in the B Corps cohort I imagine; there must be some evident advantages in the market for us in gaining this certification.

A: There are a lot of advisory organizations and consultancy firms that say they are values-driven, and while they might measure one or two elements of social benefit and progress, the B Corps certification process is quite rigorous. A B Corp must demonstrate excellence in areas, such as management practices, that can sometimes be opaque when corporations report on themselves, and entirely control the narrative of what they wish to divulge!

The certification process helped shine a light on some of the ways we had already differentiated ourselves – for example, we introduced a transparent and equitable compensation model 7 years ago. We now possess a framework for how we manage the firm in a way that keeps us above a certain threshold. So, it’s not just words, it’s a level of assurance and demonstration that we have to execute, measure, and maintain.

Many firms use the words that B Corps includes in its mission: building an inclusive, equitable, and regenerative world, but if you are a B Corps, you are required to show it, on an ongoing basis. There is nothing in that statement that is misaligned with our own values or the way we try to operate and grow our firm.

Tax Code Does Not Equate Virtue, or Lack Thereof

Q: Let’s stay with the self-governance topic for a minute more. Camber is a social impact advisory firm that works for equitable and sustainable outcomes. At the same time we are an LLC, and not a nonprofit corporation, which is the legal entity people generally associate with altruism, positive impact, and social good. Foundations are not-for-profits, for example. How does our identity as a for-profit firm create both opportunities and misconceptions, and does being a B Corps help mitigate this dissonance?

A: We sometimes hear what almost approaches a purity test in the social impact space, wherein nonprofit equals good, and for profit equals harmful, extractive, and bad. One of the great strengths about the Benefit Corporation certification is that it models a third way out of that binary.

These are companies that not only perceive themselves as enacting positive outcomes in the business world, they are given the opportunity—and the mandate—to demonstrate that, through both hard data and ways of working.

Q: I like that framing of it as an opportunity. Sometimes there is a knee-jerk assumption that if you are a for-profit company, your goal is to make the most return on investment, full stop. If anything good for society comes out of your venture, that’s secondary. But it seems like B Corps provides industry a way to model that defining and tracking positive impact is not that hard. In this moment of climate emergency, consumers, investors, and employees alike are all asking for companies to demonstrate they are good.

Some might not have knowledge or access to the tools to know how to best accomplish this; so the examples and resources B Corps provides through its outreach and brand actually have trickle down benefit even to companies who do not or cannot at present pursue certification. There are over 75,000 businesses actively using B Lab’s B Impact Assessment and benefit corporation governance structure, and many more who are incorporating B Corp Talking Points into their theory of change and business model.

A: That’s true. It is a good entity, for both direct and indirect impact in the business world.

Q: Yes, and now that they are more global, the potential for world-changing is even bigger. OK, I see that values alignment and accountability were key drivers in the decision to pursue the certification. I imagine there are also significant upsides in terms of the brand and market differentiation.

A: Yes, and this assertion extends the notion of pushing past the nonprofit/good, for-profit/bad binary we were just discussing.

We believe that being a B Corps is wonderful for Camber in terms of, again, not just saying, but proving that as a consulting firm and an advisory firm, we bring a profound set of social impact values and activations to our practice. And in our sector, that is a market differentiator.

We didn’t join B Corps expressly to attract more clients, but we sense becoming part of this cohort will over time connect us more readily with the kinds of agencies and entities we want to work with and assist, and it will provide opportunities for learning and exposure to positive impact best practices to improve Camber’s practices.

One facet of this, with broader lens, one with which you are very engaged, is the complexity around navigating internal equity and belonging. The B Corps has a growing body of work around SDG tracking, and increasingly so when it comes to DEI, racial equity, and anti-racism. They are growing their awareness, communities of practice, and bodies of work around these concepts, and indeed, we expect to not only to learn from these cohorts, but to be able to contribute to the discussions as well.

Q: And not just regionally or nationally… B Corps is a growing transnational entity, which I imagine will open networking and community-building opportunities for us as a global firm.

A: Most definitely. We are not approaching certification from a hardcore business development lens of: “let’s go find new clients,” but more from a viewpoint of, “how can we build an even more robust network with familiarity and trust,” which can lead to collaborations,  brand visibility, influence, and certainly referrals too.

To put a finer point on it, many B Corporations are consumer brands, which we are not. But we know that people not only want to buy from companies whose demonstrated values match their own, but they want to partner with them, hire them, and work for them. All of these facts provide tremendous opportunity for Camber.

Q: Yes, indeed, this looks like a very impressive community of peers to interact with—as they say, a community of “high performing peers.” I have seen many indicators around B Corps on the aggregate that show we are entering into “good company”: To pull from their fact sheet, compared to ordinary businesses, B Corps are:

• 9% more diverse
• 33% more likely to have gender-inclusion trainings
• 48% more likely to have LGBTQ-inclusion trainings
• 45% more likely to have Diversity and Inclusion training (on people of color)
• 49% more likely to employ managers from traditionally underrepresented groups in comparison to ordinary businesses (in the U.S.)
• 41% more likely to have conducted a pay equity analysis by gender, race/ethnicity, or other demographic factors and, if necessary, implemented equal compensation improvement plans or policies to manage and improve workforce diversity and inclusivity in comparison to ordinary business (which 43% of B Corps do)

Opportunities for Impact

These are impressive DEI levers. I also found impressive data around ESG impact. Compared to ordinary businesses, on the global level, B Corps:

• Protected 200,000 hectares of land, offset 16 million tons of carbon, saved 225 million liters of water, and diverted 207 thousand metric tons of waste in 2020
• Outperform on natural-resources conservation by 15%
• Are 2.8x more likely to use 100% low-impact renewable energy 9% of B Corps in developed markets have offset 100% of their GHG emissions, and are 2.5 times more likely to be carbon neutral
• Are 1.1 times more likely to donate more than 1% of their revenue to charity
• Are 28% more likely to have hosted or organized company service days in the last year and 71% more likely to offer paid time off for community service
• Are 75% more likely to hire workers from chronically underemployed populations
• Are 150% more likely to have supplier policies that encourage purchasing from local suppliers
• Screen suppliers based on use of positive social and environmental practices 210% more often 
• 32% of B Corps have a policy to give preferences to use suppliers that are owned by underrepresented groups (400% more likely than ordinary businesses)
• Are 1.9 times more likely to provide training/resources to improve the social or environmental performance of its suppliers, either through the company itself, or through a third party in comparison (23% of B Corps achieve this standard)

A: These data indicate congruence in practice with our theses around Just Transition and equity. And even though many of these measures don’t apply to our business model (we don’t manufacture products or sell consumer goods, for example), the shared thought leadership is very exciting, as is the alignment with the goals of our clients and partners.

Influence and Be Influenced

Q: Since we have been on our own ESG journey, specifically around racial equity, I would imagine we see many opportunities to influence companies in our circle as well, through some of what we are learning and experiencing as we grow as an advisory firm. What opportunities to learn and teach excite you?

A: There are so many opportunities to learn and upskill within the B Corps ecosystem. We were attracted by the depth of technology, talent, and expertise accessible within the B Corps community. And there is something really terrific about being in cohorts that have already figured out a lot of the issues around growth, scale, etc. that we are facing as a firm.

These include nuts and bolts topics like managing distributed teams, working across time zones—and even things one doesn’t necessarily correlate to strategic consulting, but which do touch upon some of our work with health care and product distribution, such as global supply chains. Additionally, our climate and environmental work is very focused on Just Transition and influencing the private sector to be better environmental and sustainable citizens. So, we see many ways to be in circles of influence and develop our own theories and practices more deeply.

Camber is now connected within a network, which provides some opportunity for building relationships with organizations that are also on a pathway to positive impact. Both when it comes to climate, or when it comes to equity and anti-racism, and even issues like how do we manage travel: client visits and workshop delivery while also trying to grapple with our own carbon footprints?

Such discussions and solutions are so essential, and existentially important. It’s encouraging to feel we aren’t going this alone, but are part of a global group of enlightened companies and entities all navigating similar challenges and driving towards the same kinds of positive solutions.

Q: Yes, B Labs has some 15 or 20 years in this game, and have a profound track record of driving positive social change. It’s unique.

The Power of Many

A: And furthermore, the opportunity to network is tremendous. We pride ourselves in being functional experts, but we are not deep content experts in every single are, nor in every single geography. There will be lots of opportunities for Camber to continue building networks of organizations and firms doing best-in-class work around everything from sustainability, to how they manage across geographies, to the efficiency tools and methods they use, just to name a few.

Take one of the most visible examples, Patagonia. They set the standard for ESG and social impact as a B Corp, and now they have shifted their model to be employee-owned. Seeing what they do gives all of us a vision for how we can become better, and evolve, and grow with what our models and realities evolve into.

I think the influence and learning and osmosis of being in these very enlightened corporate thinking spaces is going to be enormously impactful for Camber.

Q: And while we won’t be sitting in weekly meetings with hundreds of B Corps companies, there are formal and informal spheres of interaction and influence we will engage with. What other ideas or opportunities do you see in this aligned space that can help us positively influence our new peer circles in the B Corps?

A: Well, the B Corp itself is ever-adapting, and learning, and growing. And so we are all in a way on a similar path of evolution. Racial equity for example is becoming a bigger part of what they’re trying to do. In fact, when we first started in on the assessment process, their racial equity component was just starting to emerge.

I think we, and other firms that are paying close attention to these levels, will have a lot to bring to the table. And congruently, we as Camber will find ways to elevate important aspects of this shared work to our peers in the advisory space, and nonprofit, government agencies, and foundations we work with, over time.

Q: This is all a great deal of upside. Why isn’t every corporation with a good mission statement a B Corps?!

The post Camber Collective is a B-Corporation appeared first on Camber Collective.

Our Call to Action. Our appreciation for the power of narrative and conversation comes from our understanding of its power to move people to action. Here are a few actions the panelists have shared for your consideration in continuing to do our parts in creating a more equitable food system:

1. Leverage your consumer power. It is stated so often because it is undeniably true, especially in the Bay Area: Consumer power should not be underestimated or taken for granted. If you have the ability to shape your consumption patterns around local, sustainable products, learn more and take action as you can. 
2. Engage beyond consumerism. It’s important to recognize and reflect on your roles in and relationships with your food communities, and in your communities more generally. How can you engage with and participate in your communities not just as a consumer, but also as a shaper of the culture around you?
3. And engage long-term. One monumental way to engage with and support your community outside of local consumerism is to support in perpetuity a non-profit or other mission-driven collaborative that you really believe in, rather than one-time giving.

Powerful Quotes from the Panelists:

“Food systems, like every system, are born from culture… If you’re going to change a system, you need to look at the culture it’s feeding from.”

– Ada Cuadrado-Medina

“From a growing standpoint, we live in this incredibly amazing Mediterranean climate that allows for so many different types of things to be grown. Combine that with – and this comes from the next generation of people doing work in the tech sector or Silicon Valley – a growing demand from people who care more about where their food is coming from and who want a high quality of food, which is also a function of affordability and access… What I would love to see is all [these resources] being leveraged into this opportunity to overhaul the food system status quo as it is and create alternative and collaborative approaches. How do we all navigate this capitalist system in an ethical and equitable way where we hold institutions and governemtns accountable and change who some of the gatekeepers and rule-makers are in the food system?”

– James Nakahara

“The food system has been always a very difficult system for working people. It has always tried to extract the most amount of labor for the least amount of renumeration”

– Perri Kramer

“We tend to think of the world as a series of objects with boundaries, and not as the relationship between features. The more we lean into realizing everything is connected more so than we know there is a lot of wisdom in shifting the paradigm from ‘this is mine and that is yours’ to ‘What are our responsibilities to each other and what is best for the planet and our communities?’ The way that can manifest is through collaboration between these different entities – be they corporate, institutional, governmental, or non-governmental.”

– James Nakahara

“All of us are working within the constraints and challenges of the capitalist system to try to create a more equitable and just existence for the people we serve. Food System 6 does a lot of work with corporate partners to try to educate them on the way in which we view entrepreneurship and innovation; we focus on food sovereignty which is people owning the means and ends of their own production, and food ownership stays within communities and that allows them to be empowered.”

– Perri Kramer

“Rudy Jimenez, a fourth generation farmer, spoke at a recent event for Real Food Real Stories and had this moment of realization when he decided to become an organic farmer that it was spiritual work that he was doing: he wanted his community to have access to that food, and was asking the question ‘How can this place that has so much abundance have such little access to that same food? And why are we letting corporations decide stories for us?’ That is beautiful to me and really captures the spirit of what democratizing really means – giving people the ability and tools to take that power and make the story for themselves and their community.”

– Ada Cuadrado-Medina

The post One State, Two Systems | Food Equity Event appeared first on Camber Collective.

The post A New Paradigm for Resource Distribution appeared first on Camber Collective.

by Ben Jenson, Matt Holman and Gavin Boileau

Our intention with this post is to imagine what a better future for rural health care could look like, including the key elements or building blocks most critical to making the transition. We also consider the sustainability of proposed future models and the potential impact on rural communities.

KEY BOUNDARY CONDITIONS

The pace of innovation in healthcare is constrained by a complex web of existing regulatory and incentive mechanisms that collectively reinforce the status quo. While these forces remain significant, we believe the disruptions created by the COVID-19 pandemic offer an unprecedented opportunity for systems-level change.

Many of the regulatory adjustments associated with COVID-19 are supportive to transforming rural healthcare, including CMS Section 1135 Waver and Section 3704 of the CARES act, which (in some cases temporarily) enable: (i) a meaningful removal of barriers to inter-state telehealth regulations, (ii) non-HIPAA compliant platforms, and (iii) “rural-to-rural” telemedicine by allowing rural sites to serve patients at other rural sites (including their own place of residence). The continuation of these practices, particularly the first and last, are instrumental towards enabling the telehealth component of the system we propose.

While current conditions provide some tailwinds, transforming rural health also requires trade-offs that current reimbursement models strongly disincentivize. In general, delivery of high-quality and cost-effective care will require a significant shift away from delivery of elective surgeries and specialty care on-site at rural facilities. These procedures tend to be major revenue drivers for rural facilities and systems, and thus will require that payers, particularly Medicare/Medicaid, increase reimbursement for primary care and behavioral health services or otherwise redesign incentives to compensate for this shift.

THE NEW MODEL

Modernizing our rural health care delivery system will require changes across three broad dimensions, in ways unique to individual community needs, in shifting away from the current paradigm of rural health as a full-service one-stop shop to one that is more fit for context and purpose given our current available technology and resource constraints:  

Shifting Site of Care Paradigms: Quality outcomes in healthcare tend to favor volume and comparative advantage, and for most complex specialty care the level of procedural volume and expertise is lower in rural communities than in regional or urban hubs.  This does not mean that rural residents should settle for poor care or outcomes, just as lacking a high-end department store does not mean they cannot have high-end merchandize delivered to their doors within a few days.  The rural retail experience has been thoroughly reordered over the past decade, and rural health can produce better outcomes at lower costs by applying a bit of modern technology to evolve the current supply chain and logistics of care delivery.  In an ideal future, the majority of rural healthcare resources would focus on delivering comprehensive primary care that addresses a range of physical, behavioral and chronic care needs (including ancillary preventive care such as vision and oral health). Low-volume specialty care services and procedures should largely be provided via regional or urban centers of excellence, via telehealth-based models for visits or consultations or via stabilization and transport for more urgent procedures. Depending upon regionally-specific specialty needs a smaller and more targeted set of specialty services could continue to be delivered within rural communities. Emergency services would continue to be provided but be further focused toward a stabilization, triage, and transport model which limits required local hospital bed capacity. All of these changes would require rural health systems and payers to adopt more sophisticated referral mechanisms and networks as well as fundamental changes to incentive mechanisms to achieve buy-in from providers and patients alike.

Re-Architecting Infrastructure: In practice, shifting specialty and procedural volume out of rural communities may look less like a downsizing and more like a repurposing of existing space and shared resources. Hospitals and their affiliated clinics are often the economic engines of the rural areas they serve and provide considerable high-quality and multi-purpose space. Repurposing space could allow rural health systems to serve as a flexible center of holistic, community health. Operating rooms, intensive care units and other spaces no longer needed could be retrofitted into a space for community groups, civic gatherings, and seminars tailored toward physical health as well as social determinants of health. Private or mission-driven enterprises, including nutritional counselors, private retail pharmacies, or charitable groups, could leverage excess space.

Evolving the Rural Health Workforce: The proposed model of care would also require adjustments to the workforce of rural hospitals: namely an expansion of primary care and behavioral health providers as well as supporting resources to manage the enhanced logistics related to referrals, transport and case management necessary to provide an integrated patient experience. This should be buttressed by the expansion of education programs tailored toward rural health needs, including advance practice providers (e.g., NP/PA) that can play broad roles within the primary care-driven model. While specialty care delivered at individual rural hospitals will be downsized, COVID-19 presents a significant opportunity. In the past, rural health systems have struggled to hire specialists due to low patient volumes. However, recent telehealth regulation changes have allowed for rural-to-rural telehealth consults. This means that certain medical specialists can be located in rural areas and fill their time with regional service provision via a combination of telehealth consults and in-person care. Lastly, supplemental workforce adjustment is needed to adapt to a response, stabilization, triage, and transport model for acute situations. This could include additional EMTs and individuals able to staff the vehicles (e.g., helicopters, autos) needed for patient transport.

All system-wide changes come with tradeoffs. The adjustments we propose prioritize improving quality of care, increasing the sustainability of health care delivery in rural areas, and ensuring a breadth of access to care (understanding that much of this care will be delivered remotely). These steps reflect, at the highest level, a shift from profitability to sustainability of rural health care delivery. Without adjustments like these, we believe it is unlikely that the current model of rural health care delivery will be able to sustain itself.

While the model described will require major shifts to reimbursement, patient behavior, existing infrastructure, and likely policy to implement at scale, there are established cases where similar models currently exist and work very effectively.  One such model is Southcentral Foundation’s Nuka System of Care in Alaska, which focuses on the physical, mental, emotional, and spiritual wellness of its “customer owners”. (for more information, see this case study developed by their former CEO, Katherine Gottlieb). 

IMPACTS ON SUSTAINABILITY, QUALITY AND ACCESS

Rural health system sustainability is a complicated balance of cost and revenue considerations. On the cost side, patients will face competing out of pocket considerations, with the possibility of additional travel for acute cases, that may be offset fully or in part by reduced travel required given an increased use of telehealth care delivery. For health systems, the fixed costs related to providers, equipment and real estate oriented toward specialty care will be reduced, but costs related to transportation (e.g., ambulances & helicopters as well as their associated emergency personnel) will increase. The corresponding reimbursement mechanisms and regulatory framework will need to adjust to accommodate and sustainably compensate for these changes (e.g., reimbursement for primary care, referrals resulting in lower total cost of care, and coverage of emergency transport within an overall episode of care). It is likely that bundled payment or partial capitation models will be critical to adequately align incentives within this new model.

The challenge in making the case for improving quality in rural communities is that many patients do not perceive that they are receiving “low quality” care, and that the changes proposed here would in fact reduce the care available within their communities. In reality, what we are proposing would, if implemented well, result in far more comprehensive care and improved outcomes for most patients.  By focusing on primary care, acute care stabilization and triage, and specialty care referrals, rural health systems will be able to continue managing the vast majority of needs within the community while more rapidly connecting patients to care they need outside the community when they need it.

By focusing on lower-acuity care and leveraging telehealth to increase entry points into the health system, access can be expanded in the future model without any additional brick and mortar infrastructure being required. While this can be seen in some ways as a net neutral, the increased focus on supporting expanded (e.g., dental, behavioral health, etc.) service provision should provide a boost to primary care and public health resources in ways that makes preventive care more accessible and sustainable in the future.

CONSIDERING THE BIG PICTURE

Transforming rural healthcare will require many years and changes to incentives, regulations, infrastructure, and workforce. These changes themselves do not exist in a vacuum. This may require seemingly non-healthcare investments such as improvement of roads and airports, attracting new talent and retraining existing talent. It will require creativity in re-purposing current infrastructure and tough decisions in eliminating services and providers that community members are attached to.  It will require thinking very differently about hospital finances and likely absorbing some turbulence and losses during the transition. It will require both payers and providers to take more risks, literally and figuratively, in testing and transitioning toward new incentive models. It will also require new sources of government and private philanthropic funding to help fill the investment gap in expanding the pipeline of providers offering primary care and supporting services in rural areas and enabling critical technology and infrastructure investments.

Rural health care delivery in the US is built on an old model, one that is propped up by federal funding structures and business practices that do not adequately address concerns of long-term sustainability nor the true health needs of their communities. The COVID-19 pandemic has revealed the imperative and created the conditions for broad systemic change in a way we have not seen in a generation. While we often think of healthcare innovations as emerging from urban health-tech hubs, perhaps the most exciting systemic changes to improve access and outcomes exist far to the periphery of traditional funding and focus within our rural communities.

The post Envisioning the Future of Rural Health appeared first on Camber Collective.

This is how Michael Pollan, American author and academic best known for his explorations of the socio-cultural impacts of food, concludes an article underscoring how Covid-19 has exacerbated the inherent vulnerabilities and inequities of our modern food system. Adding to the discussion, a recent paper published in the Journal of Peasant Studies provides a detailed history of how we came to inherit this food system, by outlining 70 years of policy choices focused on improving efficiency in response to previous food system crises. In the 1960-70s, efficiency was pursued through industrial production methods, then in the 1980-90s it was pursued through specialization and trade, and the last two decades have pursued efficiency through corporate dominated supply chains.[2] Consistent and compounding policy responses have led to a vulnerable food system that lacks resilience and has traded economic equity, human dignity, human health, and environmental preservation in pursuit of efficiency and concentrated profit. Recognizing this, the time has come for us to force the choices that will put us back on a path to a just, nutritious, and sustainable food system.

First, let’s talk about the current realities of the food system. Then, let’s explore theories for food system transformation. Finally, let’s think about what we can do to help keep our people and our planet alive and well.

Lest we forget one of the hot topics during the early months of this pandemic, Covid-19 exposed to mainstream media the ineffective, inhumane, and highly inequitable nature of our food system.[3] Taking each of those in turn:

If we focus on ineffectiveness, we remember how dumbfounding it was to watch as our food system forced farmers to dump hundreds of gallons of unsold milk and euthanize their livestock on one end, but was unable to accommodate food banks’ ever-growing lines of hungry families suddenly unemployed by the economic shutdown on the other end.[4] A food system built for efficiency has rendered it ineffective except under perfect conditions.

However, while our food system is ineffective at getting food to those who need it, it is effective at accelerating the spread of disease – a distressing reality to confront while we sit amidst a global pandemic. Old and new research has surfaced on how the food system quickly spreads infectious disease – since 1940, agricultural drivers were associated with more than 25% of all diseases, and greater than 50% of infectious diseases caused by germs that spread between animals and people.[5],[6] That said, food system transformation will greatly improve our chances of avoiding the economic and personal pains of rampant disease in the future.  

If we continue examining the food system from the angles of inhumanity and inequity, we remember how food system workers – often workers of color – such as food processing workers and migrant farm labor, continued to face increased illness and death as government mandates kept meatpacking facilities open and restricted labor protections.[7],[8] For many of these same workers and their families, symptoms of Covid-19 were exacerbated by chronic diet-related health illnesses such as diabetes and hypertension that continue to disproportionately afflict low-income communities and communities of color.[9] The food systems’ laser focus on lucrative outputs such as grains, meat, and dairy have long left low-income communities – again, many of color – able only to afford foods that do not fully nourish human bodies. These socio-economic realities (indisputably linked to racial realities) continue to play out in a food system that places more emphasis on profit and efficiency than on nourishment and equity.

Although the news has shifted to the latest-breaking stories, the blatant vulnerabilities and gross inequities exposed in our modern food system remain rampant. This alone provides increasing evidence for and recognition of the longstanding consensus that a concerted transition to smaller, local food systems with increased resilience, distribution of power, equitable access, and diversification of output is a necessary and pressing matter of public policy.[10],[11]

While the consolidation of global supply chains in the industrialized food system made things cheaper and more efficient, the streamlined processes collapse like a long chain of dominos in the event of the smallest of disruption. Smaller systems, on the other hand, can pivot and adapt to changing environments.[12] Their localized nature also means disease does not spread as quickly or as ubiquitously as a germ hitching a ride on the Global Industrialized Food System Express. And finally, although current political choices have created an environment that incentivizes and ensures concentrated power to produce problematic outputs, if power were shifted to local communities, they could make choices that sustain, strengthen and protect their communities with adequate worker rights and appropriate health foods.

Despite consensus on the solution, there is little agreement as to what choices we should make to feasibly arrive there, and who should make those choices. Given what we know about where power lies and given that lobbyists, lawyers, large profit margins, and consumer access might not be on the side of localized food systems for a long time, what can realistically be done?

While several theories of change exist, for each theory of change advocate, there are just as many critics.

First, to those who believe writing concrete scientific reports and telling compelling stories will shift beliefs and behaviors enough to shift policy incentives and consumer preferences, there are those who are not as convinced. While science and storytelling are important, looking to the climate movement as an example, we see evidence it doesn’t matter what is said and known generally, but rather what people in positions of political and financial power proclaim. Much like the climate movement, policy for a new food economy would be expensive, and has few short or medium returns. If communities and politicians fear immediate economic loss or political unpopularity more than they fear future scientific certainty, starting such a politically and emotionally charged conversation with scientific facts is useless.

Second, to those who advocate for solving this issue from a different angle, in which powerful food industry actors themselves transition business models towards sustainability, critics similarly say that as long as policies provide them incentives to operate as they always have, and insurance allows them to write off their losses from operating in such a way, it’s too risky – foolish even – to transition away from the status quo.

Third: What if people vote with their fork until consumer demand out-competes business as usual? Enter critiques: only those who both care about long-term health and sustainability and also have the purchasing power to make choices in line with their beliefs can vote with their fork. That specific consumer segment is not large enough to create system-wide change alone, and even if it were, the process would leave behind the very people we were demanding change for in the first place, given the high prices of food. Chronic lack of purchasing power and access is the reason why America’s dollar stores are able to sell more food nationally than Whole Foods.[13] Besides, for the industries that have decided to cater to this relatively small consumer base by flooding the market with “better for you” brands and fast-casual restaurants, the pandemic seeks to prove you can’t beat capitalism at its own game: in this new normal, the first foods to go are the ones with the most preservatives and longest shelf lives, and the fast food chains have been surviving much better than local restaurants.[14],[15]

It has been made clear that systemic issues rarely have perfect solutions and come with many more questions than answers. Urgency is imperative, but negligence can be deadly. In a world where health is a function of privilege rather than a human right, where excess supply is unable to meet excess demand, and where the land that provides us with our food is treated as poorly as the person working the land, it is time to demand policy change.

Thankfully, policy is much more than the work of politicians. While responsibilities and distribution of power are uneven, the responsibility to change policy is not on politicians alone, nor does the power lie exclusively with them. We as individuals have varying levels of power and privilege we are responsible for using to influence, inform, and initiate change. To change policy, we can do at least two things:

We can gain and share knowledge. Paramount to affecting policy is the interminable work of gaining and sharing knowledge from and with different times, peoples, and places. A well-rounded understanding of the challenges and opportunities can start with having a conversation with a friend, or watching a documentary on Netflix, or even typing a relevant question into the Google search bar. In parallel, it is important to critically analyze any knowledge in order to understand the relationships it has with yourself, the source sharing the knowledge, and the system the knowledge belongs to. For example, does the knowledge reveal anything about your own role in perpetuating the status quo and preventing change, or perhaps opportunities to affect change, based on lived experience, history, or privileges? Who is sharing the knowledge and why them?

We can exercise our right to engage in policy advocacy and voting processes. In a moment in history when political activism is so high, we all know how important it can be to add one’s voice to national elections. However, our voice can be used in local elections, or in any democratic process any organization or community you are involved with might have, too. Register to vote. Find out what decisions are on the table by searching candidates on the internet or emailing the head of the organization you are involved with. Vote for or defend the position that will likely not be perfect, but will bring us away from the status quo of repeated attempts to place efficiency above all.

Morality has been pitted against politics and profit, but such battles have been won before (take the tobacco industry, for example).[16] There is hope in the fact that we got to where we are based on policy, and so we can get ourselves out the same way.

[1] Michael Pollan (2020) “The Sickness in Our Food Supply,” The New York Review of Books

[2] Jennifer Clapp & William G. Moseley (2020) “This food crisis is different: COVID-19 and the fragility of the neoliberal food security order,” The Journal of Peasant Studies, DOI: 10.1080/03066150.2020.1823838

[3] Caleb Pershan (2020) “It’s still the Jungle Out There,” Eater

[4] Tyler Whitley (2020) “Op-ed: Don’t Blame Farmers Who Have to Euthanize Their Animals. Blame the Companies They Work For,” Civil Eats

[5] Albie Miles, Kathleen Merrigan (2020) “If We Get Food Right, We Get Everything Right.” Honolulu Civil Beat

[6] Laura Spinney (2020) “We Need to Rethink Our Food System to Prevent the Next Pandemic,” Time Magazine

[7] Andrew Restuccia & Jacob Bunge (2020) “Trump Takes Executive Action to Keep Meat-Processing Plants Open,” The Wall Street Journal

[8] N.a. (2020) “Impact of COVID-19 on people’s livelihoods, their health and our food systems,” Joint statement by ILO, FAO, IFAD and WHO

[9] Pollan (2020) “The Sickness in Our Food Supply”  

[10] Chloe Sorvino (2020) “Going Local: The Case For Bringing America’s Meat Supply Closer To Home,” Forbes

[11] Clapp & Moseley (2020) “This food crisis is different”

[12] Sarah Sax, (2020) “A Vietnamese Farmers’ Cooperative in New Orleans Offers a Lesson in Resilience,” Civil Eats

[13] Elly Truesdell (2020) “Grocery Wars: A Natural Foods Reckoning,” Food + Tech Connect              

[14] Ibid.

[15] Cathy Erway (2020) “What Happens When the Only Restaurants Left Are Chains?” Grub Street

[16] Paul Verkuil (1998) “A Leadership Case Study of Tobacco and its Regulation,” Public Talk: The Online Journal of Discourse Leadership

The post Influencing Policy to Transform Food Systems appeared first on Camber Collective.

by Joanne Lee, Zack Henderson, and Bethanie Thomas  

Collaborative working sessions. Open debate. Face-to-face sharing of expertise, experiences, and opinions. Hard-won alignment on a path forward.  

With COVID-19 disrupting workplaces around the globe, many impact-oriented organizations which rely on stakeholder input, consensus-building, and partnerships have found their decision-making processes paralyzed, hamstrung by distance and the complexity posed by teleworking.  

The pandemic has forced us to identify new ways to align stakeholders and build coalitions that don’t rely on the time-honored practice of bringing stakeholders together in the same room. In this environment, we have found the Delphi approach to be an especially powerful tool for consensus-building.  

The Delphi approach uses multiple rounds of anonymized feedback and reflection to bring panels of stakeholders to consensus on complex issues in a remote working environment. In fact, its very nature as a remote consensus-building tool brings added benefits in terms of improved participation by dispersed stakeholders, reduced influences of biases, and increased efficiency over in-person convenings.      

The Delphi approach has been used on a range of topics, from aligning experts around needs for global health technology development to creating shared public health roadmaps. At Camber Collective, we have used a modified Delphi approach to successfully facilitate groups toward consensus on topics ranging from scientific parameters for new health interventions to strategy development for emergent coalitions. 

How it works

Usually requiring three stages of participant engagement, the Delphi approach uses a transparent, iterative process of feedback and response:  

By making anonymized comments visible to all parties and focusing the group on points of misalignment, participants naturally gravitate towards agreement while ensuring all voices are heard. 

Benefits  

In implementing this approach, Camber Collective has found several critical benefits that may make this approach appealing not just in the near-term of the COVID outbreak response, but in the longer-term as a decision-making asset for remote teams: 

1. Remote consensus-building on complex issues 

The Delphi process provides a systematic methodology for iterative input provided anonymously by remote, expert participants.  The model ensures that even the most complex or technical topics are reviewed comprehensively and that a wide range of voices and areas of expertise inform a collaborative final product by:  

• Establishing clear and transparent decision-making threshold criteria at the outset 

• Providing an online platform for structured content review in multiple rounds 
• Sharing back anonymized comment integration in each round for participant consideration. 

The iterative, multi-round review structure of the Delphi also provides advantages over in-person discussion, particularly in early development stages of a new concept: 

• Process is scalable to larger group of stakeholders where many points of view can be collected and documented. Very early stage, rough draft prototypes can be reviewed without a high number of unknowns distracting or limiting conversation. 
• Collected feedback can be systematically evaluated to highlight where agreement exists – driving the process forward – and naturally focuses participants’ reviews on areas of misalignment. 

Successfully achieving these benefits during an in-person meeting challenges even the most skilled facilitator. In contrast, Camber Collective has successfully carried out a Delphi process including +20 expert participants across global geographies to publish a new global standard best practice for technical health assessment. 

2. Improved equity in decision-making 

The Delphi process allows distributed groups of stakeholders to build toward consensus despite geographic boundaries – in fact, it often outperforms virtual meetings or even in-person meetings in this regard. From our experience in the global health context, this means that it is possible to effectively engage international stakeholders or voices on-the-ground. It can also accommodate different engagement styles, mitigating any outsized influence that might otherwise be given to the loudest voices in the room. 

This method is uniquely equitable as well, capitalizing on the benefits of being a partially blinded process – by offering anonymity in responses as well as equal opportunities for response, it creates a democratized process that can elevate diverse or underrepresented voices. Properly deployed, the process ensures equity by removing biases such as race, accent, gender, or even seniority. 

In Camber’s experiences both before and after the COVID-19 outbreak, the Delphi approach has yielded large enough sample sizes to be considered representative. Global health and development organizations in particular have seen the benefit of gathering in-depth feedback from stakeholders located in key geographies in the global south who might otherwise have connectivity, travel, or time zone challenges for joining even a virtual meeting. 

3. Light-lift, high-reward 

For an organization supported by an experienced Delphi facilitator, the investment in resources and time is low in comparison with in-person working groups or convenings. The Delphi’s replicable, adaptable, and scalable model for gathering input means that an experienced facilitator can easily and effectively apply this methodology towards a wide range of content and stakeholder groups.  

Remote input from participants vastly reduces time, financial, and operational cost of implementation compared to in-person working group convenings. With an experienced facilitator, a 2-3 round Delphi process can typically be carried out over 2-3 months – an impressively rapid development process to go from early ideation stages to broad-based consensus on anything from detailed guidelines to a high-level theory of change.  

Beyond facilitator time to establish the methodology, engage stakeholders, and carry out analysis, the Delphi process itself has few incremental costs. Aside from the small cost of a subscription to a simple survey platform, we often recommended conducting a final virtual convening to offer closure to the process and provide an opportunity for dynamic, live conversation to close out any final points of complex disagreement.  

Despite the challenge of the current moment, our team believes that novel approaches like the Delphi process pose an opportunity to solve complex problems with greater efficiency – not just now, but also as organizations continue to find effective working models in the “New Normal”.  Let us know if you have found other innovative solutions to stakeholder engagement, or if you would like to discuss how a Delphi process could help drive consensus for your organization. 

The post Consensus-building in the “New Normal” appeared first on Camber Collective.

Amid a national dialog on systemic racism and police use of force and the continuing need to manage COVID-19 through efforts that include contact tracing, the creation of public health case management forces could be a compelling and cost- effective way to address both challenges.

COVID-19, Black Lives Matter, and Defund the Police. In recent weeks, a confluence of crises has led to a national conversation on racial equity after COVID-focused news cycles that had previously dominated our collective mind share for most of 2020. Making progress on systemic racism requires new policies and practices, no doubt, but in the near-term it also requires a more immediate and direct response to offset and mitigate systemic failures that will take years to solve. Case management provides a great model to begin this work, and the current need for COVID-19 contact tracing provides a unique launching point. Add to this the current dialog on police funding, which provides potential municipal discretionary funding sources to expand and elevate the contact tracer’s role, and these ingredients could come together to transform US social services and even healthcare delivery in a powerful and lasting way.

At the heart of the outcry to “Defund the Police” is the very real need to re-evaluate the role and responsibilities of police officers, including tactics and use of force. While defund the police is currently polarizing, in time, it is likely there will be consensus that the role of policing in the US has evolved to include many responsibilities that officers are simply not well trained or suited to address. Are they best suited to intervene on calls about homeless loitering? Mental health checks? Substance use? The list goes on – if we take a detailed look at the case load of police officers we quickly realize a lot of what they do, day to day, can and should be done by qualified case workers, public health workers, or social workers, who understand the issues better and are more likely to show up with relevant community context, specialized training and expertise, resources and solutions. 

Now consider our ongoing battle with COVID-19, which requires investment in an estimated 100,000 temporary public health contact investigators at an estimated cost of $3.6B in the US[i][ii]. While, significant, this investment barely exceeds what the NYPD spends annually on pensions and bolsters a public health workforce in the US that has declined by 50,000 workers since 2008[iii][iv]. In many ways, the temporary role of COVID-19 contact tracers aligns well with the responsibilities currently placed on police officers that many cities are re-evaluating. Contact tracers are trained to go door to door in our communities, document cases, talk to individuals about their needs and living conditions, provide information, and identify necessary behavior changes or clinical needs. This new workforce is temporary, but it has the potential to serve a broader and more permanent need. 

Imagine if we expanded upon this investment in contact tracers to make their role permanent as a new ”public health force“ of case managers trained in basic medical/clinical knowledge as well as mediation, conflict resolution, and de-escalation. These workers would be tasked with documenting issues, providing resources, solving problems with empathy and making connections to specialists or other social services in the community. Police officers would still need to play a role in security in some instances for this work, but likely a supporting role and only when needed. This is not an entirely new idea. Camden, NJ disbanded its police department in 2012 and replaced it with a force expected to show up to calls “more like the Peace Corps than the Special Forces”. Eugene, OR and San Francisco are also in the process of re-imagining ways to supplement their police forces with officers trained in public health and social services skillsets. In 2019 the Oregon program called CAHOOTS responded to 20% of 911 calls by sending out a medic and crisis worker team to respond to behavioral health incidents; of the 24,000 calls received only 150 times were the policed called for backup. The program costs $2.1M annually, compared to the budgets of the Eugene-Springfield Police Departments $90M. On average, from 2014-2017 the program has saved the community $8.5M annually, by picking up calls otherwise would have required law enforcement, EMS response, or ER visits[v]. Around the world, countries including Sweden, Scotland, Switzerland, and Finland have all established social and public health workforces to replace and augment traditional policing responsibilities[vi]. Meanwhile, robust COVID-19 contact tracing programs and teams have been highly effective in managing and containing spread in S. Korea, Germany, Taiwan and Australia[vii].

Contact tracers-turned-community case workers could be a big part of identifying and addressing both infectious disease as well as current social inequities in the US while identifying opportunities to create sound policies and practices to drive longer-term systemic change. A shift this dramatic would not come without a cost. Expanding the remit and scope of contact tracers beyond COVID-19 would likely require redirecting discretionary funds away from police departments and possibly other state and municipal services, but reflects a rebalancing of focus versus “de-funding”. Creating such a workforce would require case workers to develop a basic understanding on a wide variety of health and social issues in the specific communities they serve – everything from food insecurity, homelessness, substance use, domestic disputes, petty crimes, cultural and race considerations and more. These case workers need to know what issues they are likely encountering during the house call and how to offer an immediate solution or resources. It also requires training to know when to use their direct line to police back-up for security, or an ambulance to help save a life, or some extra muscle from the fire department. If done well, they could become a critical fourth leg of our first responders – a public health force of case workers that connect the dots and navigate citizen needs for a wide range of social services in appropriate measures where today we have in many cases become out of balance in our incident responses. This will require case worker “detectives” who live in the communities they serve, who understand the people and local nuances, and who know how to start solving the problem.

 We are currently in a “once in a lifetime” crisis that is forcing our country to rethink everything from policy and business to politics and values. We are also in some ways fortunate to be stuck in a “new normal” purgatory for 1-2+ years as we await COVID-19 vaccines, which requires prolonged behavior modifications and investments that would be unheard of during normal times. This is the time for local and state government leaders to seize the moment and take bold actions in addressing racial inequities and our broken social safety net. Investments in innovative public health case management models can address two needs at once and are a great place to start.

[i] “”A National Plan to Enable Comprehensive COVID-19 Case Finding and Contact Tracing in the US”, Johns Hopkins University, April 2020, https://www.centerforhealthsecurity.org/our-work/pubs_archive/pubs-pdfs/2020/200410-national-plan-to-contact-tracing.pdf

[ii] “A National, Tiered Approach to Scaling up Contact Tracing”, Association of State and Territorial Health Officials, April 2020, https://www.astho.org/COVID-19/A-National-Approach-for-Contact-Tracing/

[iii] Citizens Budget Commission, https://cbcny.org/research/seven-facts-about-nypd-budget

[iv] ”A National Plan to Enable Comprehensive COVID-19 Case Finding and Contact Tracing in the US”, Johns Hopkins University, April 2020, https://www.centerforhealthsecurity.org/our-work/pubs_archive/pubs-pdfs/2020/200410-national-plan-to-contact-tracing.pdf

[v] “’CAHOOTS’: How Social Workers and Police Share Responsibilities in Eugene, Oregon”, NPR, June 10, 2020

[vi] https://www.washingtonpost.com/world/europe/police-protests-countries-reforms/2020/06/13/596eab16-abf2-11ea-a43b-be9f6494a87d_story.html

[vii] https://theconversation.com/contact-tracing-is-working-around-the-world-heres-what-the-uk-needs-to-do-to-succeed-too-140293

The post The Case for Funding Case Management appeared first on Camber Collective.

by Michaela Crunkelton Wilson

Before the days of Covid-19, if one walked down Market Street in San Francisco’s Financial District at lunch time, it would be bustling with men and women in their business professional attire, speed-walking back to their offices with an expensive fast-casual, local, organic salad in hand. Or perhaps the cheaper pre-made soup from Trader Joe’s. As one continued walking closer to the less wealthy neighborhoods of Civic Center and Tenderloin, the smattering of homeless people slowly turned commonplace, most likely begging for help or counting coins they’ve collected in hopes they have enough to buy something from the number of non-local, non-organic, but much cheaper fast-food chains and street vendors that stand in stark contrast to the fast-casuals of the Financial District.

This small anecdote is representative of the hyper-locality of inequality in the Bay Area. Inequality that routinely prevents good food – or food that sustains the health of the planet and its people – from getting to those who need it. Layer on top of this a global pandemic that exacerbates these inequalities, yet ironically, also provides it hope for change.

The good news is that good food can be almost anything, as long as it is real (not heavily processed), and diverse enough to ensure a balanced diet. The bad news: For many Californians, good food is a long shot, they’re not even getting access to food – 1 in 8 Californians currently struggle with food insecurity (defined by the California Association of Food Banks as the “occasional or constant lack of access to the food one needs for a healthy, active life”). And this is despite the fact that California produces nearly half of the nation’s fruits and vegetables.[1] So, while there is no shortage of good food, the downstream effects of inequitable distribution and consumer access and affordability impact the qualities and quantities of available food, especially for lower income populations.[2]

One of the primary manifestations of inequitable distribution is the fact that many low-income communities live in food deserts, where access to affordable good food is hard to come by. Not unlike the anecdote above, there seems to be an inverse correlation with median household income, and quality of food options available: the poorer the neighborhood, the more liquor stores and fast-food chains instead of grocery stores. Why? Because food follows money, and money follows food, and where there is not a lot of money, there is not a lot of food.

Just think about the causes and effects of transforming a food desert into an oasis. Often, a grocery store is built in a community as a result of gentrification, simply pushing old communities into new food deserts.[3] Yet even if that is not the case, and a grocery store is built in a low-income community to help remove the physical barriers of access, diets probably won’t change given the price-tag barrier of affordability.[4] As a result, low-income consumers are being left behind with access only to unhealthy foods, resulting in obesity (almost of quarter of adults in California are considered obese), diabetes (almost half of Californian adults are prediabetic or undiagnosed), nutritional deficiencies, and other chronic yet avoidable diet-related illnesses.[5]

Moreover, these systemic inequities have been worsened almost overnight due to the global coronavirus pandemic, truly separating the haves from the have-nots. Families of kids who rely on free or reduced-price lunches at school are now facing exponential hardships – statistics mention as many as 17 of 20 low-income students experience hunger each summer, and “summer” has come much earlier this year.[6] Restaurant workers who already operate under razor thin margins have gone from supplying an abundance of food to communities, to the realities of not knowing how they might feed even their own families due to layoffs and shutdowns. Food truckers, among the many hidden heroes of the food chain, face new logistical nightmares threatening not only their own jobs but also access to food for all of us.[7] And those privileged enough among us able to hoard food in a panic, leave shelves empty for people who are not so sure where the next pay check, or meal, might come from.

Yet, in a beautiful way, because the global pandemic has exacerbated challenges of the food system to the brink of imminent dissolution, it has also created the communities necessary to keep the food system afloat. News outlets and social media have been invaluable platforms to connect the haves with the have-nots. Farmers, restaurants, and nonprofit organizations share their stories, and communities come together to provide them the support they need. People have come to realize we are in this together, that without one component of the food system in place, we all suffer. And the simple awareness of what parts are hurting the most, allow people to take action to try and mend it.

Additionally, as seed packets and active dry yeast are wiped clean from the shelves, awareness is growing for what it takes to produce food. Before this pandemic, consumers expected unsustainably cheap food, and were too far removed from the production process to understand the social and environmental implications of their food choices. Perhaps the increased proximity to the food production process will now create greater appreciation for and awareness of the true costs of labor from a farm’s seed, nourishment, harvesting, cleaning, packing, distributing, shelving, selling, and preparing, to fork. One can only hope a deeper understanding of food will also bring a deeper understanding of the implications of a race to the bottom, shifting convenience-centric consumption habits and expectations.

Above all, as COVID increases people’s openness to leveraging community networks to address issues of access and affordability, the hope is that case exemplars have the opportunity to become the norm, and long-standing visions have the opportunity to come to fruition. Take the Community Foods Market in West Oakland, for example, whose doors opened in 2019 to provide accessible, nutritious food to the community for the first time since the 1970s. Built with the advisory of the historically low-income community itself, Community Foods Market is slowly dissociating the words ‘food desert’ from West Oakland, without deliberate gentrification.[8]Imagine a world where this process can be routinely replicated.

Or take, perhaps, the handful of Bay Area actors who have been envisioning new economic models of production and consumption in which public and private actors can help cover the short-term costs of the transition to sustainability, so people and planet do not suffer the consequences of excluding negative externalities in today’s food pricing. Visions of wealthy private sector consumers paying more for their own food procurement so that others can pay less, but lacking the networks and policies in place to do so. One Bay Area food hub that connects smallholder farmers with food programs within wealthy tech companies has long understood the potential to apply this idea to their own distribution networks: Perhaps less wealthy organizations in geographic proximity – such as hospitals and schools – can achieve lower costs by piggybacking on the distribution networks already employed by wealthier consumers.[9] Now more than ever, there seems a possibility to do so.

We shouldn’t have to live in a society where only those customers who are both driven by values of health and sustainability, and also have the luxury of paying the price tag associated with it – are the only ones that can sustainably engage in a good food system. Therefore, with more awareness, community engagement, and improved community networks, actors across the food chain can co-create solutions for more equitable distribution and sustainable consumption. As we are already seeing, the global pandemic is exacerbating the challenges we face, yet also accelerating the solution: communities and networks that cross socio-economic barriers.

The post Food System Challenges and Opportunities: the Bay Area Example, pt. 2 appeared first on Camber Collective.