The California Health Care Foundation is dedicated to improving California’s health care system, particularly for low-income Californians. In the past year we refreshed our strategy, and a key component of that process was to renew and increase our deep commitment to ongoing organizational learning and to enhanced impact. This approach reflects our belief that the purposes of organizational learning are to improve the quality of our work and to inform others who hold similar goals.
Central to our learning approach are CHCF’s core values. We believe that all Californians should have access to high-quality, affordable health care that meets their individual needs. We know that reliable data and useful information are essential to advancing change in the health care system — that without data we can neither understand existing gaps nor assess progress in closing them.
The same is true for our work. As an independent foundation, CHCF has a particular responsibility to be transparent and accountable to the people of California for the resources we use and the outcomes we seek. We make investments in learning and evaluation with an eye toward assisting and informing others seeking to improve health care in California: grantees, investees, implementation partners, and the field as a whole. We emphasize impact and learning to support an effective strategy and continuous improvement toward desired outcomes.
In a complex, turbulent environment where success depends on the actions and investments of many, we take a systems view. While we scan the landscape in search of fortuitous leverage points, we are also on the lookout for unintended consequences of change. We rarely seek to document the precise effect of a particular intervention or to assign responsibility for a specific outcome. Instead, we assess progress and adjust course when circumstances demand. We seek to learn from our own past experiences as well as to gain insights with partners and stakeholders beyond our walls.
At CHCF we maintain disciplined processes and use a variety of tools to support learning:
We conduct external scans and gain input and intelligence about the fields in which we work, particularly when we develop new initiatives.
We identify hypotheses and areas of uncertainty so that as projects unfold we can focus on opportunities to learn.
We identify mid-course outcomes to help us track progress.
We use a robust peer-review process to elicit input and draw out lessons at multiple stages in a project’s life cycle: when a strategic approach is developed, as projects and grants are implemented, and at a project’s conclusion through assessment of results and lessons learned.
We invest in a range of approaches to engage audiences, to advance goals and initiatives, and to reinforce CHCF’s position as a trusted and valuable partner. These include integration of strategic external engagement, plans to regularly survey stakeholders and grantees, and greater reliance on our capabilities in constituent relationship management, or CRM.
In the push for continuous improvement, we have much to learn from the many foundations, consultancies, and social impact organizations that share CHCF’s commitment to a values-based, disciplined approach to learning. As we embrace goals and tactics to advance a health care system that works for all Californians, we know we are part of a much larger community eager to learn from experience, build new capacity, and demonstrate agility in the face of complexity.
Marian Mulkey was chief learning officer at the foundation. From 2010 until 2014, she served as director of the foundation’s Health Reform and Public Programs Initiative, where she led CHCF’s work to analyze the Affordable Care Act and inform public and private stakeholders and the public on ways to implement the law that would improve and expand coverage.
Marian previously worked as senior program officer in the foundation’s Market and Policy Monitor program, where she led work to monitor California’s health insurance markets. Prior to joining CHCF, she worked as an independent health policy consultant and at Kaiser Foundation Health Plan, where her responsibilities included pricing, utilization data reporting, and policy development.
Marian received a master’s degrees in public policy and public health from the University of California, Berkeley, and a bachelor’s degree in biology and economics from Reed College in Portland, Oregon.