Great Plains Food Bank CI Report – Final

What has been most instrumenta to your progress?

We approached the grant period with a clear, determined idea about how to move forward with the work. We adopted a model of systems change, Collective Impact, and expected that the work would be somewhat linear. As we dug deeper into the work of health equity and learned about the shifting needs and focus of our partners and communities, we knew flexibility was absolutely necessary.
As a result, we leaned into a process of rapid cycle testing new ideas which allowed us to test, assess, and retest innovations. This iterative process allowed us to be adaptive to the changing needs of not only our organization, the global crisis we are in the midst of, but also what we have been learning along the way.
Outside of programmatic innovations, some of our most valuable learning has come from a local group, the Cass Clay Hunger Coalition, which we have had the opportunity to co-facilitate, help guide strategically, and test ideas with. This group is a collection of cross-sector collaborators centered on actionable strategies to improve the health, nutrition, and equitable food access for everyone living in Cass (ND) and Clay (MN) counties.

The value of relationship-building has been a primary intentionality over the course of the past few years. Upon launching our work at the Intersection of Hunger & Health, we had commitments and interest from a variety of key stakeholders across our service area. Public Health units, non-profit health systems, tribal health, and those working tangential to food/health have been important partners in this work.
Through consistent communication, one-on-one meetings, and community meetings, we’ve been able to build our credibility as innovators and collaborators ready to effect systems change. This has been made possible by taking care to build relationships laterally and vertically within organizations. While we aren’t the only organization doing hunger-relief work in the region, the trust we’ve built with healthcare partners and community health experts have made space for innovation. This trust means that our partners are willing to take a leap of faith with us, have big conversations and test out ideas together. This integrated relationship building has really enmeshed our organizations at every level and allowed for the sparking of new, yet uncharted innovations.

Part of our work focused on uncovering and addressing the root causes of hunger at GPFB is centered on shared language and definitions – an important tool for creating shared initiatives and measuring outcomes consistently. The healthcare industry tends to be silo-ed due to the necessity of unique language and definitions; things that describe patients, interactions, technology, practices, billing, and its unique culture. As we pursued relationships and new pilot programs, we put particular emphasis on learning and becoming food bank experts in that unique language.
As a result, we’ve made strides in becoming a trusted partner in their work. This allows us space to educate our partners about the unique food insecurity and hunger relief language. We talk about patients and clients collectively, social determinants of health in tandem with root causes of hunger, and discuss time and resources in terms of outcomes and reimbursement. This shift has deepened our relationships, level of trust, and partner engagement.

Key lessons learned

Change is necessary – albeit uncomfortable and sometimes unclear. The traditional role of a food bank is the acquisition, storage, and distribution of recovered food. Food banks across the nation are shifting the narrative on what it means to truly end hunger. In our service area, we know that individuals facing food insecurity are facing chronic disease at disproportionately higher rates. And as a social safety net, we play a part in finding a solution. So change is a necessary part of the way we’ve worked as an organization. Our team knows that, our partners recognize that we play a new and different role in health outcomes, but the shifts required to settle into a space of transformational change aren’t always easy to define in concrete ways.
We’ve learned that outside of the specialized staff focused on this work daily, some individuals at GPFB are still unsure how to talk about this new work. We’re continuing to put time and attention into equipping individuals with the language to tell the story of the ambiguity of systemic change. And at the same time, learning how to work (communicate about our work) at the watershed between our upstream/downstream efforts.

Cooperation is necessary but not inherent. As the only food bank in the state, we don’t necessarily compete with other local organizations for resources, staff, or clients. But the inverse is a reality for a lot of the partners we work with. From the outset, we expected everyone who was invited to be interested in coming to “the table” to define shared outcomes and move forward collectively. What we didn’t know or expect is that although cooperation is necessary, for some of our partners, competition is baked into the success of their organization. For example, by bringing together two healthcare partners, we learned that while we may have openness and trust with each of them, they don’t necessarily have that relationship with one another.
A co-collaborator of ours often says, “there’s creative energy in that conflict.” In some cases, this allowed us to push our partners to try new things they may not otherwise have adopted on their own. Ultimately, this will continue to be a focus of our work as we shift into the next phase; creating and adopting a more collaborative space that is co-owned and more importantly, unique from (but aligned with) each organizations’ mission.

Reflections on the community innovation process

The elements that make up the process diagram are an incredibly useful illustration of the framework guiding us the past few years. Starting in 2018, we began to build knowledge collectively around the central issue of food insecurity tied to increased poor health outcomes. By lifting up client voices, through the Hunger in ND 2018 study, we were building shared knowledge around the specific hunger/health issues affecting our neighbors. This data collection process is iterative. One of the most important changes that we’ve adopted is the importance of racial and socioeconomic data to support an equity lens.
As we’ve moved from generating ideas into testing and implementing solutions, we’ve been primarily focused on individual and community level needs. We’ve been able to leverage a growing excitement for new solutions that include collaborative partners committed to increasing access to nutritious foods. As we reflect on the process of innovation, the most valuable component is the fact that this is 3D, rather than linear. The permission to skip steps, pivot, learn, & leverage new knowledge and partners has been critical for our ability to embed this process into our culture.

Other key elements of Community Innovation

The diagram captures the most essential components of our work. However, we’ve learned that this diagram is really a three dimensional web. It includes layers of work that influence structural and systemic changes alongside cycles focused purely on addressing one part of the community challenge or need. And at any point in time in the process, an idea or new challenge may lead to a branching off that redirects the original intended outcome.
One of the things we consider, in a client-centered setting, is asking ourselves “who is benefitting?” Finding ways to continue making space for individuals with lived experience to be involved in leading the process of community innovation is part of where we see the next phase of our work taking us.

Progress toward an innovation

Over the course of the last several years we have begun the important first steps of co-creating an ecosystem and culture that recognizes hunger as a health crisis and food as medicine. While we value the innovations that have resulted thus far we see this work as unfinished, but can point to incredible strides toward this bold vision. At the beginning of this work, we started with emerging knowledge about the needs in our state and leveraged relationships to activate, test, and evaluate new solutions.
As a result, we have healthcare partners across the state committed to working alongside us in the communities we collectively serve. Through an iterative process, we’ve built three new statewide programs, currently serving 40 sites (and growing) in urban and rural communities across our service area. Together, we’ve impacted hundreds of patient households and in the last year alone, we’ve provided over 5000 meals and screened nearly 300 individuals for food insecurity during a regular health visit. We have been able to positively influence systems, places, and people to pursue this critical work at the intersection of hunger and health.

What it will take to reach an innovation?

What’s next?

We have laid the groundwork for a new pillar of the foundational work of GPFB, but also used this process and the journey as a springboard for future ground-breaking work. We have piloted 3 “screen and intervene” program models for support at the intersection of hunger and health: Wellness Pantry, Medically Tailored Meals, and SNAP Rx. Each providing care management, nutrition support, and long term household level benefits.
As we move ahead, we plan to sustain and replicate these primary program models. We also plan to engage our healthcare partners in a more robust data and referral sharing platform. With more holistic data, we hope to better identify disparities created by gender, place, race, means, and status. We also plan to collect and activate biomedical data to fully measure impacts on long term health outcomes. At GPFB, we know that it takes more than food to end hunger. So we’ll continue to explore the connections between food insecurity and other complexities of life; both social and structural.

If you could do it all over again…

A known path isn’t necessary and in some ways, it may inhibit the ability to be nimble and responsive. This past year, in particular, has shown us that we must be prepared enough as an organization to respond to immediate needs, but flexible enough to set aside old structures, processes, or plans that don’t move us toward innovation. Our team has gained skills around cultural competence, equity and inclusion, disaster response and recovery, and welcomed new knowledge, skills, and relationships that have redirected our focus and path forward. And that’s a good thing.