Over the next two years, Macchione and his team deepened Live Well San Diego’s impact in their agency and across the community, where they helped to forge more than 250 additional partnerships. However, they also realized that to reach the generative stage of the Health and Human Services Value Curve, they needed to integrate Live Well San Diego into the county government’s broader strategy. This was challenging because, even though senior county officials had supported the creation of the Live Well San Diego framework, county staff still were learning what Live Well meant and how it was reflected in their work. Macchione—who noted that some community stakeholders still did not believe in Live Well San Diego’s impact—explained, “Mockery lane for me included some good friends and key community partners.”
Macchione and his staff addressed this skepticism in several ways. First, they evinced what Macchione characterized as “fierce determination and integrity,” rooted in their “conviction that what they were doing was not for themselves, but their whole families and neighborhoods.” Second, when attempting to persuade community stakeholders to integrate Live Well San Diego into a broader countywide strategy, they communicated strategically. Instead of discussing sensitive issues and programs (e.g., poverty and minimum wage), they framed wellness in economic terms likely to resonate with all of the stakeholders. “It’s the healthy bottom line,” Macchione said. “Healthy people, healthy communities, [and a] healthy economy.”
Through persistence and open communication, county officials saw the value in incorporating Live Well San Diego into the county’s fiscal year 2016-17 budget. This was critical because, as Macchione said, an organization’s “budget is a reflection of [its] strategy.” What’s more, this facilitated the creation of enterprise-wide performance indicators and outcomes that the county could impact. This was because Live Well San Diego “us[ed] a shared measurement system [that] allows all partners to focus collective efforts and track collective progress.”
Specifically, individual county departments could now craft strategies and performance metrics that fed into the overall metrics, enterprise performance indicators, and areas of influence identified in the Live Well San Diego framework. For example, one of the enterprise performance indicators is economic wellbeing; this is measured in part by housing affordability (i.e., the percentage of the population spending less than a third of household income on housing). With this goal and metric explicitly identified in the county framework, the county’s Land Use and Environmental departments, Health and Human Services Agency, and Public Safety departments began amplifying and coordinating their respective efforts to issue new housing permits, build new housing units, and provide housing-related community services and supports. Several county agencies were working together to realize an integral objective in the Live Well San Diego framework.
Of the significance of these new cooperative efforts, Macchione added, “That has been a colossal shift, that we now have an inclusive vision with an understanding of what we’re all attempting to do in helping San Diegans live well by building better health, living safely, and thriving, and defining the strategic approaches about delivery systems.”
2017 and Beyond: Impact and the Path Ahead
Seven years after launching Live Well San Diego, Macchione and his colleagues recognize that fully realizing this vision means that it will continue to evolve and essentially be an ongoing work in progress. Demographics, political leadership, public policy, and economies are dynamic. Live Well San Diego stakeholders understand that there will therefore always be a need for repositioning, course correcting, and refreshing their efforts in continual pursuit of the Live Well San Diego vision. For example, San Diego continues to face significant health issues, such as a recent hepatitis A outbreak. The Live Well San Diego movement also continues to evolve, now developing a generative governance model and connecting siloed data systems.
Nonetheless, Live Well San Diego has already made an extraordinary impact. As of November 2017, Live Well San Diego had 331 partners, allowing the movement to touch over 75 percent of county residents. Many of the key performance indicators exceed state and national averages. Above all, the county team has demonstrated how a collaborative ecosystem can propel a community along the Health and Human Services Value Curve. Macchione concluded, “Government can’t do it alone. Non-profit can’t do it alone. For-profit can’t do it alone. But, collectively, we can.”