ChangeAGEntsCrowdHands_400 The opening session of the Hartford Change AGEnts Conference in Philadelphia last week.

Last week was the capstone of the first-year rollout of the Hartford Change AGEnts Initiative. This projects aims to engage and support all prior John A. Hartford Foundation health and aging grantees to focus on making systematic, large-scale practice change in the care of older Americans.

More than 160 Change AGEnts converged on Philadelphia for an intensive, day-and-a-half conference that was packed from start to finish with opportunities to learn, share knowledge, and network with others from different parts of the country and different disciplines. It was an energizing experience, not only because it gathered so much of the Hartford Foundation’s most precious assets—its people—in one place, but also because we learned more about the work already underway to improve care. We also saw new relationships and ideas emerge that will advance our mission.

The highlights were many, from the inspiring keynote address by Joe McCannon, co-founder of the Billions Institute, about how to make transformational change to a series of informative, interactive workshops where Change AGEnts engaged in such topics as making the business case for geriatrics; developing policy advocacy skills; establishing thought leadership; creating value propositions; using storytelling and social media to create change; and more, including a very special address by Norman Volk, the Chairman of the Foundation’s Board of Trustees. We plan to make information and resources from the workshops available for all our Change AGEnts in the coming weeks through the Change AGEnts online platform.

Hartford Foundation Board of Trustees Chairman Norman Volk takes part in one of the workshops. Hartford Foundation Board of Trustees Chairman Norman Volk takes part in one of the workshops.

The Change AGEnts initiative represents a natural evolution of the work we have done on behalf of older adults for three decades. Between 1982 and 2012, the Hartford Foundation invested hundreds of millions of dollars in its former approach of “enhancing the nation’s capacity of delivering effective and affordable care to its rapidly increasing population of older Americans.” We are very proud to have played a role in the development of many faculty and researchers in the health professions and the incorporation of geriatrics knowledge in curricula for future practitioners.

But we know that outside of relatively small pockets and programs, the quality of care actually delivered to older adults still fails to meet acceptable standards. Even the most successful models of care that we have helped nurture for 20 years barely begin to scratch the surface of the scope and scale needed.

Everywhere we’ve traveled, we hear geriatric experts say something like, “When I review patient/client/resident charts, I just can’t believe what I see: the inappropriate medications, the polypharmacy, the under or over treatment, the failure to plan, the lack of attention to patient and family goals of care… the harm.” It’s the same story in virtually all systems and settings of care.

Now, we want to challenge ourselves and especially our geriatrics and gerontology experts to do something about those failures. Our downstream strategic shift focuses on putting that capacity to work to realize the promise of improved health for older Americans. However, we believe that one of the chief barriers to addressing this challenge is effective leadership to help capitalize on the opportunities of health reform and put geriatrics expertise to work for all who could benefit.

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In November 2013, we therefore launched the Change AGEnts initiative at the Gerontological Society of America annual meeting with a fun and effective networking event designed to bring people together—an essential precondition for the hard work of practice change.

Since then, alumni of many Hartford Foundation programs have come together as Change AGEnts at training institutes on policy and communications, through webinars on issues such as value propositions, through grant applications such as the Action Awards, and through “cross listed” awards connected to the Beeson Scholars, Centers of Excellence in Geriatric Medicine, and the Geriatric Social Work Initiative.

At the highest intensity level, two practice networks (small interprofessional work groups of Change AGEnts) have formed: one to advance family caregiving for people with dementia and the other to try to ensure that patient-centered medical homes are also safe and effective for older adults.

This work, Interprofessional Leadership in Action, is our new signature strategy, trying to build on the expertise of our grantees and their passion for our shared mission to drive practice change. But our planning has identified four other strategies we also believe are essential to success:

  • Linking Education and Practice, training current practitioners in today’s best care, building into education the skills needed for tomorrow’s care.
  • Developing and Disseminating Models of Care, supporting evidence-based innovations to improve health outcomes for older adults while lowering costs.
  • Tools and Measures for Quality Care, promoting measures, standards, and health information technology that support appropriate care for older adults, particularly those with multiple chronic conditions and complex medical and social needs.
  • Public Policy & Communications, advancing the Foundation’s nonpartisan mission and the work of grantees through communications, advocacy, and research that inform the development of effective health and aging policies.

It would be nice if our work could be simplified to just one or two key strategies. But if there is anything the past 30 years of work have taught us, it is that changing health care is incredibly hard work and not amenable to any single “silver bullet.” It will take the convergence of many forces and alignment of many interests to really improve care for older adults.

At the end of 2014, just over two years into our efforts to begin making our new strategies real through grantmaking, we continue to feel that we are on the right track. But we are keeping our eyes and ears open to learn from experience and, as always, the expertise of others in the field.

2015 will be a very busy year and we have a great deal of grantmaking and activity planned. Until then, I hope that the holidays will give everyone time with their loved ones to recharge and rededicate themselves to our shared mission in the New Year.

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