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California Synchronizes 37 ACHs into One Harmonious System

The California Accountable Communities for Health Initiative (CACHI) provides a powerful framework for resident-driven ACHs to build healthier, stronger, more equitable communities. The public-private partnership supports a wide-ranging network of 37 ACHs in urban, suburban, and rural communities by providing grants, technical assistance, policy, learning, and evaluation.

CACHI equates its role to a symphony for a healthier California. Each ACH is a solo musician, playing its own songs. CACHI is the conductor, seeking to transform the players into a highly functioning orchestra. The Rippel Foundation has worked with CACHI to harmonize systems-thinking within and across the network of ACHs while guiding each community to move to its own beat.

CACHI’s 37-ACH Network
Accountable Communities for Health (ACH) are multi-sector collaboratives designed to improve community health and equity by aligning and coordinating activities and advancing systems changes.
Source: CACHI

Rippel’s model strikes the right note for working in complexity

When CACHI launched in 2016 with its first cohort of ACHs, Rippel became its partner to provide governance and resident engagement technical assistance grounded in stewardship. The pilot was so successful that CACHI engaged Rippel again in 2023 when it added 24 new communities to its network that was growing in size and complexity.

Rippel co-designed its approach with CACHI’s governance team, ensuring concepts could be cross-walked with CACHI’s aspirations and translated to the 37 ACHs, being mindful of their capabilities. The learning curriculum focused on building systems-thinking mindsets and the soft skills required to do effective long-term collaboration across sectors, which could include hospitals, public health, schools, public safety agencies, parks, and local businesses, along with residents. Rippel created frameworks, concepts, and tools to be used internally or with partners to build each ACH’s capacity for uptake and scale.

Fine-tuning a unique and unifying process

Four virtual sessions delivered highly interactive learning experiences to a cohort of 13 ACHs. The Rippel team guided the ACHs through the principles and practices of shared stewardship; building and sustaining high-performing collaborative teams; understanding systems and building intentional interdependence; and resident engagement, through breakouts, reflective discussions, and spotlighting successes. Individual and small group sessions provided time to discuss how the ACHs were using the frameworks in practice.

One particular framework—the “snowflake”—struck a chord with ACHs as they seek to move away from traditional leadership distribution models to one that prioritizes intentional interdependence and resident voice and decentralizes decision-making. As one ACH participant commented, “It resonates with how complex this process is and that it ebbs and flows and is unique and yet unifying.”

Orchestrating shared stewardship

Rippel created a new set of standards with CACHI, connecting all ACHs through stewardship as the foundation for their growing network. The tools, resources, and webinars live on CACHI’s website, accessible to all as each ACH applies them in their unique community and as new ACHs onboard.

By adopting Rippel’s philosophy that a thriving future requires thinking and acting differently, CACHI is embracing new mindsets to encourage new results. ACHs are seeking ways to nurture points of synergy, leverage their long-term partnerships, and align investments. Most of all, they are prioritizing community voice for a healthier California.