November 2018: Key Qualities of an Effective Upstream Leader


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Vol 1 Issue 8

Dear friends,

A special thing happened in Baltimore this month. Upstreamists from 31 healthcare organizations around the country—trailblazers who have been working to move care upstream in their own institutions, in their own cities, some for as long as two years now—finally met in person.


The HealthBegins team and I traveled to Baltimore to meet them. These leaders hail from the 31 organizations participating in the CMS Accountable Health Communities initiative, which aims to build clinical-community bridges to better address beneficiaries’ health-related social needs. And we are privileged to partner with them to provide technical assistance on their journeys.


There, amid the in-depth sessions and spontaneous conversations about common struggles, we saw evidence of an important fact that has been on my mind: that the right tools and workflows are essential but not enough to ensure us a successful journey upstream. For that, we need one more thing: great upstream leaders.


The pioneers in Baltimore showed me again that this work ultimately hinges on motivating people.


This idea was at the core of our recent webinar: “Preparing Clinic Leaders and Staff for Success.” We explored why the complexity of big change demands that we actively work to identify diverse stakeholders, reach out to them and engage them. As the HealthBegins Upstream Clinic Engagement Strategy outlines, those stakeholders can include everyone from clinicians to case managers to IT specialists to receptionists — and they must include the natural champions as well as the natural curmudgeons. We need them all on our team.


For leaders, that means cultivating more than the skills to implement Upstream Quality Improvement. It requires different ways of thinking and acting — certain essential habits of behavior and mind. A recent NEJM Catalyst article outlines a core set of them: curiosity, humility, willingness, perseverance, and self-discipline.


These are the kinds of qualities we’re inspired to see in a rising wave of upstream-improvement leaders — including those in Baltimore, those in the American Hospital Association’s new Hospital-Community Collaborative, and those we spotlighted in my 2013 TED Book, The Upstream Doctors, who carry on their mission today.


(Know an upstream leader whose work could inspire and instruct us all? Please nominate them to be spotlighted as an Upstreamist in Action on the HealthBegins blog here.)


Leaders like these teach us that institutional culture is as important a concern as tidy charts, that listening is more than an accidental act, and that new leadership can and should spring from unconventional corners — from colleagues such as community partners, social workers, or patients themselves.


We believe so much in these leaders’ role that we’re helping to grow a whole new generation of them. We’re designing a soon-to-debut Community of Practice for the courageous organizations and leaders engaged in this work.


This learning space will thrive on the insights and experience of all of you, teaching and learning with each other. Together, we will show the impact of a new kind of leader for a new kind of care.


We’ll cultivate not just the leaders we have, but also the leaders we need.



Rishi Manchanda

New from The Upstreamist, the HealthBegins Blog:

Key Lessons on Structural Racism & Health Equity: Highlights from the HealthBegins Webinar

Our recent webinar on healthcare’s role in fighting structural racism drew record-setting attendance and a passionate discussion. The conversation must not end there. To carry it forward and help catalyze passion into action, here is a summary of key lessons learned in the webinar. 

A Hospital Marketer Pushes Primary Care Upstream

Upstreamist in Action: As a community-relations specialist, Jessica Saunders knew the community around Dayton Children’s Hospital deeply. Then she used that closeness to the community, along with Upstream QI, to lead her hospital upstream.

Charting a Course for Social Determinants of Health

Healthcare systems are talking about moving upstream. The Upstream Strategy Compass can help them get there.


Watch Our November Webinar:The Journey Upstream: Designing Measures for Success

As we paddle upstream to address social needs and improve health, we need to gauge our progress regularly and make swift course corrections. This presentation demystifies the measurement of complex outcomes, equipping participants with the essential knowledge to evaluate the impact of upstream interventions at three important scales: for individuals, institutions, and communities.

Look for new HealthBegins webinars coming in 2019!

Have a topic that you’d love to see us cover in a webinar?
Please tell us! Email at

Upcoming Events: Find HealthBegins Here

Sharp Healthcare’s 2018 Primary Care Conference
December 1 | Kohola, HawaiiPrimary care physicians gather to learn about the latest developments in the field.

YMCA Community Integrated Health Conference
December 10 | Washington, D.C.

Attendees share ways to create integration between the healthcare system and community-based heath interventions.

IHI National Forum 2018
December 12 | Orlando

Healthcare professionals explore how improvement science methodologies can be used to effect real change in patient safety and care.

Presenting powerful upstream results at an upcoming conference? Nominate yourself to be featured as a HealthBegins Upstreamist in Action at

Upstream Opportunities

NYC Health + Hospitals is recruiting a Medical Director, Social Determinants of Health 

If you have fellowships, events, or other opportunities you’d like us to share, please email us at

Upstream News

Curated highlights of happenings affecting upstream care. Links are not endorsements.

2019 Open Enrollment Off To Slow Start As Uninsured Rate Remains Steady

Health Affairs Blog

Hospitals Hire Frontline Workers to Improve Care, Trim Costs

Wall Street Journal

Talking About Costs: Innovation In Clinician-Patient Conversations

Health Affairs Blog

CRISPR inventor Feng Zhang calls for moratorium on gene-edited babies

MIT Technology Review 

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