The Magnolia Place Initiative is a collaboration of faith-based and community groups within a 500-block portion of Los Angeles that crosses Pico Union, West Adams and the North Figueroa Corridor, west of downtown. This project used smartphones to help a group of Magnolia Place residents record images and information from their neighborhoods in ways that may contribute to meaningful change while building community capacity for research. We developed a "Holiday Campaign" around Halloween, which involved taking snapshots and mapping the observations, and created a rating scale for measuring holiday spirit. We also wrote a Spanish-language guide for the project.

1. Magnolia Community Initiative
Vision: All 35,000 children in the Magnolia catchment area will
break all records of success in their education, health, and the
quality of nurturing care and economic stability they receive
from their families and community.

2. About the Magnolia Community Initiative
• Voluntary network of 70 organizations
• Involves government and regional organizations – including
Los Angeles County Chief Executive Office – to influence
infrastructure that affects many residents, and to facilitate
spread of what works beyond the catchment geography
• Emphasizes sustainable, scalable, evidence-based strategies:
(1) increase access, use and quality of family-desired services, activities,
resources and support;
(2) strengthen social ties among residents; and
(3) improve economic opportunities and development.
• Connects diverse programs and providers (including
physicians, child care and preschools, and mental health) to
shared accountability and a common change process

3. Achieving Population Outcomes
1. Work as a system to achieve population outcomes
2. Use design ideas that increase synergy/alignment of all sectors,
at all levels (policy, practice, families)
3. Increase expectations of, and accountability for, impact for a
population
4. Combine expertise on “what to try” with expertise on “how to
change”
5. Use tests and prototypes to implement
promising ideas that customize to work
consistently, across settings, and under all
conditions
6. Use networks to produce and accelerate
innovation, learning and spread

4. EDSI.
Measuring Progress for the Population
Magnolia Community Dashboard
EDSI .
EARLY
DEVELOPMENTAL
June 2012 SCREENING
AND INTERV
INITIATIVE
ENTION
Developmental Progress of Children Entering Kindergarten % of 3rd Grade Children
Vulnerable Very ready
Who Are Proficient in
Developmental 18%
23%
32% 29%
23% 20%
Reading Reading
13% 13% 15% 18% 13%
progress, by
9% 27% proficiency,
kindergarten
Communica on Physical Language &
cogni ve
Social
competence
Emo onal
maturity
Has at least 2 areas
of vulnerability
Has IEP
third grade
% Parents of Children 0-5 With Protective Factors % Parents Achieving Family Goals
100% 100%
80% 80%
60% 60%
Family and
At least 1 neighbor
! " #$ (&))&%$
personal problem
( , -'. +$/ % &'"1%
could discuss a
with whom you
Protective
&'"( #*+%
Flexible when life
! "#$%' $#()($$)
when needed
*+& )#$% ,"#,/)
medical care
doesn’t go as
40%
! "#$% $)%
40%
0*%
( " )$ $ +)$
Can get
planned
! " " #$ $
%&'
community
.
*+( "
%&'
&
20% 20%
factors for
,-
0% 0%
families
Social
Connec ons
(% with 2 of 2)
Concrete
Supports (% with
6 of 6)
Resilience (%
with 5 of 5)
Social
Condi ons
Parent
Health
Economic
Stability
Paren ng
conditions
% Parents Reading With Their Child Daily % Parents Repor ng Ties to Neighbors
100% Parent Experiences in Magnolia Partner
80% Settings, and in the Community Overall
60% Goal
40% In doctor offices
In child care
20%
In family support programs
0%
Parent Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul
2011 2012
In linkage organizations
In the community overall
Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul
2011 2012
activities and 100%
% Parents Repor ng Posi ve Rela onship
with Child
% Parents Helped with Family Income/
Finances
% Parents Receiving Empathic Care
behaviors 80%
60%
40%
20%
0%
Measures of
Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul
real-time
Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul
2011 2012 2011 2012 2011 2012
% Parents Discussing Resources for Families % Parents Asked About Child % Parents Asked About Family Stressors
100%
Development Concerns
improvement
80%
60% in services
Potential and 40%
20%
and supports
0%
actual reach to Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul
2011 2012
Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul
2011 2012
Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul
2011 2012
% Parents Discussing Resources for Social % Parents Asked About Depression
children in the 100%
Support Current & Potential Reach to Children
% receiving care in this system
% reached by network doctor
community 80%
60%
% reached by network child care
0% 100%
40% Number of questionnaires per month
Health 7 31 9 35 24 15 15 22 19 31 9 5
20% Child care 20 - - - 33 39 40 40 - 40 - -
Family support 51 50 57 68 70 44 60 59 33 25 48 38
0% Linkage orgs - - - - - - - - - - - -
Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Community 127 - 106 - - - 96 - 97 - - 86 Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul
J A S O N D J F M A M J J
2011 2012 2011 2012 2011 2012

5. Counts of residents in contact with partner
100
150
200
250
300
350
50
0
WIC
St Thomas
CBSC
Hoover Rec
Toberman
Magnolia El
Normandie
Red Shield
St Johns
LA County
Camino Nuevo
All Peoples
PACE
CNI
Leo Politi
Best Start
Network Reach to Residents
Hope St
NAC
the past year
Esperanza
Crystal Stairs
Pathways
Pan American
Angelica
Public Counsel
most common network partners
Welcome Baby
89% of survey respondents had
CFRC
75% had contact with at least one of 5
SAJE
contact with at least one partner in
1736 center
Magnolia Community Survey, October 2011 (790 residents; all ages)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Cumulative %

6. children
provider
Counts of
seeing the
0
50
100
150
200
250
300
Ei
Cl Cli sn
in ni St er
ica ca Jo
M Sa hn
s
Cl acA n Ju
in rt da
ica hu s
Sa r P
n ar
Past 12 Months
Ka P Mig k
ise ic ue
rP oC l
e lin
Te rma ica
M res ne
Ca sr O a M nte
lif sc e
or ar di
ni c
W a Rom al
Fa
om m ero
en
Ch S ily C
an i a a
Ce d C ldre n M re
nt hil n's ig
ro dr u
M en Hos el
e d 's p i
ica We tal
Ar lln
th es
s
Qu ur P
ee ar
ns k
Cl
in c
provider in the network
ica Al are
de tam
la ed
M
Dr uje
Ho . G r
Ce ra h
nt Te cio alili
ur re Lo
y W sa p
e
om Me z
Cl e di
c
in Ca n's al
ica sa Cl
About 19% of children saw a health care
de de inic
Lo Sa
s A lud
ng
el
e
Ot s
he
rs
0%
parent surveys completed on 632 children); cumulative percentages include some duplicate counts
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Health Care Providers Seen by Children Ages 0-5 in
PRELIMINARY DATA. Parents surveyed in WIC centers within Magnolia catchment, 2010-12. N=682 (of

7. How to Generate Ideas That Will Achieve
System Level Results
New is known
Little Known
Best science
Ideas
or published History of Ideas
success
Evidence based
Test Pilot
Prototype Reliability (consistency)
Scale and spread
Peter Margolis, EDSI Pacoima Collaborative Design Meeting, 3 November 2009

8. A Recipe for Population Impact
Model for Improvement
Evidence-Based Programs and
Content What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
Act Plan
Study Do
Network for Continual Learning
Change Concepts Select
Topic Participants
Version 2.0
CQN Asthma Project Practice Key Driver Diagram
Interventions
Key Drivers 

Form a 3-5 person interdisciplinary QI Team
Formally communicate to entire practice the importance and goal of this
Prework
GLOBAL CQN AIM Engaging Your QI Team and project
We will build a sustainable quality Your Practice  Meet regularly to work on improvement

improvement infrastructure within our practice
to achieve measurable improvements in
*The QI team and practice is active and
engaged in improving practice processes
and patient outcomes

All physicians and team members complete QI Basics on EQIPP
Collect and enter baseline data
Change P P
asthma outcomes  Generate performance data monthly

Specific Aim
From fall 2009 to fall 2010, we will achieve 
Communicate with the state chapter and leaders within the organization
Turn in all necessary data and forms
Concepts A D A D
measurable improvements in asthma  Attend all necessary meetings and phone conferences
outcomes by implementing the NHLBI
guidelines and making CQN’s key practice
changes Using a Registry to Manage  Select and install a registry tool
S S
Measures/Goals
Your Asthma Population
*Identify each asthma patient at every visit
*Identify needed services for each patient
*Recall patients for follow-up



Determine staff workflow to support registry use
Populate registry with patient data
Routinely maintain registry data
Expert LS 1 LS 2 LS 3
Group
Outcome Measures:  Use registry to manage patient care & support population management
 >90% of patients well controlled
Process Measures
Using a Planned Care  Select template tool from registry or create a flow sheet
 >90% of patients have “optimal” asthma care (all Approach to Ensure Reliable  Determine workflow to support use of encounter form at time of visit
of the following) Asthma Care in the Office  Use encounter form with all asthma patients
 assessment of asthma control using a
* CQN Encounter Form
* Care team is aware of patient needs and
 Ensure registry updated each time encounter form used
validated instrument work together to ensure all needed  Monitor use of encounter form
 stepwise approach to identify treatment services are completed
options and adjust therapy
 written asthma action plan  Select & customize evidence-based protocols for your office
Developing an Approach to
 patients >6 mos. Of age with flu shot  Determine staff workflow to support protocol, including standing orders
Employing Protocols
(or flu shot recommendation)
* Standardize Care Processes  Use protocols with all patients
* Practice wide asthma guidelines  Monitor use of protocols
 >90% of practice’s asthma patients have at least implemented
an annual assessment using a structured encounter
form
Providing Self management  Obtain patient education materials
Support  Determine staff workflow to support SMS
* Realized patient and care team  Provide training to staff in SMS
relationship
 Assess and set patient goals and degree of control collaboratively
 Document & Monitor patient progress toward goals
 Link with community resources
Peter Margolis, CCHMC; Ed Wagner, MD, MPH: MacColl Institute;
Associates in Process Improvement; Institute for Healthcare Improvement

9. PDSA Example – Texting for Daily Reading
Drivers
Support parents to manage their
child’s needs & promote development
Current % of third grade children proficient in
reading: 27% Can we increase the
outcomes: % of children entering kindergarten frequency of daily
with communication vulnerability: 18%
book-sharing by
Parent practice: 100%
% Reading daily introducing texting,
80%
60%
to prompt reading
40%
20%
and to enable parents
0%
Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul
2011 2012
to share their
System practice: % Discussing importance of reading successes with each
100%
80%
other, in real time?
60%
40%
20%
0%
Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul
2011 2012

10. Collaboration with the CTSI – Year 2
Aim 1: Test the impact of several key functions of
partnered infrastructure for translational research, to
increase the volume and breadth of partnered research
activities and funding, and to accelerate the timing of
population impact
• Using MCI Research and Evaluation group to identify
common priority topics, and link researchers and
network partners
• CERP staff support of data visualization for community
residents
• Biostatistics consulting to facilitate impact evaluation

11. Collaboration with the CTSI – Year 2
Aim 2: Identify effective, scalable applications of mobile
health technology that improve population health
•Feasibility pilot with Center for Embedded Networked
Sensing (CENS) to identify effective uses of smartphones for
helping residents describe their neighborhoods and daily
lives in ways that contribute to meaningful action for
neighborhood change
– Offer residents access to Ohmage, which is an open-source,
mobile to web platform that records, analyzes, and visualizes
data from prompted experience samples entered by residents
– “Holiday survey” to develop positive neighborhood asset
measures
– Storytelling narratives about “a day in the life”

12. Neighborhood Observation
Holiday Micro-Community Participation Survey Checklist Team Leader________________________________
Date:_ 12/________/2011 Start-Time:_____:_____ End-Time:_____:_____ Team Members:_____________________________
SINGLE OR IF MULTIPLE, HOLIDAY WRITE TYPE OF
UNIT PHOTO PHOTO
Addresses MULTIPLE HOW MANY DÉCOR DECORATION & LOCATION
NUMBER TAKEN? #
UNIT UNITS? RATING
STRING OF LIGHT AROUND
Example: 1234 14th Street M 4 A 4 YES 1
ROOFLINE
Example2: 1234 14th Street M 4 B 1 YES 2
WREATH
1. S OR M
2.
3.
4.
5.
Key: Decorations - 0=None, 1= one holiday item, 2= two items, 3= 3 items, 4= four or more items
How to number units if number not listed or visible
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