tuba city regional health care corporation michelle archuleta, ms hpdp director, project director dm...
TRANSCRIPT
Tuba City Tuba City Regional Health Care Regional Health Care CorporationCorporation
Michelle Archuleta, MS HPDP Director, Project Director DM Grants
SDPI Diabetes Grantee MeetingNovember 14, 2008
Washington, DC
Discovery into what Discovery into what makes a Successful makes a Successful
CollaborationCollaboration Past, Present, FuturePast, Present, Future Leadership InfluencesLeadership Influences What is our role in creating change as What is our role in creating change as
a programa program EmergenceEmergence Adaptive Systems, Complexity TheoryAdaptive Systems, Complexity Theory Lessons learnedLessons learned
Impact of SDPIImpact of SDPICommunity Directed GrantCommunity Directed Grant
Navajo Nation – Special Diabetes Programs, Navajo Nation – Special Diabetes Programs, community services, wellness centers, Urban community services, wellness centers, Urban Program (NACA) Flagstaff Program (NACA) Flagstaff
Navajo Area IHSNavajo Area IHS Service Unit Level – Clinics, Hospitals (locally Service Unit Level – Clinics, Hospitals (locally
directed diabetes & treatment efforts)directed diabetes & treatment efforts) Clinic Area Initiatives – Dental, Gestational Clinic Area Initiatives – Dental, Gestational Community Initiative - HPDP (Navajo Philosophy Community Initiative - HPDP (Navajo Philosophy
of Life - Four Direction Framework)of Life - Four Direction Framework) Wellness, Prevention, Total Population HealthWellness, Prevention, Total Population Health Coordinated School Health, Community Coordinated School Health, Community
Fitness, Health Communications, Wellness on Fitness, Health Communications, Wellness on Wheels, Community DevelopmentWheels, Community Development
Tuba City Tuba City Regional Health Care CorporationRegional Health Care Corporation
Discovering what happens when networks of relationships form among people who discover they share a common cause and vision of what’s possible.
• Immunization Rates consistently over 90%• Culturally appropriate parenting skills
• Early Childhood Development
• Coordinated School Health
• Nutrition
• Expanding community
fitness opportunities
• Promoting Healthy Relationships • Domestic Violence Prevention
Workshops• Adult Preventative Health Screenings
• Elders
• Community Capacity Building
• Community specific health
data systems
• Community Wellness planning
Healthy People and Communities from Four Directions
Success of Navajo Area Success of Navajo Area HPDP HPDP
Understanding where you come from helps you move forward
Four Directions of Navajo Philosophy of Life Embracing cultural
wisdom Set the vision,
framework, adapted to meet the needs
Time of creating and employing tools, went after knowledge
Time of dreaming and making discoveries
Community focused approach delivered in collaboration and partnership within the Navajo Area IHS medical system and HPDP Coordinators
Program Refinement Primary,
Secondary, & Tertiary Prevention Efforts
Capacity Building & Community Development
TCRHCCTCRHCCCoordination of SDPI Diabetes Coordination of SDPI Diabetes
GrantsGrants Community Directed (non-competitive)
33% Community Based Diabetes Prevention Efforts Health Promotion Department
HPDP Director – Michelle Archuleta, MS HPDP Funded Program Staff: 1-HP Coordinator, 1-School
Health Coordinator, 1- Administrative Assistant (hospital funded)
HPDP Grant Funded Program Staff: 1-HP Specialist, 1-School Health Assistant, 1-Grant Writer (vacant)
SDPI Grants are administered HPDP Director - DM Grants Project Director (Budgets, fiscal expenditures, continuation
applications, personnel, ensure and support program staff to continue their success in obtaining the goals of our DM Grants)
Primary/Secondary Primary/Secondary PreventionPrevention The overall objective is to decrease the incidence of diabetes among The overall objective is to decrease the incidence of diabetes among
Navajo and San Juan Southern Paiute people through a focused, Navajo and San Juan Southern Paiute people through a focused, coordinated series of innovative projects promoting wellness. coordinated series of innovative projects promoting wellness.
To expand the coordinated school health program in every school To expand the coordinated school health program in every school (headstart through high school) in Tuba City and surrounding (headstart through high school) in Tuba City and surrounding communities; communities;
To develop and implement a fitness/nutrition promotion program based To develop and implement a fitness/nutrition promotion program based on a mobile “wellness on wheels” unit; on a mobile “wellness on wheels” unit;
To provide a culturally-appropriate media campaign promoting physical To provide a culturally-appropriate media campaign promoting physical activity, nutrition and diabetes awareness; activity, nutrition and diabetes awareness;
Increase opportunities for participation in physical activity through a Increase opportunities for participation in physical activity through a coordinated community-based program of events, clubs, local wellness coordinated community-based program of events, clubs, local wellness center, community mini-grants, and fitness programs; center, community mini-grants, and fitness programs;
To develop and implement process and impact evaluation for the Tuba To develop and implement process and impact evaluation for the Tuba City Area; City Area;
To increase rates of reported physical activity;To increase rates of reported physical activity; To decrease consumption of “high fat” or “high sugar” foods; To decrease consumption of “high fat” or “high sugar” foods; To increase rates of consumption of fruits and vegetables; and To increase rates of consumption of fruits and vegetables; and To continue support and implement the lessons of the DPP in personal To continue support and implement the lessons of the DPP in personal
coaching and support.coaching and support.
Diabetes Clinical Services under Division of Medical
Services Community Directed (non-competitive)
67% Diabetes Treatment DCS Director – Kristin Graziano, DO,
MPH Grant Funded Program Staff: 1-DM
Coordinator, 1-PH Nutritionist/Educator, 2-DM Health Techs & 1-DM Educator, CDE (hospital funded)
Tertiary Prevention/Care & Tertiary Prevention/Care & TreatmentTreatment
The long-term objectives are: The long-term objectives are: To decrease the incidence of diabetic complications among Navajo To decrease the incidence of diabetic complications among Navajo
and San Juan Southern Paiute people (e.g. neuropathy, retinopathy, and San Juan Southern Paiute people (e.g. neuropathy, retinopathy, nephropathy, vascular and heart disease), by improving the nephropathy, vascular and heart disease), by improving the coordination and availability of care for diabetic patients and their coordination and availability of care for diabetic patients and their families in Tuba City and surrounding communities; families in Tuba City and surrounding communities;
To improve compliance with diabetes standards of care for patients To improve compliance with diabetes standards of care for patients receiving care from the Tuba City Regional Health Care Corporation; receiving care from the Tuba City Regional Health Care Corporation;
To increase screening rates for diabetes; To increase screening rates for diabetes; To improve control of blood glucose, blood cholesterol, and blood To improve control of blood glucose, blood cholesterol, and blood
pressure; pressure; To improve access to diabetic care services including educational To improve access to diabetic care services including educational
and nutritional counseling, eye, foot and oral health screening, and and nutritional counseling, eye, foot and oral health screening, and case management;case management;
To receive IHS recognition status for the Diabetes To receive IHS recognition status for the Diabetes Clinical Education Program.Clinical Education Program.
TCRHCC TCRHCC SDPI Demonstration SDPI Demonstration
Project Project DPP Competitive GrantDPP Competitive Grant Rural Outreach – Lifestyle Intensive Rural Outreach – Lifestyle Intensive
Program Program Diabetes Prevention Program under HPDP Diabetes Prevention Program under HPDP
DPP Coordinator – Evelina MahoDPP Coordinator – Evelina Maho Grant Funded Program Staff: 1-Program Grant Funded Program Staff: 1-Program
Assistant (recruiter), 1-Community Activity Assistant (recruiter), 1-Community Activity Specialist, 1-RPMS Specialist, 1-Specialist, 1-RPMS Specialist, 1-Administrative AssistantAdministrative Assistant
After-Core Program: program volunteersAfter-Core Program: program volunteers REZ Fitness LeadersREZ Fitness Leaders
InfluencInfluenceses
Michelle Archuleta, HPDP Director
Grant Administration SkillsOrganizational Development
Robyn Maho, HP Coordinator
Hopi/NavajoGrew up in HPDP Evelina Maho,
DPP CoordinatorHome Grown-Tuba City
Strong with Navajo Culture And Traditions
Kristin Graziano,Diabetes Physician Advisor
Clinic ChampionPublic Health
Committed People
Dedicated to the health and well-being of Families
& Communities
The Lifecycle of The Lifecycle of EmergenceEmergence
The Berkana Institute Margaret Wheatley
Networks
Communities of
PracticeSystems ofInfluence
K’e
Discovering Shared Meaning and Purpose
Developing New Practices Together
New Practices Become the Norm
Using Emergence to take Social Innovation to Scale
Physical Activity
ClinicCommunity
Outreach
Fitness
HealthEducation
Special Projects
MediaMarketing
School Health
Emergence
Project Teams – Shared Leadership
Strength Based Approach
Management Training
Data
- Move out of roles into passion - Invited others to participate- Formed Networks, CoP’s, New systems of Influence
EmergenceEmergence
HPDP and DPP coming togetherHPDP and DPP coming together Growing PainsGrowing Pains Trusted we would be stronger Trusted we would be stronger
together than separatetogether than separate
What is Organizational What is Organizational DevelopmentDevelopment
Change – Paradigm ShiftsChange – Paradigm Shifts Facilitation, Collaborative MethodsFacilitation, Collaborative Methods Human BehaviorHuman Behavior Large and Small Scale Large and Small Scale Organization Effectiveness-systems & Organization Effectiveness-systems &
processesprocesses Multi, Cross Disciplinary ApproachesMulti, Cross Disciplinary Approaches Leadership DevelopmentLeadership Development Management TrainingManagement Training Guiding, Coaching, Mentoring, Guiding, Coaching, Mentoring,
InfluencingInfluencing
Low Energy
E F
NO TIME
TO MAKE IT HAPPEN
OVERWHELMED
CONVENTIONAL APPROACHCONVENTIONAL APPROACH
Top Only – Few involved answers from experts Focusing on what’s wrong Searching for “Root Cause” of Failure/Decay if you look for problems, you’ll find and create more problems
“Fix” the past
Obstacles treated as barriers
HOW DOES THIS HAPPEN ?!?
Mechanical
Chalk Lines
STATIC, INERT, DEAD
EXAUSTED!
» Vibrant
« » Alive «
In-Sync
HIGH Energy
E F
Whole Greater than
Sum of Parts
Energy CAN’T be stopped
APPRECIATIVE APPROACHAPPRECIATIVE APPROACH
All (or all levels) involved solutions from within Focus on WHAT WORKS
Search for root causes of success “If you look for successes, you’ll find and create more successes”
Create the Future Obstacles treated as Ramps into NEW Territory
HOW DOES THIS HAPPEN ?!?
MORE ALIVE!
» Vibrant
«» Alive «
Time FliesNEW PossibilitiesUnexpect
ed
CREATIVITY
ORGANIC, ORGANIC, EMERGENTEMERGENT
Leadership in a Leadership in a liberating wayliberating way
Being reflectiveBeing reflective Working experientiallyWorking experientially Thinking criticallyThinking critically Leadership occurs at all Leadership occurs at all
levelslevels Anyone can be a leaderAnyone can be a leader
A Critical Understanding of A Critical Understanding of LeadershipLeadership
““Leadership is a relationship, in Leadership is a relationship, in which leaders inspire or engage which leaders inspire or engage others to extend their capacity to others to extend their capacity to imagine, think and act in positive imagine, think and act in positive
new ways.”new ways.”
- Amanda Sinclair, Leadership for the - Amanda Sinclair, Leadership for the Disillusioned Disillusioned
Program Level
Finance Level
National Level
Leadership and ChangeComplexity TheorySelf Organize
Program Priorities
Program Staff
Grants.gov
Diabetes Committees
DM & NutritionArea Consultants
DGO
TDLC
PMS
NDTP
A1-33
SF 269
SF 270Continuation Application
Allowable Costs
DiabetesPrevention
DiabetesTreatment
CFO
Coordinating Center
Grant Reviews
NOA
ProjectOfficer
WebEXAccountsPayable
Oracle
ARMS
NIHB
CEO
Tribes
Managing Change and Understanding Transition
Letting Go,Ending,Losing
TransitionPeriod, Phase
New Beginning
Time
LeveL of
Management
Neutral Zone
How did Tuba City do it?How did Tuba City do it? PL - 638, thrust us into change PL - 638, thrust us into change Relied on Partnerships – Navajo Area HPDPRelied on Partnerships – Navajo Area HPDP DM Program Involvement DM Program Involvement
DM registry, DM Audit, Educators, Screenings, clinic DM registry, DM Audit, Educators, Screenings, clinic partnerspartners
Learned new language (Grants Policy Manual)Learned new language (Grants Policy Manual) DGO, PMS, Continuation Application process, NEPA, DGO, PMS, Continuation Application process, NEPA,
SF 269, 270, cost-reimbursementSF 269, 270, cost-reimbursement, , A1-33, grants.gov, A1-33, grants.gov, NOANOA
Passion – Identify the champions and support them Passion – Identify the champions and support them Leadership – Lifecycle of Emergence – Networks, CoP, Leadership – Lifecycle of Emergence – Networks, CoP,
Systems of InfluenceSystems of Influence Organizational Development – reflection, experiential, Organizational Development – reflection, experiential,
critical thinkingcritical thinking Timing and Good LuckTiming and Good Luck
What does Change look What does Change look like?like?
The Essential’s The Essential’s People – participate, contribute, come People – participate, contribute, come
together together Vision – who, what, why, when, where, and Vision – who, what, why, when, where, and
howhow Community Based – culture, environment, Community Based – culture, environment,
family, schools, outreachfamily, schools, outreach Patient Care – individual, family, relationship Patient Care – individual, family, relationship
basedbased Leadership – emerges, expands, invitesLeadership – emerges, expands, invites Passion – follow, nurture and encouragePassion – follow, nurture and encourage Coordination, Communication, Collaboration Coordination, Communication, Collaboration CHANGE CHANGE
Future Needs (2000)Future Needs (2000)
Stable fundingStable funding More time to assess resultsMore time to assess results More data re what works with our More data re what works with our
population;population; What motivates continued participation?What motivates continued participation? Would support groups be effective?Would support groups be effective? What are the best ways to teach nutrition?What are the best ways to teach nutrition? How do we get community/political buy-in?How do we get community/political buy-in?
Thank You!Thank You!