Tuba City Regional Health Care Corporation

1. Tuba City Regional Health Care Corporation Michelle Archuleta, MS HPDP Director, Project Director DM Grants SDPI Diabetes Grantee Meeting November 14, 2008 Washington, DC

2. Discovery into what makes a Successful Collaboration Past, Present, Future Leadership Influences What is our role in creating change as a program Emergence Adaptive Systems, Complexity Theory Lessons learned

3. Impact of SDPICommunity Directed Grant • Navajo Nation – Special Diabetes Programs, community services, wellness centers, Urban Program (NACA) Flagstaff • Navajo Area IHS • Service Unit Level – Clinics, Hospitals (locally directed diabetes & treatment efforts) • Clinic Area Initiatives – Dental, Gestational • Community Initiative - HPDP (Navajo Philosophy of Life - Four Direction Framework) • Wellness, Prevention, Total Population Health • Coordinated School Health, Community Fitness, Health Communications, Wellness on Wheels, Community Development

4. Tuba City Regional 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.

5. Healthy People and Communities from Four Directions • Immunization Rates consistently over 90% • Culturally appropriate parenting skills • Early Childhood Development • Elders • Community • Capacity • Building • Community • specific health data systems • Community • Wellness • planning • Coordinated School Health • Nutrition • Expanding community fitness opportunities • Promoting Healthy Relationships • Domestic Violence Prevention Workshops • Adult Preventative Health Screenings

6. 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 Success of Navajo Area HPDP

7. TCRHCCCoordination of SDPI Diabetes Grants • 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)

8. Primary/Secondary Prevention The overall objective is to decrease the incidence of diabetes among Navajo and San Juan Southern Paiute people through a focused, coordinated series of innovative projects promoting wellness. To expand the coordinated school health program in every school (headstart through high school) in Tuba City and surrounding communities; To develop and implement a fitness/nutrition promotion program based on a mobile “wellness on wheels” unit; To provide a culturally-appropriate media campaign promoting physical activity, nutrition and diabetes awareness; Increase opportunities for participation in physical activity through a coordinated community-based program of events, clubs, local wellness center, community mini-grants, and fitness programs; To develop and implement process and impact evaluation for the Tuba City Area; To increase rates of reported physical activity; To decrease consumption of “high fat” or “high sugar” foods; To increase rates of consumption of fruits and vegetables; and To continue support and implement the lessons of the DPP in personal coaching and support.

9. 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)

10. Tertiary Prevention/Care & Treatment The long-term objectives are: To decrease the incidence of diabetic complications among Navajo and San Juan Southern Paiute people (e.g. neuropathy, retinopathy, nephropathy, vascular and heart disease), by improving the coordination and availability of care for diabetic patients and their families in Tuba City and surrounding communities; To improve compliance with diabetes standards of care for patients receiving care from the Tuba City Regional Health Care Corporation; To increase screening rates for diabetes; To improve control of blood glucose, blood cholesterol, and blood pressure; To improve access to diabetic care services including educational and nutritional counseling, eye, foot and oral health screening, and case management; To receive IHS recognition status for the Diabetes Clinical Education Program.

11. TCRHCC SDPI Demonstration Project • DPP Competitive Grant • Rural Outreach – Lifestyle Intensive Program • Diabetes Prevention Program under HPDP • DPP Coordinator – Evelina Maho • Grant Funded Program Staff: 1-Program Assistant (recruiter), 1-Community Activity Specialist, 1-RPMS Specialist, 1-Administrative Assistant • After-Core Program: program volunteers • REZ Fitness Leaders

12. Influences Dedicated to the health and well-being of Families & Communities Robyn Maho, HP Coordinator Hopi/Navajo Grew up in HPDP Evelina Maho, DPP Coordinator Home Grown-Tuba City Strong with Navajo Culture And Traditions Michelle Archuleta, HPDP Director Grant Administration Skills Organizational Development Kristin Graziano, Diabetes Physician Advisor Clinic Champion Public Health Committed People

13. The Lifecycle of Emergence Discovering Shared Meaning and Purpose Networks New Practices Become the Norm Communities of Practice Systems of Influence K’e Developing New Practices Together Using Emergence to take Social Innovation to Scale The Berkana Institute Margaret Wheatley

14. Emergence Project Teams – Shared Leadership Strength Based Approach Management Training • - Move out of roles into passion • Invited others to participate • Formed Networks, CoP’s, • New systems of Influence Physical Activity School Health Data Special Projects Health Education Clinic Community Outreach Media Marketing Fitness

15. Emergence • HPDP and DPP coming together • Growing Pains • Trusted we would be stronger together than separate

16. Prevention With Me Begins diabetes prevention program Tuba City Regional Health Care Corporation

17. What is Organizational Development • Change – Paradigm Shifts • Facilitation, Collaborative Methods • Human Behavior • Large and Small Scale • Organization Effectiveness-systems & processes • Multi, Cross Disciplinary Approaches • Leadership Development • Management Training • Guiding, Coaching, Mentoring, Influencing

18. CONVENTIONAL APPROACH Chalk Lines Define Problems Time Drags No Fun Hard Work Mechanical » Vibrant « Analyze Failures STATIC, INERT, DEAD »Alive « HOW DOES THIS HAPPEN ?!? EXAUSTED! 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 OVERWHELMED NO TIME TO MAKE IT HAPPEN Low Energy E F

19. APPRECIATIVE APPROACH AMPLIFY WHAT GIVES LIFE Search for What Works Time Flies » Vibrant « NEW Possibilities CREATIVITY »Alive « Unexpected MORE ALIVE! ORGANIC, EMERGENT In-Sync HOW DOES THIS HAPPEN ?!? Energy CAN’T be stopped 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 Whole Greater than Sum of Parts HIGH Energy E F

20. Leadership in a liberating way • Being reflective • Working experientially • Thinking critically • Leadership occurs at all levels • Anyone can be a leader

21. A Critical Understanding of Leadership “Leadership is a relationship, in which leaders inspire or engage others to extend their capacity to imagine, think and act in positive new ways.” - Amanda Sinclair, Leadership for the Disillusioned

22. DM & Nutrition Area Consultants Coordinating Center Leadership and Change Complexity Theory Self Organize TDLC NDTP NIHB CFO Oracle PMS National Level Accounts Payable WebEX ARMS Project Officer Continuation Application SF 270 Grant Reviews CEO Finance Level DGO Diabetes Committees Diabetes Prevention SF 269 NOA Allowable Costs Program Level A1-33 Tribes Grants.gov Diabetes Treatment Program Priorities Program Staff

23. Managing Change and Understanding Transition Leve L of Managemen t New Beginning Neutral Zone Transition Period, Phase Letting Go, Ending, Losing Time

24. How did Tuba City do it? • PL - 638, thrust us into change • Relied on Partnerships – Navajo Area HPDP • DM Program Involvement • DM registry, DM Audit, Educators, Screenings, clinic partners • Learned new language (Grants Policy Manual) • DGO, PMS, Continuation Application process, NEPA, SF 269, 270, cost-reimbursement, A1-33, grants.gov, NOA • Passion – Identify the champions and support them • Leadership – Lifecycle of Emergence – Networks, CoP, Systems of Influence • Organizational Development – reflection, experiential, critical thinking • Timing and Good Luck

25. What does Change look like?

26. The Essential’s People – participate, contribute, come together Vision – who, what, why, when, where, and how Community Based – culture, environment, family, schools, outreach Patient Care – individual, family, relationship based Leadership – emerges, expands, invites Passion – follow, nurture and encourage Coordination, Communication, Collaboration CHANGE

27. Future Needs (2000) • Stable funding • More time to assess results • More data re what works with our population; • What motivates continued participation? • Would support groups be effective? • What are the best ways to teach nutrition? • How do we get community/political buy-in?

28. Thank You!