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

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Presentation on theme: "Tuba City Regional Health Care Corporation Michelle Archuleta, MS HPDP Director, Project Director DM Grants SDPI Diabetes Grantee Meeting November 14,"— Presentation transcript:

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

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

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

5 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 whats possible.

6 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

7 Success of Navajo Area 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

8 TCRHCC Coordination 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)

9 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. 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 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 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; 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; 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 develop and implement process and impact evaluation for the Tuba 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 coaching and support. To continue support and implement the lessons of the DPP in personal coaching and support.

10 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)

11 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 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 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 increase screening rates for diabetes; To improve control of blood glucose, blood cholesterol, and blood pressure; 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 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. To receive IHS recognition status for the Diabetes Clinical Education Program.

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

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

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

15 Physical Activity Clinic Community Outreach Fitness Health Education Special Projects Media Marketing 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, CoPs, New systems of Influence

16 Emergence HPDP and DPP coming together HPDP and DPP coming together Growing Pains Growing Pains Trusted we would be stronger together than separate Trusted we would be stronger together than separate

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

19 Low Energy E F NO TIME TO MAKE IT HAPPEN OVERWHELMED CONVENTIONAL APPROACH Top Only – Few involved answers from experts Focusing on whats wrong Searching for Root Cause of Failure/Decay if you look for problems, youll 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 «

20 In-Sync HIGH Energy E F Whole Greater than Sum of Parts Energy CANT be stopped APPRECIATIVE APPROACH All (or all levels) involved solutions from within Focus on WHAT WORKS Search for root causes of success If you look for successes, youll find and create more successes Create the Future Obstacles treated as Ramps into NEW Territory HOW DOES THIS HAPPEN ?!? MORE ALIVE! » Vibrant « » Alive « Time Flies NEW Possibilities Unexpected CREATIVITY ORGANIC, EMERGENT

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

22 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

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

24 Managing Change and Understanding Transition Letting Go, Ending, Losing Transition Period, Phase New Beginning Time L e v e L of M a n a g e m e n t Neutral Zone

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

26 What does Change look like?

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

28 Future Needs (2000) Stable funding Stable funding More time to assess results More time to assess results More data re what works with our population; More data re what works with our 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?

29 Thank You!


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