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

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!