Transcript “Learning Organization:” Community Health Outreach Work (CHOW)

Creating and Sustaining a “Learning
Organization”: Community Health
Outreach Work (CHOW) Project
Case Study
Heather Lusk, MSW: Executive Director, CHOW Project
[email protected]
Lorraine C. Marais, Ed.D., MSW: CEO Ubuntu Generative
Mentoring and OD Consultancy Services
[email protected]
www.ubuntunonprofitconsultancy.com
Overview of Presentation
* Introducing the speakers
* Intent and outcomes for the presentation
* Theory of Change (TOC): What is a “learning
organization”?
* Model for presentation: 5 Learning Disciplines (LD)
applied to CHOW
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Mental Models (LD 1)
Shared Vision
(LD 2)
Team Learning (LD 3)
Systems Thinking (LD 4)
Personal Mastery (LD 5)
* CHOW: The Story of CHOW
• The context: Hawaii
• Historical/Timeline CHOW change process
• Application of 5 Learning Disciplines
Intent and Outcomes of
Presentation
After this presentation, participants are
able to:
1. Understand and apply the LDs to own
organization based on the lessons from
CHOW
2. Committed to bring about positive change
to own organization based on an explicit
and conscious theory of change (TOC)
3. Recognition of the value of LO and the 5
LDs
Theory of Change (TOC): What
is a “Learning Organization”?
* Theoretical underpinnings
• Senge (1997, 2003)
 Generative and adaptive learning
 Multi-layered learning
 Inter-dependent and interconnected
Individual
Group
Agency
Five Learning Disciplines
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Mental Models
Shared Vision
Team Learning
Systems Thinking
Personal Mastery
Shared Vision
(LD 1)
(LD 2)
(LD 3)
(LD 4)
(LD 5)
Team Learning
Mental Model
Systems Thinking
Personal
Mastery
The Story of the CHOW Project
* Context: Hawaii
* Overview of CHOW: Video and Pictures
* CHOW Historical and Timeline of the
Change Process
* Application of the 5 LDs to CHOW’s
change process
Contextual factors: Hawaii
* Most remote archipelago in the world
• Urban and rural with water between counties
and therefore resource scarcity
• 1.4 million residents with 80% on Oahu
* Diverse population
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•
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•
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37.7%
22.7%
9.4%
8.9%
1.5%
Asian
White
Native Hawaiian and other Pacific Islander
Latino
African American
* Tourism drives Hawaii economy and impacts social
issues
• 3.4 million visitors a year – 14 billion dollar tourist
industry
Contextual factors: Hawaii
* 7,777 non-profits in Hawaii in 2008
• 57% of residents volunteer
• 93% of households give cash, goods or services in contributions
* Strong military presence
* Honolulu has highest rate of homelessness in U.S.
• Very high cost of living, affordable housing shortage
• New study found need to make over $34 an hour to afford 2 bedroom
 Highest in US
* Hawaii has highest rate of liver cancer in U.S. (hepatitis B and C)
• Also high rates of TB, MRSA and other infectious diseases (even dengue)
* Youth in Hawaii:
• Latest age of initiation for sex but also lowest condom use rate in U.S.
• High rate of suicide attempts
• Strong connections to family (ohana)
The (Not so) Hidden
Side of Paradise
VS
History and Timeline of
Change Process of CHOW
* 1989 – pilot syringe exchange pilot
* 1992 – Act 152 passed to allow syringe exchange (SEP)
* 1993 – CHOW awarded Hawaii’s first SEP grant
• 38,000 syringes exchanged statewide
* 1999 – CHOW incorporated as 501c3
* 1999 – 2009 offered syringe services only with small
(3 member) management-oriented Board of Directors
• 500,000 syringes exchanged statewide in 2009
• Through 2009 only ONE funding source (DOH)
 CHOW notified that DOH expects 300,000+ funding cut
History and timeline of change
process of CHOW (continue)
* 2010 Lorraine joins CHOW Board as President
* 2011 Heather joins CHOW and CHOW
* 2012 Strategic planning process with Richard Male
• DOH follows through with 350K funding cut (1/3 of grant)
• CHOW annual budget 668,000
* 2013-2015 implementation of SP* www.chowproject.org
• Expanded services, enhanced visibility, increased funding,
strategic collaborations
• 2015 just under 1 million syringes exchanged statewide
• 2015 CHOW budget 2.8 million
* 2013 -2015 External community collaboration
* 2016 Repeat the strategic cycle
CHOW Organizational Chart
Current CHOW Services
* Syringe exchange
* HIV and hepatitis C counseling, testing and
referral
* Hepatitis and HIV care coordination
* Health education
* Housing navigation and case management
* Wound care
* Overdose prevention
* Hygiene kits, safer sex supplies, other harm
reduction supplies
* Referrals and Outreach
* Training, outreach and education in
community
CHOW Services
CHOW and 5 LDs
LD 1: Mental Models
• Perception of consumers and community
stigma
• Past & current OD culture
• “Being in the shadows”
• Limiting our own potential
• Understanding who we are and our own
potential (changing the way we thought of
ourselves)
• Challenge to translate it into action
• Current Mental Model
LD 1: Mental Models
CHOW Organizational Culture
Before
After
* One funding source/service * Diverse funding
* Traditional hierarchal
* Data-driven programming
structure
* Embody values of agency
• ED made all decisions alone
• Staff never met Board
• Lack of transparency
* Fear
•
•
•
*
If CHOW was visible would be shut down
What happens here stays here
Initiative penalized
Services done in isolation
*
*
*
*
within org structure and
culture
Board/staff integration
Innovation encouraged
Visibility enhanced
Continuum of services
• Internal and external to
CHOW
LD 1: Mental Model
Current Mental Model
Challenge to Action
* CHOW is out and proud!
• Evidence-based services
* CHOW is part of the solution and active
in coalition-building
• Homelessness, substance use, mental
health
* CHOW participants and staff are our
greatest resource
• Change is now the status quo
LD 2: Shared Vision and CHOW
• Role of creating a common understanding of
who we are, who we want to be and how do
we get there (identity)
• Planning content and process (role of strategic,
assessment and resource development
planning)
• Changing the hearts and minds of staff, board,
consumers & community
• How to keep the vision alive
LD 2: Shared Vision
Creating a Common
Understanding of Identity
CHOW’s old mission:
To prevent the transmission of HIV/AIDS
and other blood-borne pathogens among
high-risk drug users, especially injection
drug users (IDUs) in the State of Hawaii.
LD 2: Shared Vision
CHOW’s New Mission
Statement
The Community Health Outreach Work (CHOW)
Project is dedicated to serving individuals, families
and communities adversely affected by drug use,
especially people who inject drugs, through a
participant-centered harm reduction approach.
CHOW works to reduce drug-related harms such
as but not limited to HIV, hepatitis B/C,
homelessness and overdose. CHOW supports the
optimal health and well-being of people affected
by drug use throughout the State of Hawaiʿi.
LD 2: Shared Vision
Planning Content and Process
* Evolved Program Profile
• Enhance and expand our services to our
participants, expand research, get involved
in advocacy, enhance collaborations
* Ensured Infrastructure and Systems
• Enhance effectiveness in meeting mission
and vision
* Strategic plan was separated into
activities with current funding and
those which need additional funding
21
LD 2: Shared Vision
CHOW Values
* Participant-centered: listen to and honor peoples’ needs
* Non-judgmental: care without judgment and with respect
* Accessibility: eliminate barriers to access services based on peoples’
* The self-determination rights of each person:
circumstances
respect and honor individual
privacy, freedom, and choice
* Empowerment: provide opportunities for empowering participants to make positive
changes in their health and well-being
* Positive change: support positive incremental change through options, not directives
* Centrality of relationships:
recognize the importance of trust and relationships as
the building blocks for successful service provision and positive change
*
Holistic and strength-based approach: belief in the resiliencies of people to
enhance the well-being of family and community
LD 2: Shared Vision
Current CHOW Vision
* promote the overall health and well-being of people
and communities affected by drug use,
* foster collaborative prevention strategies and
reduce the risks of hepatitis B/C, HIV and overdose,
* empower individuals and communities to make
positive incremental change in health and well-being
* eliminate the stigma of drug use through community
education and outreach, and
* advocate on behalf of people and families whose
quality of life has been disrupted by the broader
impacts of drug use.
LD 2: Shared Vision
Changing the hearts and minds
Strategic Planning
Capacity Building
and Training
Resource
Development
Evaluation
Capacity Building
and Training
LD 2: Shared Vision
How to keep the vision alive?
* Visioning
exercise
* SP/mission
vision/values at
every staff
meeting
* Board/staff
retreats
LD 3: Team Learning and
CHOW
• Role of Board Leadership in change
process
• External OD Consultant comments
• Role of staff and Consumers
• How to continuously bring it together?
LD 3: Team Learning
CHOW Leadership: Board Members
https://youtu.be/-WSfzrFIYvI
LD 3: Team Learning
Role of Staff and Consumers
Staff evaluations and staff development
plans linked to vision and strategic plan
Consumer feedback integrated through
annual evaluation and focus groups
LD 3: Team Learning
External OD consultant
www.richardmale.com
https://www.youtube.com/watch?v=QG
9rZYv4mhY
LD 4: Systems Thinking and
CHOW
• Seeing the connection between internal
and external systems (then, now and
future)
• Creating a picture of the whole and its
parts
LD 4: Systems Thinking
Systems Connections
Systems within CHOW
Training and
Capacity Building
Job description
Staff evaluation and
development plan
Policies and Procedures
Systems affecting
CHOW Participants
Access to healthcare
and other services
Stigma
Addiction
Housing and Basic Needs
LD 4: Systems Thinking
Big Picture/Small Picture
Individual
Group
Agency
LD 5: Personal Mastery and
CHOW
• Moving from consciousness
reflection
understanding
identifying competencies
skills development
implementation
• Resistance to change and how to motivate
staff/board
• Role of leadership (ED and managers)
• ED’s own journey
LD 5: Personal Mastery
Commitment to Continuous Learning
* Case Study:
Kavika: Data Entry Clerk to Finance Manager
• Externalized accounting and auditing
• Partnership with Board Treasurer and outside
accountant to assess capacity
• Training and capacity building
• Now – all accounting internal
Individual
(with external audit)
Group
Agency
LD 5: Personal Mastery
Moving beyond consciousness
Daily log example
LD 5: Personal Mastery
Dealing with Resistance to Change
Parallel of behavior
change and harm
reduction values with
participants and CHOW
organizational change
Making change explicit
and discussing fears
and challenges without
consequences
LD 5: Personal Mastery
Role of Leadership
* Shift from ED-centered to leadership
team-centered decision making
• Increased communication, autonomy,
responsibilities
• Move from supervision to coaching
 AT LEAST one hour per week with each
* Building on strengths/redistributing tasks
* Balance of amnesty and accountability
LD 5: Personal Mastery
ED’s journey
Lets practice
In groups of three reflect on the following:
1) To what extent are you practicing the LO
philosophy without know it?
2) Which of the LDs do you already have in place?
3) What should you do next when you return home
in regard to LO and LDs
Which ones we do well and which need improvement?
4) Discussion and Q & A
Shared Vision
Team Learning
Mental Model
Systems Thinking
Personal
Mastery
Mahalo!
For more information:
* Heather Lusk, MSW: Executive Director, CHOW
Project
* [email protected]
* www.chowproject.org
* Lorraine C. Marais, Ed.D., MSW: CEO Ubuntu
Generative Mentoring and OD Consultancy
Services
* [email protected]