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An Open School learner tells the story of the long journey to launch the first interprofessional, multi-university, student-run free clinic in our state.
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Learning to Lead: How Health Care Students Launched a Clinic for People Experiencing Homelessness

By Emileigh Canales | Monday, October 16, 2017

Bridges

Emileigh Canales, right, helped lead a project to launch a clinic for people experiencing homelessness as part of the IHI course, Leadership and Organizing for Change.

I believe in the great capacity of students to change the world – though I haven’t always been as optimistic as I am now.

As a graduate student, I remember learning about the many challenges within our health care system: rising costs, lack of universal access, inequitable health outcomes… we all know the list well. I was overwhelmed every time someone referred to my colleagues and me as the “next generation of health care leaders.” I had no idea how to create change. As a student, I wanted to make a difference, but didn’t know how.

For the past year and a half, I have been working with a group of dedicated students to do just that: lead change. It’s been a long journey to launch the first interprofessional, multi-university, student-run free clinic in our state, but we did it, and we are so excited to share our story.

Back in December 2015, Transition Projects, a community-based non-profit that helps people transition from homelessness to housing, reached out to Oregon Health and Science University (OHSU) Family Medicine with a need for better health care access for their participants. Even though Oregon expanded Medicaid in 2014 with the Affordable Care Act, there are still many psychosocial barriers to primary care, leaving large gaps in access to care for people experiencing homelessness.

A dean at the OHSU School of Medicine gathered a small group of students and faculty to take on this leadership opportunity. For students, these clinics are a great avenue for service learning through hands-on, practical application of academic learning; for participants, these clinics increase access to care. Yet enthusiasm alone would not get us to our ambitious goal.

Drawing on skills learned in the IHI’s Leadership and Organizing for Change course, our students understood that power to make change comes from organizing teams in collective action centered on shared values. We knew that we must join forces to reach our goal, and that leadership didn’t mean doing it all alone; it meant enabling our colleagues to achieve shared purpose in the face of uncertainty.

We held a kick-off meeting in January 2016 that convened 36 people, including students, faculty, and community partners. We chose to start with a relational, asset-based approach to solidify our shared values that would ground us in this work as one strong team – rather than a bunch of individuals. By taking a systematic view of the resources that we all brought to the project, we could approach the work from a place of abundance rather than lack.

In this meeting, we acknowledged that we didn’t have all the answers. More importantly, we knew that the answers were out there, and that we could find them. We prioritized our needs and strategized on how to meet those needs through the assets we had. These activities helped us walk away from the kick-off with a shared purpose – a sense of how we were going to use what we had to achieve our ambitious goal.

Within one month, our team doubled in size! Sixty-four people attended our February meeting and our challenge became how to focus the large group to make progress toward our shared purpose. During the meeting, we gave space for large group brainstorming on how to build a leadership team and organize our efforts. The student Co-Chairs took the feedback from this meeting to develop our distributive model of leadership. The Co-Chairs recruited student Team Leads for each of the five teams in our model, then asked the large group of volunteers to self-select into one of the five teams. We paired our faculty and community-based advisors (based on their strengths, experiences, and assets) with each team so that each hub of the snowflake had student leaders, a faculty and community advisor, and student volunteers.

In this interdependent model, the leaders at the center of this model build a team of leaders around them who, in turn, develop teams of leaders around them, and so on.  Each team has its own scope and responsibilities, and decision-making authority. Throughout this process, we have had over 100 students experience leadership roles in our model, with four student Co-Chairs (each representing a different health profession), seven faculty, and five community partners working together.

We learned how important it is for have everyone to have a seat at the table. Our meetings are open to all students, faculty, and community partners. We have faculty learning from students, students learning from those who have experience with homelessness, and everyone contributing to the launch of the free clinic.

Bridges Collaborative Clinic opened on September 30 to provide health and social services to people currently experiencing homelessness in our community. The mission of the Clinic is to engage vulnerable populations by providing low-barrier, participant-centered care and services in the Portland Metro area through an interprofessional, student-led clinic. I believe that the benefits it provides to the community, the students, and the affiliated universities are invaluable.  

On that day, we met our participant population, and with full hearts, stepped into the next phase of our journey, from launching an interprofessional student-run free clinic to operating one. Taking a relational approach has created a strong foundation from which our students can continue this work.

While I might not be able to overcome all the problems our health care system is facing today, I no longer need to shy away from being part of the next generation of health care leaders. There are so many alongside me working as change agents to improve the health of our communities. Together, we can make a lasting difference.

Emileigh Canales, MPH, is a Quality Improvement Analyst at CareOregon and a former Open School Chapter President at Portland State University/Oregon Health & Science University. 

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