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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