The past year I have been working with Texas Association of Community Health Centers (TACHC) through their connection to the Leading Change Network. TACHC is an association that support Federally Qualified Health Care Centers in providing quality healthcare to Texans without health insurance. As a result of changes in the federal and state budgets TACHC asked me to work with them in designing and running an community organizing campaign that will engage patients to become advocates for their own access to healthcare. I have the opportunity to work with many folks building community-run movements but this campaign has been especially powerful for me as I grew up in Houston without health insurance. I had my sports physicals at Urgent Care facilities, secretly got birth control at Planned Parenthood and used babysitting money for medicine: this campaign hits home. In addition, I’ve been impressed with TACHC’s desire to create and implement a long-term solution for the community. They want to move from a purely institutional-led model of community health to one that shares power and decision making with their patients; this encourages long-term sustainability and creates opportunities for real change in people’s lives. Unfortunately, despite these intentions it’s been hard to design a full on organizing campaign when the primary goal, to secure funding for healthcare, was chosen by TACHC.
This challenge became clear this weekend at TACHC’s annual conference during meetings with their newly hired Community Organizer, Courtney Weaver. Courtney is great, she understands the importance of developing leadership and is asking all the right questions. This weekend she and I were doing some skills training, strategy coaching and debriefing her first two weeks with TACHC when Courtney asked about the difference between organizing people to achieve a desired policy change (field advocacy) and organizing that begins out of a community’s frustration. She’s correct to raise this tension, we aren’t giving the community 100% control and opening up all options to them because it’s essential that we address the funding gap but we are trying to do this while building up the leadership of patients. Our question is; how do we successfully achieve shared leadership given this dynamic.
I attempted to tackle this question Monday during my session at Annual Conference titled, Patients to Constituents – An Introduction to the Transformational Change Model. I shared my own experience of transformation and my experience creating communities where transformation can occur – it was my hope that those stories would give the participants an idea of what ‘real change’ meant for a person and for a community. I also talked about how we as leaders can develop programs that use a transformational theory of change. In this model we are not focused on finding the solution for other people “if we solve it then they will change” but we are instead looking to create relationships that honor agency, dignity and the capability of the other. In those relationships they begin to see that they are deserving of change leading to them taking action and winning change. Our theory of change is, “if they understand their worth then they will work to create a world that honors that worth.” The longer I work in areas such as mission, community development or outreach the more I am convinced that real change is rooted in the transformation of an individual not the solving of a problem. We change when we are given the opportunity to assume a new identity that compels us to live differently in the world; in this situation, that compels us to advocate for our own health needs.
The discussion that followed was about how health centers could become communities where people could assume an identity of solution, rather than problem. I was encouraged by the options people had to offer. A few of the participants suggested we start by looking at the way their board/staff operated and how they were or were not sharing power. One member recognized that unless they started to have faith in their patients they would never share power. I encouraged the group to use the campaign to start modeling a different type of leadership, when used right the organizing practices (story, relationships, strategy, teams and action) have the ability to shift power dynamics.
At the end of the discussion I left feeling more hopeful about the ability for this campaign to facilitate real change. It will take work because without coaching/accountability the directors of these communities will fall back into their same patterns with their patients: do this, learn this, read this … but if they work together I could see how through shared leadership, this campaign cold be the beginning of a new kind of relationship, and a new identity, through TACHC’s work. I’m thrilled about this, there is nothing more important than people assuming their identity as the beloved.
And, while I certainly appreciated Courtney’s question, I am reminded that it isn’t always about the tool – pure organizing or half organizing or full on field advocacy – it’s mostly about being agents of real change by building transformational community and that’s what we need.