Collaborative Leadership Plan_Melanie Johnsoncook (1)

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1 Chinle MedXpress Collaborative Leadership Plan Prepared by Melanie Johnsoncook 12/6/2023

2 Propose a process innovation and an implementation strategy to meet the needs of the Chinle population. Complete this template ( suggested length of 8 – 10 pages ) by doing the following: A. Process Innovation Proposal 1. Summarize the needs of the Chinle population. The Chinle community requires more accessible and affordable healthcare options, health insurance, preventative measures for health risks and reducing obesity rates. There are currently, 47.8% (1803) (U.S. Census Bureau, 2021) of residents who are uninsured, which makes it a challenge for them to receive medical care. Moreover, 57.3% (2113) (U.S. Census Bureau, 2021) of residents live below the poverty line, which means they may not be able to afford medical care even if they have health insurance. 2. Explain how cultural differences and socioeconomic factors relate to current healthcare trends. Socioeconomic and cultural factors play a significant role in healthcare trends and community health. Socioeconomic factors are determined by economic stability, education quality and access, healthcare quality and access, as well as the built environment and social context of the community. Examples of this include safe housing, transportation, language and literacy skills, violence discrimination, education, job opportunities, income and much more. (Healthy People 2030 - Social Determinants of Health | Health.gov, n.d.). Cultural factors are based on three levels: clinical, organizational, and systemic. The healthcare system must take responsibility for developing programs that meet the needs and resources of their patient population. This can include bringing in traditional healers, interpreters, providers and nurses with the same cultural background and understanding, as well as community representatives (Betancourt, J. R., Green, A. R., & Carrillo, J. E., October 2002). 3. Propose a process innovation solution to address the summarized needs in part A1 by doing the following: a. Describe the process innovation solution. I believe that the solution to the problem lies in a process innovation called "Chinle MedXpress It is an app that can be accessed by physicians in their offices and by healthcare workers in the field. Patients can receive healthcare services without leaving the comfort of their homes or schools, without the need for internet access, transportation, or money. This program is designed to work with other community resources such as the Navajo Department of Health, Chinle Chapter government, traditional

3 healers and medicine men, health coaches, and the IHS Public Health Department. By collaborating with these resources, we can provide healthcare services to the community instead of requiring them to travel to the nearest medical facility. The healthcare workers will focus on preventive care, nutrition, exercise, and managing chronic illnesses. They will report back to the physicians' offices, which will help keep the hospitals and clinics below capacity, allowing patients with emergencies to receive timely care. This innovation is not intended to replace the traditional procedure of seeing a provider, but to help people who cannot afford to see a physician or do not have the means to do so. b. Discuss how the patient population or community will interact with the process innovation solution. To receive on-the-go care through the MedXpress app, patients will need to sign up through their provider's office or a local health facility. Once they have signed up, the providers will work with local staff and stakeholders to schedule a first appointment and get the patient set up with MedXpress. For school age children, their teachers, guardians or parents can sign them up to receive care which will be given during school hours by the school nurse, or the MedXpress if there is enough need for it. After this, patients can have as many or as few appointments as they need to support their health. If there is something a patient needs that is beyond the scope of the MedXpress they will call upon the public safety workers to take them to their nearest facility for further treatment. c. Explain how this process innovation solution improves an existing process or meets an unmet need in the community. This innovation aims to address the current unmet need for healthcare by offering a range of services. These services include combating health problems, educating patients on health promotion and disease prevention, providing dietary and nutrition information, as well as connecting patients with other necessary resources. The ultimate goal of this innovation is to help patients develop trust in community leaders, who can play a vital role in solving the widespread problem of obesity. 4. Explain how your process innovation solution is relevant and feasible based on each of the following: a. needs analysis

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4 b. cultural analysis Explanation of Relevance Explanation of Feasibility Needs analysis The Chinle community has a high demand for external resources to invest in their health and well-being. It is imperative to offer healthcare services to everyone in the community, regardless of their financial status or access to transportation. This innovation will curb those concerns by bringing healthcare to the community. In order to address health risks, various parties including local leaders, internal and external stakeholders, and physicians will collaborate to provide services aimed at promoting healthy eating habits, increased physical activity, and regular health monitoring for patients. The ultimate objective is to ensure that every program participant experiences a positive transformation in their health and wellbeing. Cultural analysis It is essential to be mindful of the culture that exists within the population we are dealing with. We want to ensure that the community retains a sense of autonomy while acknowledging that there is a problem that needs to be addressed. Studies have shown that obesity is a significant issue for both Navajo children and adults. The high prevalence of obesity is linked to the increasing incidence of chronic diseases such as type 2 diabetes, heart disease, stroke, arthritis, and breathing problems (DHHS, 2001, Story et al., 1999). These findings indicate that many members of the community are at risk for developing health issues and require intervention. It is crucial to let the community know that there are stakeholders who will be taking part in preserving their culture and educating other stakeholders on how to integrate this innovation in the best way possible. We need to be aware of what is culturally acceptable to the population and what is not, so that we can strike a balance. The success of the innovation is heavily dependent on the support we receive from both the community and stakeholders. 5. Discuss how each of the following factors shaped your proposed process innovation solution:

5 a. cultural aspects b. stakeholder engagement c. community involvement Factor Impact on Process Innovation Cultural aspects The traditional Navajo teachings emphasize on the importance of health and advocate for the concept of moderation or balance in all things. This means that excessive consumption of anything is considered a risk for becoming unhealthy (Chinle Service Unit Profile, n.d.). Culture is an important context for understanding problems and can provide valuable insights into the most effective ways of resolving them. The Chinle MedXpress is an innovative program aimed at helping the community. To be successful, it is essential to take cultural considerations into account. Ignoring the cultural values of the community would render this innovation useless because no one would be interested in it. Stakeholder engagement In order to develop effective solutions, it is crucial to take into account the requirements and concerns of all stakeholders involved. They are investing their valuable time and money into this innovation, and their input should be given the highest priority. It is important to ensure the involvement of stakeholders in the process, as the success or failure of the innovation will have an impact on everyone involved. Community involvement As previously stated, this innovation is geared at bettering the health of the community. This innovation is not meant to disrupt their lives or cause harm, it is just meant to solve a problem. In order to do that we have to involve community feedback when devising practical solutions. By gaining a deep understanding of their needs, innovators can create products that better cater to them. B. Implementation Strategy 1. Identify the resources necessary to implement the process innovation solution. To successfully implement this innovation, we need to partner with internal and external stakeholders for manpower, time, money, resources, as well as local hospitals, clinics, and the community.

6 2. Explain how the identified resources will be used to implement the process innovation solution. The resources we have identified will be utilized to implement the innovation. We will work with the stakeholders to gather funding for this innovation and hire staff to ensure smooth processes. It is crucial to partner with local hospitals and clinics so that they are not only informed about what is happening in their community, but also so that they can provide assistance if needed. However, all of this will be for naught if we don't have a community that is able, willing, and ready to adopt this innovation. The success of the innovation will depend on the participation of all involved parties, and if even one person is unable or unwilling to proceed, the entire innovation will be jeopardized. 3. Describe the stakeholder collaboration plan, including key conveners, as part of the implementation strategy. The first step towards implementing this innovation is to meet with the Traditional Healers and Medicine Men. Their input would be valuable in determining if this innovation would be culturally acceptable and beneficial for the community. If so, the most effective means of communicating the plan to the community. After that, I would engage with the Navajo Department of Health and the IHS Public Health Department. Together, we would develop policies and procedures for this innovation and formulate an innovation strategy. Once the strategy is in place, I would present it to the local hospital leaders, clinic staff, and health coaches. This will help us determine the best way to incorporate the innovation into the community, taking into account their lifestyles and health needs. Finally, once everyone else is on board, I would meet with the Chinle Chapter Government. I will finalize all planning, discuss funding, and seek their approval and feedback for the implementation of this innovation. a. Explain how your collaboration plan is aligned with Leavitt’s principles and collaborative efforts. I have created a collaborative plan that is in line with Leavitt's collaborative efforts. The plan takes into account the stakeholders, both internal and external, as well as community members who are best suited for this

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7 innovation. A collaboratively intelligent team should consist of outcome- oriented, transparent, empathic, optimistic, and principle-focused individuals (Leavitt, M., & McKeown, R., 2013). I strongly believe that the people I have chosen for this innovation are the best ones for the job and will provide the best outcomes. 4. Describe your leadership strategy to address challenges and leverage opportunities regarding community involvement in implementing the process innovation solution. Challenges Opportunities Chinle Chapter Government could be receiving an excessive number of requests from other innovations that are offering the same service. Offer for the Chapter to try the innovation on a free trial basis with the assistance of a local physician's office. After the trial, I could report the results to the Chinle Chapter Government. If they are satisfied with the outcome, they may be more inclined to support it. IHS Public Health- This group of leaders already implements many things into the community (Leavitt, M., & McKeown, R., 2013). They would likely be concerned that another innovation is being implemented, and they could question the integrity of it. When addressing obesity, prioritizing nutrition and exercise is crucial. This group currently organizes walking programs, so collaborating with community health and nutrition groups is highly beneficial for innovation. Traditional healers prioritize cultural integrity (Leavitt, M., & McKeown, R., 2013). Initial implementation challenges arise if they don't perceive the innovation as helpful. I could offer to collaborate with their group on projects they are currently working on. This would allow me to better understand their community, traditions and cultures, which may prove beneficial to our innovation. The Diné Youth Office advocates, educates, and develops resilient, healthy generations of youth through partnerships to balance and thrive in a diverse society (Diné Youth, n.d.). While this group will not be called upon to be a stakeholder, it is important to work with these other innovative groups that are currently trying to change the health of the community. It would be a great learning opportunity, for me to be educated on the community and their members, from a group who works with them already.

8 5. Explain how cultural aspects could affect the implementation of the process innovation solution. Internal External The internal stakeholders of Chinle MedXpress are essential to the success of the project because the community relies on them to solve problems. If MedXpress fails, it would have a negative impact on the stakeholders. Therefore, it is crucial to promote transparency and understanding from the outset. This will help establish a healthy relationship among all stakeholders and the community, which is critical for the success of this innovation. The external stakeholders of Chinle MedXpress would be affected by this innovation just as much as the internal stakeholders because they also care about the health of the community. They are aware of the existing problem and are hoping for a positive change. It's crucial for these stakeholders to keep in mind that change doesn't happen overnight. It would require persistence and perseverance to achieve success with this innovation. 6. Identify three implementation benchmarks or milestones for the implementation of the process innovation solution. a. Justify why each benchmark or milestone was chosen. Implementation Benchmark Justification Pilot- A 6 month program for 10 case studies, in which the innovation is implemented into the community before any high level internal or external stakeholders are brought in. Implementing a pilot of Chinle MedXpress would allow potential stakeholders to understand the innovation better and address any issues before going live. To carry out the pilot, we would need to collaborate with local health facilities and physicians' offices to hire staff and provide them with proper training, education, nutrition information, and exercise programs. This would ensure the successful implementation of the innovation. We would plan to meet with stakeholders and physicians every 30 days to report back on how this program is doing so far, and discuss next steps. Go live Prep- After piloting Chinle MedXpress for 6 months, we would bring on At this stage, all internal and external stakeholders are familiar with the functioning of the innovation. The next step would be to convene a meeting with all interested parties and go over the innovation strategy. We would then present our findings to the wider community and elaborate on how we intend to implement this innovation.

9 stakeholders, and plan on how to implement the program. Additionally, we would guide those community members who are interested in signing up for the program once it actually goes live. Go live- After one year in the works, Chinle MedXpress is finally ready to implement into the community. At this stage we would have a monthly meeting setup with the stakeholders to continually track progress. We would plan a community event for the Go Live, where we would discuss the finalized details of the innovation, as well as introduce stakeholders, leaders, and other community resources to the community. We would then advise the community on how to sign up if they are interested. 7. Predict the results of your process innovation solution by completing an impact assessment that incorporates all dimensions of Miller’s Impact Assessment Framework. Individual- A4 Empowerment. This innovation will provide individuals with the necessary tools to improve their health by monitoring chronic conditions, exercising, eating better, and feeling supported by community leaders who listen and understand. Health Services- B3 Care Efficiency. This innovation improves care efficiency by allowing physicians to monitor their patients’ health on a continual basis, reducing unnecessary emergency room visits. Community- C1 Access to Health Services. The main objective of this initiative is to make healthcare accessible to the community, eliminating the need for community members to worry about how they can receive medical attention. This approach is also significant for those who experience anxiety when visiting a doctor's office or being in crowded places. By providing care at home, patients can comfortably receive the necessary medical attention. Operations- D1 Capacity and Utilization. It is currently unclear whether hospitals or local physician offices have enough capacity to accommodate all patients. However, the implementation of this innovation could unintentionally reduce the number of patients in hospitals. This is because patients would be able to receive primary care at home, which would save time, energy, and money for hospital staff. Organization and Workforce- E1 Leadership and Culture. This innovation is designed for leaders who aspire to see their community prosper, while also catering to the health needs of the members. It also considers traditional leaders who aim to preserve the community's culture. Strategy and Finance- F2 Operating costs. The operating costs for this innovation will be much lower compared to the cost of hospital care. Often,

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10 patients end up in the hospital due to poverty, lack of transportation, or other issues that prevent them from receiving adequate care. Although it may appear to be expensive at first, in the long run, it will even out and benefit everyone involved. Risk Management- G4 Operational. It is important to keep in mind that not everyone is equally comfortable with technology. As a result, it may require some effort, time and patience to become familiar with the technology involved in this innovative solution. However, once the facilities, staff, physicians and patients have become accustomed to it, they will understand its benefits and realize that it is the best option for them in this particular situation. Information Management- H1 Information. The purpose of this innovation is to create a seamless experience for patients seeking medical care and physicians keeping track of their medical history. It is essential that everyone involved understands that uploading or obtaining information should be effortless. This option is the best way to achieve their goals within the community. 8. Create a vision statement that conveys the shared objectives of the community alliance. Healthy Bodies, Healthy Minds, Healthy Life. C. APA Sources Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized. Betancourt, J. R., Green, A. R., & Carrillo, J. E. (2002, October). Cultural competence in health care: Emerging frameworks and practical approaches. The Commonwealth Fund. https://www.commonwealthfund.org/publications/fund- reports/2002/oct/cultural-competence-health-care-emerging-frameworks-and Social Determinants of Health - Healthy People 2030 | Health.gov. (n.d.). https://health.gov/healthypeople/priority-areas/social-determinants-health Halpern P. Obesity and American Indians/Alaska Natives. Washington DC: U.S. Department of Health and Human Services; (2007).

11 Chinle. (n.d.). Navajo Nation Special Diabetes Project. http://www.nnsdp.org/Chinle.aspx Chinle Service Unit Profile. (n.d.). Master of Health Administration, 1-12. Dine Youth, (n.d.). [Chinle Agency Website]. https://www.dineyouth.com/chinle.aspx Miller, C. (n.d.) Impact assessment framework. Master of Healthcare Administration Program. Western Governors University, 1 — 33.

Collaborative Leadership Plan_Melanie Johnsoncook (1)

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