Empowering Community-Driven Change: Leadership in Southcentral Foundation’s Nuka System of Care

Health care organizations often struggle with the question of how to implement change. The process of implementing change can be difficult and is sometimes met with institutional resistance. Southcentral Foundation’s approach may prove useful for other organizations to study. SCF is an Alaska Native customer-owned system responsible for providing health care and related services to approximately 65,000 Alaska Native and American Indian people in Alaska’s Cook Inlet region. SCF took on this responsibility in 1998 and subsequently implemented major reforms to the health care system with the goal of better serving its patients (referred to as “customer-owners” at SCF). All change at SCF is driven by customer-owners. SCF constantly solicits their input, and engages with the community in a variety of ways on a regular basis, to gather their feedback and determine the changes and improvements they want to see made. Once the customer-owners have given direction for what to do, SCF implements change on an organizational level. SCF leadership empowers employees to make needed change while ensuring that everyone in the organization remains focused on the goals and values of the organization. SCF’s leadership is committed to several principles to support employees as they make improvements desired by customer-owners. SCF’s leadership encourages calculated risk-taking innovation and creativity on the part of employees; they are encouraged to try out new ideas and look for new approaches to problems. SCF’s leadership drives quick change while being conscious of the potential for work fatigue in employees. SCF also strives to grow leadership from within by mentoring employees and supporting them in educational efforts. SCF’s leadership works to maximize individual employee skill while encouraging personal relationships within all employee ranks without sacrificing accountability. Employees are encouraged to take ownership of the organization and are given power in decision-making. SCF’s leadership is also committed to building and maintaining the infrastructure needed to support the organization, as well as a data system to measure quality and improvements. SCF’s approach to making changes, both large and small, has proven beneficial both for the organization and for customer-owners. ER visits for customer-owners declined by 36 percent from 2000 to 2015, and hospital admissions also declined by 36 percent in that same period. SCF has exceeded the 90th percentile in Healthcare Effectiveness Data Information Set (HEDIS) measures such as diabetes care annual testing and diabetes hba1c control. 96 percent of customer-owners are satisfied with the care provided by SCF, and SCF has also achieved 93 percent employee satisfaction. SCF has sustained these improvements for almost two decades. Although SCF’s operating principles are derived from Alaska Native culture and values, other organizations can learn valuable lessons from SCF’s approach to leadership and driving change. Though specifics will vary between organizations, SCF’s culture of encouragement and support can work in any organization, and can bring better results for both employees and the people being served. Empowering employees and patients both to drive organizational change is something that every health care organization should consider.