Sitka Health Summit Sitka, AK

Our Partner Organizations SouthEast Alaska Regional Health Consortium (SEARHC) Sitka Community Hospital State of Alaska Public Health Nursing Brave Heart Volunteers

Our SCALE Team Nancy Knapp, Data Specialist Clara Gray, Health Educator Zack Desmond, Local Improvement Advisor

Since the last CHILA, we are excited to share what we are most proud of…. We have completed our MAPP data collection and aggregation process!!! We are establishing priorities for a report due September 15th! We will share them with the community in the weeks leading up to our Health Summit Planning Day on October 9th.

A story about something we learned since CHILA1…. On Tuesday August 18th, extremely heavy rains caused a landslide that destroyed several homes, killed three Sitkans, and temporarily displaced many more. The outpouring of support for those affected was astounding. From social media pages to the slide site, Sitkans took every opportunity to demonstrate their care and concern for their neighbors. The community continues to grieve as the school year begins and life resumes. With an opportunity to reintegrate after a tragedy like the landslides on August 18th, we also have a choice to make about who we will become. Nothing is the same. We are changed. Only how remains to be learned.

What we learned about engaging community members with lived experience It starts with hello. Being in relationship is key. When we asked our friend Paulette to join us for a community gathering to honor the losses in our community, she said she would if she could finish cleaning the community kitchen in time. So we helped clean the kitchen! What are we willing to do to make sure that those with lived experience participate? Bring on the dirty dishes!

What we learned about engaging the BROADER community in developing our aim I think we’ll learn a lot more following our community health planning day on October 9th. This is where we’ll have an opportunity to share the strengths and trends of the last few years according to MAPP data and ask the community if this reflects observed reality, and also what’s missing.

Our aim for SCALE is….. TENTATIVE: By Dec 2016, 85% of Alaska Native youth in Sitka will have a reduced risk of cardiovascular disease, as measured by consumption of healthy foods AND access to traditional foods and ways of being. There’s more here as we’ve yet to establish our aim with community partners with lived experience! We plan to improve equity by ensuring that access to traditional foods and traditional activities are at the center of our efforts to reduce risk of cardiovascular disease for the population.

Our Driver Diagram See EXAMPLE on next page Primary Drivers Secondary Drivers Our Driver Diagram Access to Traditional food abundant areas Affordability of healthy foods at local grocers Ease of access to non-healthy foods Presence of healthy food options at school Presence of healthy food options at home Permitting process, fuel, equipment for gathering tradiational foods. Access to healthy foods Aim: 85% of Alaska Native youth will have a reduced risk of cardiovascular disease. Outcome Measures: 1. 2. 3. Familiarity with traditional foods, harvesting, processing, and preparation Presence of healthy food options at school and in community Peer approval for consuming healthy foods Presence of healthy food options in the home Use of healthy foods Availability of culturally relevant physical activities Access to what are considered by some to be “White Recreation Areas” (includes trail system and local gym/community center) Peer approval for Physical activity Education around risk factors for cardiovascular health Cultural or familial willingness to discuss disease and risk Awareness of risk See EXAMPLE on next page

A Theory of How to Improve a System Improvement Science in ActionNWIA Building Improvement Capability Session 3NWIA Building Improvement Capability Session 2Improvement Science in Action • April 22-24, 2009 Improvement Science in Action Using Measurement for Quality Improvement A Theory of How to Improve a System Here’s a schematic view of a system – a ‘driver diagram’. On the left we depict the outcome in the yellow box. As we move right we drill down into the network of causes that drive the outcome, from ‘primary’ to ‘secondary’ drivers. On the right we depict the ideas for system changes that might ultimately impact the outcome. This diagram represents our theory about how to modify the system to change the outcome. Effect Cause Drives 10 Using Measurement for Quality Improvement • April 2009 © 2010 R. ScovilleUsing Measurement for Quality Improvement • April 2009 10 10

Metrics we are considering to our track progress EXAMPLE: Metrics for Healthy Eating Youth exposure to traditional foods at school and in community Traditional food consumption (self-reported) Fruit/vegetable expenditures % of healthy/local food options at schools

What we learned from “Switch” Rider: Point to bright spots, show the rider the script (traditional foods calendar and how many groiups already access the natural resources in our community!) Elephant: Healthy Competition is good motivation! (Thanks Healthy in the Hills) Path: How are we obstructing access now? How are we encouraging the consumption of unhealthy foods? (lack of affordable foods)

Top two things we learned from other communities since CHILA1 Utilize local provider EHR data for “real-time” indicators of health improvements for course-adjustment purposes. (Healthy Communities of Cattaraugus County, NY) Guidelines to help us Interview Community Stakeholders, extracted from “Community: The Structure of Belonging” by Peter Block (Live Algoma, WI)

Our biggest challenge(s) right now are….. Not having an explicit aim YET. Picking only a select few priorities from the vast amount of data uncovered by our MAPP assessment and aggregation. Carrying the community’s energy to stand together and hold each other up forward into the abstracted world of population health improvement Reorienting as a team with a new local improvement adviser and a shifting body of individuals that make up our core participants Sustaining connection with our champions and community members with lived experience. Redefining the Health Summit’s role and intent for and with the community constituents who have participated in planning day for several years and inviting new constituents into a slightly different process without alienating them!

We hope to learn this at CHILA2… More about how communities have executed summer activities since CHILA1 How to turn plans into actions by applying a driver diagram into PDSA cycles in real time! How to engage interested community stakeholders sustainably so that there’s a system change at the higher “administrative” level of our community health coalition. Always: How to bring joy to the process of improvement! How to bring an institution back into the health improvement process through changes in leadership.

Best way to contact us: Sitka Health Summit – Zack Desmond, LIA zachary@braveheartvolunteers.org 907 747 4600 & 206 941 3911 (Zack’s cell) We also love letters! Sitka Health Summit PO Box 6336 Sitka, AK 99835