1. Managing a homeless health care organization as a learning organization: A case study Carl Nelson, PhD Northeastern University Boston, MA

2. Objectives Illustrate the creation of inter and intra organizational learning environments to achieve improved outcomes in homeless heath care organizations. Demonstrate development of a stakeholder analysis as a guide to strategic choice. Develop respect for the measurement and analysis of complex socio-economic, clinical, and government policy related variables. Illustrate the difficulties and importance of maintaining an organization’s core values in times of rapid change. Discuss the internal and external leadership requirements of a new non-profit organization’s chief executive officer.

3. Top Ten Medical Problems of the Homeless: Relative Risk

4. Revenues

5. Wages, Salaries, Benefits

8. Five learning disciplines  Personal Mastery-Staff members expand their personal capacity to create the results most desired by them and the organization.  Mental Models-Staff members reflect upon, clarify and improve their internal pictures of the environment, and see how this shapes actions and decisions.  Shared Vision-Staff commitment for achieving a shared image of the future.  Team Learning-Staff groups achieve abilities greater than the sum of individual member’s talents.  Systems Thinking-Staff is able to describe, understand, and change system.

9. Desired Components 1.Shelter-based outreach to and engagement of patients. Assistance with social services and medical services referral and advocacy. 2.Street outreach and engagement programs. 3.The ability to provide integrated outpatient primary care, specialty services and linkages to hospital emergency rooms. 4.An electronic medical record capacity at key sites where homeless people enter the system or receive their care. 5.Integrated mental health and substance abuse assessment and treatment, and linkage to emergency behavioral health services and residential follow-up care. 6.Linkages to shelter-based nursing clinics and “stay-in” units. 7.Access to a medical respite/sub-acute in-patient facility for homeless adults. 8.Linkages to transitional and permanent housing programs, and housing search services.

10. Discussions Principles-What we are or wish to be Insights-What we know or understand Rules-What we must and may do Organizational Behavior-What we do Results-What we achieve

11. Post Script An irremediable clash of philosophies Attacks on Managed Care Saved by intra organizational learning Unanswered questions