St. Luke’s Health Initiatives

Yesterday I was preparing for a phone call with the St. Luke’s Health Initiatives in Phoenix. They’ve invited me to participate in their December annual conference as a “not-expert” giving a “not-keynote.” After reading through the notes from their recent planning meetings, my attention went to the website to deepen my understanding of what they are doing. And I was blown away. The first documents I came across was St Lukes Health Initiatives Fall 03. It is an amazing look at resilience in health. It begins with a suggestion familiar to many of us: what if rather than being the absence of illness and pathology, health is actually the harmonious integration of mind and body within a responsive community?

In the frame work St. Luke’s has been using, there are at least three central components of resilient social-ecological communities: diversity, redundancy and feedback loops. They go on to define community as group of people with diverse characteristics who are linked by social ties, share common perspectives, and engage in joint action in geographical locations or settings — and then go on and define what each of these things actually are. It’s a powerful report and the points directions for each of us to attend to our own health. The video to the right is a work in progress which illustrates some of this thinking.

So, after reading it, I head back to the St. Luke’s website for more. And quickly I’m led to St Lukes Health Initiatives Fall 08, the report five years later. Take a look at it. The quality of the work and the directness of the language is delightful. The report ends with 16 lessons learned:

  • FOCUS ON COMMUNITIES-AS-PLACE. We build healthy, resilient communities in physical, space-bound settings where we live, work and play. The siren song of communities of interest, practice and identity can enhance our ability to improve community health, but it can also direct our attention, resources and energy away from place-bound connections of social reciprocity and support.
  • START WITH SHARED CONVERSATIONS. This will lead to shared relationships and shared identity. These, in turn, will contribute over time to shared meaning, shared trust, shared motivation and shared action. The result is the adaptable, engaged community.
  • PULL, DON’T PUSH. ATTRACT, DON’T PROMOTE. Invite others in to build networks of engagement, involvement and shared action. Don’t treat people like consumers or clients. Attract others by modeling the result you desire. Don’t promote an ideology or set of techniques everyone else has to accept.
  • TAP INTO INDIVIDUAL AND COMMUNITY STRENGTHS. Use these to build tangible assets (housing jobs, infrastructure) and develop the knowledge and skills (education) that create the conditions for optimal health and sustainability.
  • DEVELOP AND EXTEND NETWORKS OF LEARNING, PRACTICE AND ACTION. Think associationally. Build up and out, down and in simultaneously.
  • BE A CONNECTOR. Channel and connect ideas, energy, resources. Everything flows from this.
  • SPEAK TO POWER. Find and encourage the community’s collective voice to connect with economic and political resources in ever wider circles of influence, investment and consequence.
  • CONSIDER THE AUDIENCE. Adapt your language and message frames accordingly.
  • MOVE FROM ACCOUNTABILITY TO LEARNING. Disseminate what you learn as widely and transparently as possible. Accountability will arise naturally from the shared learning (meanings) of the community.
  • SEED AND FEED. Start with a focused task or project that has a good probability for success. Build on success by scanning for new opportunities and sowing seeds. Pursue those that take root and start to grow. Not all of them will.
  • INVEST FOR LONGER TIME PERIODS. Seeds that take root do better with focused, longer-term investments of human and financial resources. Be watchful – but don’t be in a rush to hurry on to the next big thing.
  • TAKE TIME TO MAKE TIME. Community building is long distance and never ending. Get off the clock now and then. Replenish yourself and others. It always winds back around.
  • DRINK FROM THE WELL. Find, nurture and drink from community wells of trusted information, services and social connections. They are individuals and organizations alike. If you can’t find one, drill for one. Connect others to it.
  • PLAN TO ORGANIZE, ORGANIZE TO PLAN. Do both in pencil so you can adapt to change.
  • LISTEN, LEARN AND LET GO. People come from very different places. Let them speak. People learn in different ways. Give them options and time. Lead by example. We raise healthy children this way. Why would communities be any different?

FIRE, READY, AIM. In community building, clarity emerges from practice, not practice from clarity. Start with action (fire), refine your practice based on what you’re learning (ready), then develop your theory of change (aim). Use that theory and knowledge to inform further practice, and so on in a cycle of never-ending adaptability, learning and change.

This is good, solid thinking. What’s also striking about it is that it isn’t rare anymore. Of course, it would be a huge stretch to say it is common thinking — but that’s the direction.

Frequently these days I’m confronted by the fact that we know a lot about new ways of thinking and being. Many of us no longer have any particular faith in the ways things have been done in the past. We’re even beginning to develop common language. I loved it that these reports speak of using attraction rather than promotion, for example. In the Berkana Exchange community it was Unitierra in Oaxaca, Mexico where I first heard people talking about commotion rather than promotion. Exactly the same idea. Or Nipun Meta from Charity Focus talks about fire, ready, steady, but it is the same essence as fire, ready, aim in the report’s last point.

The question, of course, is what will help us all practice more consistently in the field defined by these principles, values and beliefs? What’s growing here that can be cultivated? How do we begin to create frameworks, processes and structures which help us practice and learn in this field rather than always being distracted and thrown off balance when someone comes asking for our strategic plan or pre-planned outcomes?

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6 thoughts on “St. Luke’s Health Initiatives”

  1. Dawn Larzelier

    This is great stuff. I’m going to let it ruminate and, at your suggestion, I will share my experiences.

    I would also like to share this with others in my community here in Boise, ID as we organize to work toward the prevention of child abuse and homelessness.

    There is a lot of good information here. Thanks!!!!
    Dawn Larzelier

  2. Hi Bob
    I read the PDF — St Luke’s Health Initiative Fall ‘08 that you have linked to. I can understand why you were blown away! It is rich.. in content and approach. I love the fact that it is based on so many interviews with people in community building. It resonates a lot with me. It has so much wisdom in it!
    I like how they point to translation as a skill, and how they present facilitation as the wider notion of convening.
    I appreciated learning about the drive 100 years ago that came from volunteer civil sector… wow! so interesting! asset formation, social protection, economic agency, social advocacy — incredible human drive that was not organised top-down.
    I also like how they advice the parallel use of top-down, horizontal and bottom-up strategies.
    The whole strength-based approach makes sense absolutely and they cite many examples and reference to this as a real fundamental solution when applied.
    Thank you for pointing this out to me. It will be very useful — I am starting a new venture and I will refer to this document as a way of indicating the approach I am taking.
    I like your point as to the fact that in many ways we know a lot of this, but that we need to be able to articulate these points, and not balk when someone asks for the detailed plan or strategic outcomes. YES!

  3. Mornin’ Bob, I like it. It’s rare that I spend much time on any one site/blog, but I’ve spent the last hour here reading the links to the St Luke’s Hospital Community Project. Very impressive. I’m sending it on to some folks I know at Leadership Eastside, the Seattle Foundation and Evergreen Hospital because I think it may be something they might be interested in building on. To be continued…


    Be Well, My Friend.

  4. Hi Dan, Delighted to see you here! I was amazed when I discovered these reports last week. WE KNOW THIS TERRITORY! It is so very familiar to increasing numbers of us and when we read reports like these, it is like a breath of fresh air. I found the comments in the second report especially grounding. Within communities and organizations we lack common language for expressing these ideas, but many of us feel them. When I was talking with one of the people at the initiative last week I asked “how many of the people involved ‘get it’ in terms of what’s said in the reports. Her response wasn’t surprising — she talked about how many of the participants in the initiative still come to them as a funding source and don’t yet embrace the picture offered here. I am becoming more and more convinced that what’s needed now are committed practice fields within organizations and communities as well as translocal connections which support our learning together. Thanks for stopping in, old friend!

  5. Hi Bob, congratulations with your website! Can we use your URL of this post – good news to spread! (because you said ‘only open for friends’)

  6. Absolutely, Ria. My plan for this site is for it to be a living inquiry into what each of us can do to create healthy and resilient communities. I see it as a place for me to develop my ideas in the company of others. And, of course, I invite you and others who come in to do so as well!

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