CEO Update

As a person of color, I am constantly amazed at the contradictions and inconsistencies in policy and practices in the U.S. There are days I wish I didn’t read the news, and other days I’m amazed at what can be learned with one keystroke and internet access.  

Members of our team struggle some days and are lighter on others. We provide space for expressing whatever emerges on any given day. I have had great teams over the years, but this group at North Sound ACH is really special and I’m honored to be working with them, and with you. June 30 was a hard day for our team as they reconciled the final decisions of the Supreme Court this term.

It was a strange Supreme Court month – their early decisions were surprising (‘maybe it isn’t as bad as we feared’) only to end their term with a couple of decisions that used something called the ‘major questions doctrine’ – per Wikipedia “a principle of statutory interpretation in United States administrative law which states that courts will presume that Congress does not delegate to executive agencies issues of major political or economic significance.” So this begs a serious question – does Congress pass laws without delegating responsibility to federal agencies to carry out laws? It could be an oops, or it could be intentional; either way, it seems like a major fixable flaw. 

Intersectionality was front of mind for me on June 30. As a lesbian and person of color, I was trying to understand what the court was saying to me, my children, and my family. We give the Supreme Court so much power to rule, overrule and guide the values of this country, and I wonder if we’re missing a fourth stool in this democracy – the branch of government that is looking at what we need for the future, to ensure that we have a future. 

Parts of our globe are under smoke domes, heat domes, flooding, tornados, out-of-control fires, war, famine, and violence. For several weeks now every day has broken a heat record in cities across this country. None of us are immune to these changes, no matter where we live. Which branch of government is trying to navigate our future and the impact of today’s choices on that future state?

The court can pick and choose which cases to hear – which I often think wields more power than the decisions they make. They announced on June 30 that next year they will hear a case about whether someone under a domestic violence restraining order can possess a gun. Anyone who has ever experienced domestic violence is wondering when and if the court will consider the victim’s right to ‘life, liberty, and the pursuit of happiness.’

To celebrate the 4^th of July, five days after hearing that a business (regardless of whether they are actually in business) can intentionally decline to serve me because of my choice of identity, Nanc and I went with friends to see a play in Bellingham – “What the Constitution Means to Me.” I was not prepared for the scope of this small play, but I walked away with one realization. The Supreme Court has not yet made a decision that says that anyone besides white men are full and whole human beings with full rights in this country. That kind of blew my mind. 

When I graduated from high school women could not get a credit card without a spouse or father co-signing, were not entitled to a jury of their peers, and there was no such thing as sexual assault by a spouse. 

When given the opportunity to decide whether women can access contraception, the court said yes, if a doctor and their husband say yes. When deciding whether a woman and her children, who had a restraining order against an abusive husband, could count on the police to respond when her spouse abducted her children, the court said no. Even knowing that the husband killed those children. The court ruled that he had a right to take those children and the wife had no right to expect law enforcement to respond. 

In the past year, federal agencies have come together around the Vital Conditions for Health and Well-being. It is nearing 50 federal agencies who have signed onto a federal plan for equitable recovery. It’s worth checking out; it is the same framework that the North Sound ACH Board adopted in December 2020. It is time for us to find ways to control our destiny; maybe this is a strategy that will find federal agencies ready to do this work with us. Well, my fingers are crossed on this. 

Back to the play, two other tidbits – there has only been one justice from west of the Mississippi in the history of the court; doesn’t that make you want to ask “hey what???” I wonder if that can possibly be true. But then I think of the New York Times articles recently about how unhealthy air is on the east coast with all the smoke. They are right, but I’m not sure that I saw this level of national news when the smoke was covering us here on the left coast. 

The main part of the play ended with a recording of Ruth Bader Ginsburg as she was asked about women on the Supreme Court. Her response “I’m sometimes asked when will there be enough? And when I say ‘when there are nine’ people are shocked. But there’d been nine men, and nobody’s ever raised a question about that.” It was a thought-provoking way to spend the 4^th of July.

At work, two thoughts are top of my mind this week – creating a compassionate workplace, and hiring people with ‘lived experience.’ Both are terms that have been rising in mainstream media and both deserve some deeper discussion. 

This has been a tough couple of months for me and my family. I lost one of my sisters at the end of 2021, and lost my oldest brother in January, the day before we started our Partner Convening. This past week, I had two nephews in separate ICUs, one recovering from a stroke, and the other passing away. I’ve been struggling in some moments, and fully functional in others. I come from a large family, the fifth of six children. My parents had 22 grandchildren, and the great grandchildren list keeps growing. I grew up in poverty, and to this day I can’t imagine how my parents supported us all on my dad’s salary. (When he retired after 33 years working for the federal government, his salary was less than mine in my first year after college.) I’m trying to grapple with my older brother dying in the same time frame as one of our nephews. Our worlds and experiences are that different.   

My nephew struggled with addiction and alcohol, and yet, even as we knew he was burdening his physical self, we never imagined that his body would give out on him so young. I’m reminded of the book “The Body Keeps the Score.” My nephew carried years of accumulated physical and emotional trauma and even when he was ‘well,’ those years took a toll on his health and well-being. 

There was a recent opinion piece in the New York Times that has also been on my mind – When Someone You Love is Upset, Ask This One Question? It suggested asking “do you want to be helped, heard, or hugged?” I tried that with my team this week to see how it would play out. I shared about my two nephews, my brother facing a decision about taking his son off of life support and how that was weighing on me. I knew that they would feel sympathy for me and my family, empathy for what I’m going through, but I knew I didn’t want to tell them everything about my life and my family in that setting. They could not help me or my nephew with this pain, but they could surround me with compassion. Standing on a street corner in La Conner after a meeting, being hugged by five people who I know are also going through their own struggles, was medicine that I needed at that moment.

For our teams, I want to offer space where they can bring their whole selves to the table, but that doesn’t mean they have to share their whole stories with strangers or co-workers. Their lived experience is their own, and they get to choose if, how, and how much they want to share with others. My job is to create a space that allows them to feel safe in what they have to give on any given day. We all bring our experiences with us – family history, personal experiences, laughter, seriousness, and trauma. We don’t need a trauma-filled workspace, but we do need space that recognizes that my mood, my affect, my willingness to lean in, my attention span, my level of engagement that can and will be altered by things that my coworkers can’t see, and I may not want to bare all to them.  I want no assumptions made about why I am behaving in any certain way. Curiosity yes; judgment and assumptions no. Asking if there is anything I need, yes. Assuming I need to be fixed, no.

I share with colleagues that I’m always amazed at this emoji – 😂 – wondering if it is laughing while crying, or crying while laughing. It sounds silly, but when I am at my most vulnerable, some things can still bring me joy, or make me laugh. And when I am feeling joyful, parts of me still feel pain and tears at the underlying emotions that sit around our stories. It doesn’t mean that I am “fine” or that I’m “not fine.” I can be both at the same time. So if you stop me and ask me how I’m doing, my answer depends on how large of my own eco-system I’m responding from. “I’m doing well.” “Nanc and I are doing great.” “Our kids and their families are doing fine.” “I am grieving and suffering.” “My nephews lived really challenging lives, and we are all hurting around them.” All of those sentences can come forward at the same moment and all be true, and I never know which one will come forth first. At the same time people are being shot for knocking on doors, for pulling into a driveway, for rolling a basketball on a lawn. How can any of us be totally fine? It depends on how wide of a circle I’m responding from. 

A compassionate workplace would allow space for all of those, not because we need to pull a fire alarm, but in order to recognize that whole and amazing human beings can also be hurting, harmed, and living with things we are unaware of. Imagine a world where we can all be whole human beings and no one is trying to tell me a story with only one arc to it. It’s a lot of work, takes some trust and vulnerability, and it is totally possible.

In mid-February, former President Jimmy Carter opted for hospice care, and the media immediately began writing eulogies and obituaries, as if entering hospice means that death is imminent. In the statement from the family, “the decision was made after a series of short hospital stays.” It reminded me of my dad, who also chose hospice after a hospital stay where he realized that for him at 96, there was no cure for what was happening with his body. He wanted to be seen as a whole human being, and not as a patient who was dying. He wanted to live the rest of his life in peace, with family, in comfort, surrounded by caring individuals. He enrolled in hospice and lived for another 16 months. Eight years earlier my mom also chose hospice, but she had to advocate for it within her health system, and was so relieved after doing so. The reason she had to fight for it: her clinical team was afraid that she would give up her will to live if hospice was presented to her as an option.

I think sometimes we forget that being inside of a medical-treatment and cure-focused system is exhausting and takes its own toll on those who want a more peaceful arc to their lives. I’ve been thinking of the Carter family a lot this week, especially with the more recent news that the former president is ‘doing well’ in hospice, and I applaud their bravery in sending these messages out publicly.

How does this relate to North Sound ACH and its themes of belonging, targeted universalism, and equity? It is about how we belong to and with another, how we provide care and nourishment to each other, and how we make each person be seen in their total humanity, leaving space for our uniqueness and our commonality.

Imagine if we could do that in all facets of our lives, not just the final days, but every day? If those themes of caring, without thinking of cures, could extend to our policies around housing, employment, food security, immigration, transportation, health, and yes – even health care. If we can bridge themes of leading with belonging, humanity and love, we can accomplish so much more than by crafting more boxes, eligibility criteria, and rules that allow some people access while denying access to others.

Our histories differ, our current situations differ, and our access to meeting our vital needs differ. What we hold in common is our humanity, the fact that we are here and part of the fabric of our communities, and we will not heal if we allow portions of that fabric to continue to fray. For us to create a space where all belong, we must truly see and welcome everyone in the common space.

Be well,

The past twenty-four hours have brought snow, hail, rain, bright blue sky and tremendous winds. It must be getting close to spring, right?  

We held the first in-person partner convening in three years in January, and it was a mix of emotions – joy, passion, camaraderie, frustration, and challenge to do better and take more actions. New relationships were made, and I’ve already heard of small groups that are continuing to meet since their ‘open space’ discussions. We have almost twenty project submissions that have been submitted so far, and the Regional Projects Investments Support Committee (formerly called the Review Committee) is eager to start reviewing and approving them to move forward. 

For the past six years, one of the largest responsibilities that North Sound ACH has undertaken is a partnership with the Washington Health Care Authority (HCA) to carry out its Medicaid Transformation Project – a federal waiver that allowed initiatives to flourish and grow to advance the health and well-being of people on Medicaid. It was an incentive-based agreement, and there were things that each region had to demonstrate in order to earn dollars for the region. And oddly, while the work is completed and there are no more deliverables, we will not receive the last of North Sound’s earnings until mid/late 2024.

That leaves us with unprecedented opportunities to imagine how we can invest dollars to advance equitable well-being across the region. That’s what we have been seeking from you in reporting, surveys, zoom discussions, and the partner convenings. Who could have envisioned that we’d be hearing demands to acknowledge historic and current oppression and harm, and learning a salsa dance in the hallway? Laughing at the joy of seeing people in real life, and feeling the discomfort of painful truths that must be learned and recognized. I have lived my life ‘in-between’ – visible and invisible, marginalized and in seats of privilege, access to leaders with power and had my voice muted. What we are asking members of the network to take part in will not happen in any single meeting. Movements rarely do. But I believe it will continue to grow, as we find space for those who are impatient and those who are so new they don’t know what the impatience is about. We can have joy and lean into discomfort in the same day, the same hour, the same meetings. We must. And, as we build trust and relationship it will become more clear just how far we can move this work forward. 

Another thing that the end of the (first) Medicaid waiver does for us, is provide a period of transition. Internally things are changing at North Sound ACH, and we will announce some of those changes in the upcoming newsletter. New and emerging leaders are stepping into roles that have been crafted because of your input. In the second quarter, we will be hosting a convening of DEI leads from across the Network (if interested, please fill out this survey), and planning for a region-wide Community Health Worker convening. 

I appreciate each and every person who shares their ideas with me and our team, even when you think we don’t want to hear what you’re saying – we do; and we incorporate what we learn into our upcoming planning. Throughout my career I’ve often said “I don’t need another someone just like me; I need someone who brings other perspectives, other experiences, other purviews – how else can I learn what I haven’t seen?” That’s what our team does, what you add to us and to each other, and I hope you will continue on this journey as we continue to make this region one where all feel they belong. 

Be well, 

We build on the strengths of all in the community and amplify their voices, stepping back so that nothing is in the way of communities making the best decisions they can within their own networks.”

“We have intentionally sunsetted structures that do not meet the needs of the next generation, and have invested resources to build what will meet their future needs.” 

“The concept of ‘eligibility’ disappears from our lexicon.

That’s what I wrote on my radical re-imagination post-its – I want that world for my grandson and whatever his future brings. Maybe it isn’t radical enough, but our dreams morph and stretch depending on the mind’s work that day. 

As we internally debrief about the convening, the notion of exhaling has been stuck in my mind. I learned it while preparing for the birth of my oldest, but didn’t understand it until I was in the process of delivery. And for 41 years (yes, the age of my oldest), I come back to that time and time again. It is during an exhale that we can navigate when we’re in pain, when we’ve pulled a muscle, or experiencing a spasm. Inhaling provides oxygen and blood flow, and exhaling provides a period of ease.  

Our team decided to re-enter the universe of in-person meetings, believing that creative brainstorming is better when we’re in rooms together. We have optimized the heck out of Zoom, and we haven’t seen the last zoom call, but there’s a different feeling of having a call with someone you’ve just met versus a handshake or a hug in person. We’re just so glad to not be as reliant on technology. There is something magical, for lack of a better word, that occurs when I can turn to a person next to me, or while walking the hall, or grabbing food, with curiosity, asking questions to learn more.  

We talked about trust over those two days but in reality, it is harder to trust when we don’t have relationships with each other. The intention of both two days was to connect us, introduce us, and ignite/re-ignite relationships with each other. 

We had some times that felt tense. Issues were raised about radical imagining, challenging us to go deeper and further. Tension that caused some in the room to hold their breath, anxious about what would happen next. What we didn’t do well was to collectively exhale, allow the tension to sit, learn from it, and figure out how to navigate the next steps. We can get better at that.

Organizations are used to having deliverables, outcomes; an agenda, a syllabus, and tools that they can take home at the end of a conference, ready to file away or share with others. Our hope – is that the tools you took home were a name, contact information, and an idea for a future collaborative project or partnership(s). 

Because the richness of North Sound ACH is you, our team, board, partner organizations, and further extensions into communities. We have built a strong team, ready to help you amplify and grow your work and impact. Our board sets the organization’s direction by stating a purpose for our existence – to create a just and inclusive culture and the necessary conditions for all community members to thrive.  

We’re looking for ways to directly connect where you see needs and how the ACH leverages available resources, and how we look for additional resources to bring to the table. 

I was reflecting on Van Kuno’s comment about how people see her as always being very “calm and zen.” Many people see me in a similar way – this gentle, calm elder. You don’t often get to see the idealist, impatient, and tenacious Liz. I have spent my career at the intersections of policy and practice, between traditional decision-makers and people who are most impacted, between formal and academic language, and plain language. I’ve spent many a day as an activist and advocate, and these days as a bridge builder.

We won’t think ‘outside the box’ unless we recognize how easy it is to accept current structures and paradigms as givens and immovable, without realizing that we’re assuming they must stay in place (perpetuating their existence). It is always good to get those reminders and not seize up but to also exhale.

I was very grateful to be in space with you all, I picked up a lot of ideas in small discussions with those I haven’t seen in a long while, and from others who I met for the first time. 

I hope you all took the time to complete our post-convening survey. Being the first time in-person in three years, we want to hear from you before we plan subsequent sessions. We look forward to sharing future space with you to dream, heal, and brainstorm solutions that build new constructs and legacies. 

Glad to be on this journey with you –