With 20 years of leadership work at the nexus of healthcare and housing, John brings to his coaching, consultation, and technical assistance a deep and broad understanding of the opportunities and challenges encountered by change agents in these sectors. He recognizes they must juggle complex strategic challenges with managing the everyday pressures of keeping the doors open. He supports them in effectively pulling off this juggling act — to lead change while sustaining, and even expanding, operational capacity.
Calling on his own successes in change management and administration, he partners with clients to focus on organizational and community leadership through multiple lenses, including:
- Inspiring stakeholders, including board members, partner agency leadership, front-line service providers, funders, and policy makers
- Minimizing conflict and blame by cultivating organizational norms rooted in mindful communication, self-compassion, and genuine care for the wellbeing of teammates
- Aligning innovation with opportunities afforded by the policy and funding environment
- Collaborating with customers, direct services staff, and community partners in moving “up onto the balcony” to access a more open perspective on strategic challenges and opportunities
- Creating and evaluating pilot initiatives that disrupt default approaches to meeting needs, interpreting problems, and crafting solutions.
John’s approach acknowledges that problems like staff turn-over and shortages of qualified candidates, management burn-out, insufficient funding, and uncertainty in the political and policy environment can’t be placed in a state of suspended animation. On the other hand, transformational change depends on developing both strong strategic alliances and a culture of continuous learning in which teams embrace the need to boldly innovate. In supporting leaders who grapple with this tension, John starts with exploring the question of purpose, i.e., better defining the client’s Why—both personally and organizationally.
As articulated by Ronald Heifetz, Marty Linsky, and Alexander Grashow in their seminal book The Practice of Adaptive Leadership, this exploration of purpose represents an essential first step. Leaders who inspire true innovation, they argue, “anchor change in the values, competencies, and strategic orientations that should endure…” Establishing and nurturing common ground around the Why creates a foundation of good will upon which the wisdom of both internal and external stakeholders can inspire and inform needed change.
The most transformative and adaptive leaders are those who can connect a bold vision of the future to the nitty gritty details around what works well in providing services on an everyday level. John therefore supports clients to not only inspire buy-in for needed innovation, but also to incorporate the input of consumers and front-line service providers—those who are the most familiar with service needs and barriers at the ground level. In John’s experience, if these needs and barriers are not sufficiently appreciated up-front, disconnections between vision and reality can undermine the best-intentioned strategic plans.
In addition, John works from a belief that the power and sustainability of strategic plans depend on how well leaders call forth the natural decency, generosity, kindness, integrity, and intelligence of the people who comprise the teams that implement them. He works with clients to gain clarity and explore resources for making this fundamental value more prominent in their organizational cultures.
Diversity, Equity, and Inclusion (DEI) work provides a great example of how adaptive and transformative leadership can make the difference between creating meaningful change and producing a report that will do little more than sit on a shelf and gather dust. John’s blogpost Leading for Racial Equity reflects on the leadership lessons he’s taken away from his racial equity organizational development work.
Adaptive leadership has also proven critical to John’s success in fostering collaboration and innovation among decision-makers who bring disparate perspectives to seemingly intractable problems like homelessness and barriers to recovery for people with chronic health conditions who are living without a home. He’s employed the approach described here to create and strengthen numerous partnership-based strategies that have required active, ongoing support from:
- Health systems
- State and local governments
- Managed Care Organizations
- Federally Qualified Health Centers
- Continuum of Care planning bodies
- Community Mental Health agencies
- Permanent Supportive Housing agencies
- Substance Use Disorder service providers
- Shelter and other homeless services agencies.
In each case he forged leadership consensus by engaging diverse stakeholders “up on the balcony” to create values-based visions for change. He then involved front-line service teams directly in detailed planning that turned those visions into reality. The following examples include initiatives for which John led the start-up of completely new programs and others for which he led significant expansions, both in funding and services and/or sites:
- Health Care for the Homeless clinical networks
- Medical respite/recuperative care programs
- Mobile integrated health care programs
- Integrated physical and behavioral health care provision in supportive housing
- Outpatient clinics providing integrated primary care and mental health care
- Street medicine programs
- Coordinated responses to preventing or containing communicable disease outbreaks.
Read John's Articles
Data unmistakably link race with poor health and housing outcomes, and leaders within public health agencies, community health care organizations, and housing and homeless services entities have attempted to develop new strategies to produce more equitable outcomes. In seeking deep and lasting impact, however, these leaders encounter barriers stemming from the persistent influence of unconscious bias and white supremacy that pervades our culture. For instance, researchers found that the most commonly used assessment tool for prioritizing access to scarce housing units for people experiencing homelessness results in statistically significant discrepancies in scores that favor whites over people of color. Genuine dialogue around these issues, which includes both clients and staff of color as well as managers at all levels, regardless of their racial identity, is needed.
As Public Health thought leaders push for greater understanding of the social determinants of health, they increasingly focus on stable, affordable housing as a critical piece of the puzzle for reducing the risk of worsening chronic health conditions, frequent and/or avoidable hospitalization, increased costs, and early mortality for vulnerable populations. Kaiser-Permanente Chief Community Health Officer Bechara Choucair and National Health Care for the Homeless Council CEO Bobby Watts persuasively argue in Rx for Health: A Place to Call Home that “homelessness itself can accurately be characterized as a dangerous health condition.” The statistics they cite demonstrating dramatic health outcome and mortality disparities for people experiencing homelessness strongly suggest that increasing access to safe and secure housing would, at a population health level, have an enormous impact.  Simply stated, preventing people from losing their housing in the first place also prevents poor health outcomes. In turn, re-housing people who have become homeless reduces the danger of rapidly deteriorating health that is part and parcel of homelessness. Yet there are thousands upon thousands of people across the U.S. whose unmanaged chronic conditions have already been exacerbated by homelessness. Effectively and sustainably addressing their needs entails grappling with an array of policy and operational challenges.
National experts have called out the aging of the homeless population as an impending crisis.  This demographic shift is happening rapidly, mirroring general population trends. Nationwide, currently half of single homeless adults are aged 50 or older, compared to 11% in 1990.  Moreover, according to a white paper prepared by the Corporation for Supportive Housing (CSH) and presented to a New York City coalition studying ways to address the aging of the homeless population, “not only are those on the streets getting older, but their health is deteriorating at rates much faster than the general population.”  The paper cites research showing that homeless adults over 50 had a higher prevalence of geriatric conditions than that seen in housed adults 20 years older.  Another study showed that older homeless adults were 3.6 times as likely to have a chronic medical condition as homeless adults under 50.  Such findings clearly indicate a pressing need for housing and services that specifically address geriatric conditions among older homeless adults living across varied environments.