How do you tackle challenges head on when you have very big shoes to fill? In this episode, host Douglas Nelson talks with Jim Hickman, the Chief Executive Officer of Center for Youth Wellness, about his profound responsibility of stepping in for California’s first Surgeon General and continuing to build on the great work she started at the Center for Youth Wellness. Jim talks about how their organization is changing the way care is delivered in America, and shares how he’s bringing along the management team, the people who provide the care, and the board to move with an expanded view of the organization in this direction. He also shares how you can keep your focus on the mission of your organization rather than getting lost in the process of the change.
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Keeping Your Focus On The Mission With Jim Hickman
We have Jim Hickman, a longtime Bay Area Health and Philanthropy Executive who is the Chief Executive Officer for the Center of Youth Wellness in San Francisco. Welcome to the show, Jim.
Thanks a lot, Doug. I’m glad to be here.
Jim, as we get started, why don’t you tell us a little bit about the work of the Center for Youth Wellness? What is your undertaking in the renewal of that organization?
The Center for Youth Wellness is an incredible example of what one person can do to start a movement to change the way care is delivered in America. A few years ago, I had the opportunity to work with a doctor named Nadine Burke Harris, one of the sole pediatricians here in the Bayview Hunters Point Community in Southeast San Francisco. She had realized that her patients who are showing up, had medical conditions, but also those conditions were being exacerbated by other social factors. In particular, she latched onto a very compelling yet unheralded study called The Adverse Childhood Experiences Study.
That was a study conducted by Kaiser in the ‘90s that showed the connection between trauma, childhood trauma and greater disease burden and lowered life expectancy in later years. They decided to create a pediatric healthcare center that focused on applying that scientific approach to the biology of injustice is what I would call it. How poverty, racism, housing insecurity, food insecurity have a real and harmful biological and neurological impact on the development of children. That work was so profound that in 2018, Dr. Nadine Burke Harris was named California’s first surgeon general, and she asked me to step in and continue to build on the great work she started here at the Center for Youth Wellness.
Those are some big shoes to fill. I know you are familiar with the issue. You’ve been quite involved with this cause for a number of years. What was your approach when you came in first as the interim CEO?
[bctt tweet=”Some would argue that the organization and the individual are one and the same.” username=””]
Like all organizations that go through a founder transition, it’s an opportunity to reflect and ask, what we accomplish. What are some things that we missed that we wished we had done? I came in with the approach of simply how you put in a new structure for someone so high profile. How do you keep the organization relevant? At the same time, CYW was getting a lot of attention to the fact that we developed a very significant screening tool that’ll be used in California for the screening of children on Medicaid for trauma.
No matter what we did, we’re going to be engaged moving away from that aspirational movement-building phase of the organization to a much more focused on implementation and capacity building. That was a natural opportunity to take a step back and ask ourselves, do we have the right competencies, capabilities, and capacities to go from the aspirational to the operational? That became though the lens I used to redesign the way our organization functioned to our North Star. Where we need to go both with our philanthropy program, but more important with our programming and the years ahead.
You’ve put your finger on one of the untold stories of how organizations are either successful or not successful, which is that we’re going to transition now. We’re going to think aspirationally, how do you bring along the management team, the people who provide the care, direct client service as well as the board and saying, “Yes. This is our North Star. Yes, we are going to move in this direction.”
What’s great about that and also the challenge of that is the Center for Youth Wellness has several components. We provide direct service to children and families in the Bayview Hunters Point Community. We operate a clinic where we provide primary care and mental health services. We also do research in partnership with USCSF, a major research institution in the United States, if not in the world. We do some very important branding and communications work to raise the issue and awareness around adverse childhood experiences and toxic stress. We’ve got quite the milieu of activity going on here. What it took was to, again, recognize the accomplishments that at the end of the day, the Center for Youth Wellness can claim many accomplishments.
Probably the most profound is its founders now the surgeon general of California whose task is to make adverse childhood experiences. It’s one of the fundamental constructs that we use to look at developing children and families. With that win behind us, it was easy, but also hard to step back and go, “What else can we accomplish? Is the work done?” As an organization and with the board? Doug, we spent time as an organization asking ourselves, “Is our mission over?” We had a conversation with the board for getting several options for a go-forward plan for the organization. One of the conversations we had was, “Have we accomplished the goal of the organization?” We now have universal screening happening in California. Are we done? The board concluded after some important deliberation that there was still work to be done. There was still implementation work to be done, but allowing the board to entertain that conversation of, are we done, doesn’t often happen in the nonprofit setting.
What were the arguments in favor of declaring success and rolling up the organization?
A couple, one is this organization was not a traditional direct service. You heard it was a hybrid model. As you know, Doug hybrid models are hard to find. There is always that quiet desperation that comes with philanthropy anyways, but it was especially acute here. The work was so emerging in terms of both science and practice. Secondly, you had a founder who frankly is one of the most-watched TED Talks, as a New York Times bestselling books. She’s now the surgeon general. It’s hard shoes to fill indeed, but some would argue that the organization and the individual are one and the same. The question that the board discussed is their life at the Center for Youth Wellness without its Founder, Dr. Nadine Burke Harris. The conclusion they drew was, “Yes there was.” There’s a lot more work to be done that will take her profound insights and carry them forward.
Did it take somebody with a real sense of service leadership to be able to step in following that very prominent, very successful founder? Did you find yourself having to give yourself a pep talk in the hallway before meetings at the board or before you get to work in the morning?
Doug, you may remember the traffic patterns of the Bay Area. Having a commute from Oakland to San Francisco gives you a lot of time in the car to think about things. I describe myself as an extreme possible-list. Meaning I believe good things can happen and it’s not about waiting for them. It’s about catalyzing them. There are so many positive tailwinds for children and families in California when it comes to policy, when it comes to philanthropy, when it comes to social justice. Frankly, it would be a shame not to make, put mine all into this effort. That’s what kept me going because even a modest success would be additive and has a lot going for it in this climate.
It’s an interesting point you raised there around philanthropy, particularly given how dominant the founder had been in the philanthropic efforts of the organization. How do you step in and renew that case for support or renew those conversations with top donors now that the founder has moved onto a different position?
One of the things I pride myself on is being an honest broker and having raised funds in my career along with leading organizations. It’s a natural caution that we as leaders have when it comes to telling philanthropists we’re going through a change process. It’s a little bumpy. We’ve learned some things that, “Had we known this in hindsight, the organization might’ve made different decisions.” It’s having the depth and breadth of experience to take those realistic outcomes of any time there’s a leadership transition. It’s explaining how they’re going to be designed additive to your new future direction. CYW 1.0 was singularly focused on training pediatricians and how to screen kids for ACEs and toxic stress.
I’m not a pediatrician. I have the luxury of coming in and taking a different point of view to the mission and saying, “Kids only spend fifteen minutes per appointment four times a year at best in the pediatrician’s office.” The rest of their time, they’re outside of that office with their family members or in their community. How are we making sure that we’re creating the right context for that child and that family outside the pediatric office in a way that they’re not going to be retraumatized? We can’t control everything. How do we raise the knowledge and create an integrated experience for that filming when it comes to, you’re here because you feel sick, but what you’re feeling is hunger.
[bctt tweet=”Good things can happen, but don’t wait for them. Go out and catalyse them.” username=””]
How do we connect those dots and build support systems that understand what trauma does to a family and what it takes us to move a family out of a traumatized state into more of a point of stability? Talking to a pediatrician is not the answer to that. I’ve been able to come in and articulate a more wide-angle lens approach to our mission that makes sense to a lot of people. That basically say, “You can’t leave the family and the community out of any social justice solution to a medical issue caused by poverty and racism.”
That wide-angle lens is probably refreshing for many people in the organization. It’s something that they can be excited about. How have you brought your management team along with this expanded view of the organization?
It’s in a couple of ways. People whose anchor point was the founder because of the inspirational mission she articulated. You have to make the case to them that the mission is still valid. It’s in a new phase of its deployment. It’s a realization and here’s what that looks like. Here’s your role in it. Sometimes founder-driven missions can be so powerful. It’s hard to find your own ownership of it. A lot of the work I do is flattening organizations, flattening the hierarchy, taking more of a workgroup approach frontline and make sure that the people who do the work own it and influences the direction in the organization.
A lot of this work is about culture change. Understanding that when you go from the aspirational to the operational, when you go from being about thought leadership and movement building to capacity building and implementation, when you go from a founder model mission and vision to a more mature model and mission-driven approach to how you operationalize things, you need a different team. You need different working agreements. You need different understandings of how the work gets done. Most of my time here is about culture change.
How have you approached that? How do you bring everyone together and say, “This is the direction of let’s co-create the direction and the culture that we want to have?”
I started by doing something simple. I went through three phases of this interim CEO role. The first was to stabilize the organization. Again, you had an incredibly charismatic leader leave not to go someplace else, but to be elevated to a position of influence that was only added into our mission. How do we as an organization stabilize our role and how we work on a day to day basis knowing that the way it used to work is now forever changing. We have new leadership. Number two, what a great opportunity to do a deep dive into each of our programs and each of our support departments and ask ourselves what are we doing and why.
From that, I did that work with a colleague, my Chief of Staff, Gatanya Arnic and I. We identify where are the hidden gems inside the organization that maybe were overshadowed because of the prior thought leadership strategy. We overlook some other elements of the organization that is now probably much more value add in this version 2.0 environment. Thirdly, we reset the organization. We say, “We’re not going to build our 2.0 organization based on these assets over here.” People saw why that matters, what’s going on in the external environment where the demand was not for convincing us that screening of kids matters.
We had won that battle. It’s now, what do we do to restructure the communities they live in? How do we help the parents engage with this knowledge in a different way with themselves and their children? Yes, pediatricians are always going to be at the forefront of seeing kids in their early years, but kids leave the pediatrician’s office and immediately go to YMCA. How do we bring them into the conversation as well? We unfolded it, laying a little bit of fudge in a pan. People slowly saw how that all while you’re together and came to be a new fuller picture of CYW.
It sounds like a great journey to have come across. How important in that is for the members of your team to see that big picture, to see not as the fudge hits the pan, but what the ingredients are to make the fudge in the first place?
It’s very important because what they saw under Dr. Nadine Burke Harris was this person single handily brought to prominence of this issue of adverse childhood experiences and toxic stress. What they hadn’t to deal with, but now they are having to deal with, we at CYW are having to deal with this, we spent a lot of time on the illuminating problem. Now we’re in a phase of work here in California and across the United States. I was in Charlotte, North Carolina, where there’s an incredible movement around ACEs and addressing that in the community. It’s about what do you do? What’s the intervention? What’s the pathway to helping these families get the resources they need and the supports they need to heal. People see how important our contributions to that conversation. Unfortunately, we are still a leader in that space as well.
How important has the conversation with your board chair or the board been in this setting of the new North Star?
It’s been interesting. I originally was working with a transition committee of the board, a sub-committee of three board members, who I spoke weekly with. I map them through all the organizational changes in both strategy structure and staffing, as well as bringing to them those sometimes uncomfortable insights that come from having a fresh set of eyes on an organization. Over time, we built a trusted relationship that ultimately led to me being offered a full-time role. Equally important though, because these things are always easy, I had a board leadership change in the middle of this. Our longstanding board chair was commuting from West to the East coast on a weekly basis. Finally, for all the right reasons decided to move east to be closer to work. That led to a board leadership change, which we then work to the time with the announcement of my CEO role as well. In baseball, the term is a double switch, but what we did was sit, use that as a signal to our donors and stakeholders that this new era of CYW leadership and impact was underway.
[bctt tweet=”A change of leadership is a great opportunity to do a deep dive into your programs and ask yourselves what you are doing and why.” username=””]
One of the things that fascinates me about organizations that go through this very positive constructive change is the role of the board. One of the things we see a lot in our work here at the Discovery Group is board members wanting to be part of the solution. The question they often ask is, “I feel like the organization isn’t asking enough of me. What can I do to be helpful?” Thinking not about your role, but all of the other organizations you’ve been involved with. What advice would you give to the board member who is sitting around the table, with an organization that is going through a great amount of change?
The gold standard in board work these days is the idea of a generative board. That is the early indicator, the pathfinders on a lot of way for what the community and the organization can do together to create change and positive impact in their community. My board is probably exhausted from me. We spent a lot of time in the first six months of working together in the weeds, to help them understand truly what the Center for Youth Wellness is. What’s underneath the hood? The walkthrough that they probably will never want to do again of understanding how nonprofits make their way in the world.
We’re marching towards this idea now. How do we have our board members lead with ideas? Creating the opportunities for them to engage in conversations with experts outside of our organization. Understand context that they can bring back and make sure that our mission is relevant to the needs of the community. It’s staying in sync with or ahead of emerging trends, policy and practice that we want to make sure we’re leaders. It’s hard to do because a lot of times board members start with what’s my fundraising role? I want to tell people about the work we do. It takes time for people to be conversant and comfortable with what the organization does itself.
Can you think of an example in this transition that you’ve made where you’ve had a board member start to lead with ideas? What does that look like? What are the tactics involved?
I can think of a couple. One of the tactics was we had to do a beauty contest fundraising competition here in Silicon Valley, which we succeeded. We won a grant from a local organization through that. We co-structured that presentation and the site visit. Because I was the interim CEO, I asked a board member that co-lead that with me. What was powerful about that was how that board member herself heard what the outside parties were saying about our organization in a way that board members don’t often get. It was that one experience generated a series of reflections that helped us make this transition faster and clearer about what is the purpose of CYW post Dr. Nadine Burke Harris. Having a board member engaged in a conversation about what the work is and having others reflect it back and ask questions, opened up what the possibilities are for this organization.
That exposure to not only how others see the organization, but hearing other organizations talk about their own role does open up the flood gates for what is possible within the organization.
One of the things that I’m excited about with the board I’m working with now is what’s possible is not defined by philanthropy, which is the other important conversation to have. Yes, at the end of the day, you need the resources, but resources are not just sufficient fundraising dollars. It’s also leadership and commitment, passion, the ability to go out and tell that story and understand why stories matter. That’s the other piece of this. Helping board members see that, you know, their own role was broader than raising money or making sure we have a good clean financial audit.
We both seen boards that spend time on the finance committee report than the governance committee than the other committee than the program committee. At the end of the meeting comes and none of these important issues had been put on the table. How do you make sure that the important generative conversation or that pathfinder role as you described it, is a regular part of the conversations around the board table?
Partly by limiting the number of times we have reports like that in the board meeting, sincerely. I do think it’s a great way to perform a duty without necessarily performing at the highest level. They’re important roles and functions. There are lots of ways to do that. That’s what consent agendas are for. I’ll give you an example. We had a first-ever board conversation about signing on to an amicus brief for the Supreme Court case dealing with DACA recipients. The Center for Youth Wellness had never taken a public stand like that and yet many of our colleagues, many of our scientific peers were doing that. If you have a board meeting where all you’re doing is processing reports, you don’t have the hour it takes to ask ourselves why we would do this, why does it matter? What does it matter now? How is this consistent with our mission? This is not a program we’re delivering. This is not a grant deliverable for a funder, but yet what does this say about what we think is important in that world. That’s what unstructured or those types of agenda of the board meetings can lead to.
I’ll bet those board members left that meeting feeling like they had contributed meaningfully to the mission of the organization for having had that conversation.
To a mission that is bigger than our four walls.
That’s the trick of keeping donors. That’s the trick of keeping board members feeling inspired, engaged and bringing their best selves to the board table. Tell me, if you are coming up to your one-year mark in working with this organization, you’ve undertaken a great deal of change. How are you keeping your own focus on the mission of the organization rather than getting lost in the process of the change?
[bctt tweet=”We undervalue the power of philanthropy to make a change.” username=””]
It’s easy to do. I have to step out of my front door here where my offices on the 3rd Street in the Bayview and see the families I meet. As a matter of fact, Thursday night is our quarterly community advisory committee meeting where I meet with members of the community who live here every day, who value what we do, who have ideas, input and opinions on how we perform our mission in the community. That’s what keeps it honest. When I walk out my office door and I see a young family in our waiting rooms for the clinic, that tells me we’re doing something right. If they keep coming back, that tells me we’re helping them. That’s how I measure our success and the relevance of the work that I do every day.
I’m interested in your perspective too on what advice you would give to someone who is coming in to be the leader of an organization following the founder. What’s the best way to make that successful or what have you found to be successful in your case?
I’ve experienced in across the board in my career, oftentimes people say they want to change. I’m sure you’ve worked with boards or management teams like, “We need to change.” You have to push on that. Make sure that’s truly what they want because often what you find is what they want to change as the circumstances of the moment and not necessarily changing the fundamentals of an organization or recasting its mission to be more relevant to the external world rather than the internal boardroom. That’s a delicate and often difficult conversation.
I would say to anyone who’s faced and comes into our founder role, coming as a successor to a founder, you have to be prepared to walk away. One of the things I said during my work as the interim was my goal was to create a clear sustainable and functional organization. If I do that, there’ll be 100 different candidates for the CEO of this organization. That to me was my goal to make an organization that’s hugely sought after because of how it is situated for impact, the solid base of which it has started. It will continue to grow. That was my North Star. If I delivered that, I felt I had done my job being CEO ongoing is to me the icing on the cake.
They decided with the 100 people who wanted to be the CEO after you’d done your work that they’d rather have you.
They heard my jokes and liked them that’s how I described that.
You have been involved in a number of different organizations throughout your career. You’ve been involved in starting organizations, turnarounds and at least two instances that I know of. What would you say surprises you as a leader in the social profit sector?
It’s how we undervalue the power of philanthropy to make a change. Doug, you may recall, I had an old phrase when we worked together, I talked about, “De-risking innovation with philanthropy.” That’s my favorite phrase to throw out in front of our grant-making foundation board. I talk about experiences that we shared together at Sutter Health or other organizations I’ve been in where philanthropy was that risk capital that made change palatable. It does play that role throughout history. Any social movement started with one donor who is willing to take a risk on a leader on, on an organization, on an idea, on a community. Not all of those pan out but when they do, they change the world.
You’d like to see people taking more of those risks?
Absolutely, people particularly here in the Bay Area, Doug. You put a lot of money into risky ventures because of the 10X expectations five years down the road. What’s our 10X expectation to change the fate of families in America?
You’re in a great position, Jim, to help answer that question in some new and surprising ways. Maybe we can check in with you in another year and see how you’re doing there at the Center for Youth Wellness.
We do work in Canada too, so who knows? Maybe I’ll show up in your doorstep, Doug.
The door is always open for you, Jim. Thank you so much for taking the time to be part of the Discovery Pod.
About Jim Hickman
A senior executive with more than twenty years of experience in community-based health and philanthropy, Jim Hickman assumed the role of interim Chief Executive Officer of Center for Youth Wellness (CYW) in January 2019. His leadership comes at a pivotal moment for CYW, as the organization accelerates its work to achieve universal screening for ACEs in California.
Hickman’s advocacy around toxic stress is borne from years fighting the systemic roots of poverty, as well as his journey to understand his own experience of childhood adversity. His leadership at CYW is a continuation of his unwavering commitment to advance the health of underserved communities, which are disproportionately affected by toxic stress. Before coming to CYW, Hickman headed Hickman Strategies, a firm he co-founded to help innovators find new ways to deliver health services to diverse populations.
Recently, Hickman served as the President and CEO of Sutter Health Better Health East Bay (BHEB), a Sutter Health philanthropic foundation that used a data-driven approach to solve healthcare issues for the underserved and those who require complex care in a community setting. Before joining Better Health East Bay, Hickman led strategic communications and advocacy campaigns for California’s largest Bill & Melinda Gates Foundation global health grantee, PATH Drug Development.
Hickman held posts with the White House Working Group on Welfare Reform and U.S. Department of Health and Human Services during the Clinton Administration. Hickman holds a BA in Political Science and Business Economics from the University of California at Santa Barbara and an MBA from Santa Clara University.
He is a graduate of Leadership San Francisco and the joint Stanford Graduate School of Business and School of Medicine Innovative Health Care Leader Program.