About This Episode

Dr. Sarah Mitchell started her career as a rural family physician. When a personal health crisis forced her to step away, she saw firsthand how broken the communication systems were for patients trying to navigate care in underserved communities.

That experience led her to found Community Health Partners, which has grown from a single clinic to a network serving 43,000 patients annually across rural America. In this conversation, she shares the communication infrastructure changes that made the biggest difference.

Key moments

  • 2:15 – What “hitting rock bottom” looked like for Dr. Mitchell
  • 8:30 – The communication gaps she discovered as a patient
  • 15:45 – Building the first clinic with SMS-first engagement
  • 23:10 – How automated texting reduced no-shows by 34%
  • 31:00 – Scaling to 43,000 patients: what broke and what held
  • 38:20 – Advice for leaders in mission-driven organizations
Episode Transcript

Our [Music] next guest says, "Back then, if you wanted support for your child with a disability in Alaska, you had two options. Give them up or go broke. We decided to build something better, and we never stopped." I love this. I love this so much. Michelle, welcome. Thank you so much for taking this time. I I mean, it's goes back to sometimes we have a plan, but the plan sometimes is even bigger than us, bigger than what we can even think. And you started in education. What kind of shifted your path to that full-time advocacy? Well, again, I, you know, I came up here, um, I graduated from college and was going to take some time before I went back to get a teaching certificate. And during that time, a friend from college said, "Hey, why don't you come to San Jose and work in the small institution?" And it was nothing I had many years in Alaska, you either had to go into poverty to keep your child with a disability at home and get support or you had to give them up if you wanted to maintain your job and your lifestyle, etc. And there was a parent talking to the governor's wife at a dinner that we had during that event, talking about how much she missed tucking her daughter into bed and explained to the governor's wife that she had to give her child up because of all the the the way the system was structured. And as often as the case, stories are what move it. We've really grounded ourselves and beliefs and values and mission and even on a bad day, you know, you can say, well, that person disappointed me. But the culture and the the values that I hold dear has bound us all together. And when you get a group of people that share the same passion, you can row pretty well together and and that's that's kept people and the relationships with the people that we support. I can tell you a number of years where we all have, you know, waves I appreciate it and buy it. I don't do it. I'm pretty sure you're an artist in, you know, various different ways. For sure. Um, I can't I can't just not acknowledge the plant behind you because I'm a plant guy, you know. Oh, yes. I I love plants. Are you a plant? as as Medicaid waiverss shrink, we're in a very challenging time with what's happening at the government level. How are you staying afloat and and just staying creative? Is there anything that you guys have to pivot to to make sure that um you weren't losing anything on the back end? Well, I think you always have to stand on the wall of advocacy when you're in this um particular space. In Alaska, we're structured a little bit differently than some other states. So at this moment in time, Medicaid is okay. And Medicaid is a mandated uh And um that's that's that's how we've grown. I think if you provide good service and I think that there's there's changing trajectories. Some people don't like the big, you know, organizations and they're looking at smaller providers, but I think that there is a lot of safety and security in a larger provider. And um we're going to be here. We've been here for 56 years, we're going to continue on. Uh whereas maybe a small provider eventually may retire, up there and they um basically live off the land and they have animals and they're embedded into the community and they live the life that they want to live because they wanted to live a rural lifestyle. They didn't want to be an urban anchorage. So, it's really listening to the person and saying what do you what does support look like for you and then coming up with a plan to design that for them. I love it. Meeting them at where they're at, would you would say? Yeah. different kind of way for people with uh a disability to be able to live as independently as possible without dependency on staff. So I think technology is our friend if we use it well. If the Heart and Hustle podcast has ever sparked any idea or made you think differently, do us a favor. Make sure to guys share this, post it on LinkedIn, or even text that nonprofit friend that you just have. Whatever works. This is what keeps the conversation going and allows us to just grow this community together. I love that. And when we talk about CEOs and business owners in in your community with disabilities, what are people still getting wrong about ability and leadership? Well, I think that there I always tell my staff here, you have to challenge your assumptions. all the time. So when you see somebody um you see somebody in a wheelchair and if people are really honest, there's an assumption that that person is less than. have to think about the future a little bit but you can worry yourself to death about are we going to have funding tomorrow are we gonna have people tomorrow and through the pandemic it just was so clear to me one day at a time daily bread today we've got enough for today and every day was that way and I think that when you're a marathon runner it's one step at a time um you might be thinking about okay yes I'm going to finish but you know if you get too focused on the end you're not pacing yourself in the moment for me the there is so much work to be more efficient, uh, and make a big bigger difference." And if we could just talk to the people that are listening right now, what's one thing anyone listening can do today to just make sure they they make their own community more inclusive? Be kind. Just be kind. And I think when you're like a dog, when their hackles go up, people are not doing it enough um and in a world of where we already feel separated right like just be kind to one another we don't know what someone else is going through you know just be kind to one another um so I love that you mentioned be kind so easy but yet so hard it's yeah it's it's a it's a leap sometimes to to just and I think that you know for the last five, six years that we went through so much, so many things, maybe even 10. And I wrestled at times like what can I really do to make a difference? And you really think about, well, I could I could love more. Michelle, that um you know, the blind question that we love to have. You spent decades fighting for others, but what's one moment when someone actually had to fight for you? And how did that change the way you actually lead today? Oo. Well, I think that there have been times here that have been very challenging and I can think of some some people who and again parents or people we support who have when I have thought I can't do this one more day have come and said thank mean, what a way to really start this off, huh, Michelle? Thank you for having me today. I appreciate it. Absolutely. Um, you get into this space. You moved to Alaska in 1984 for what you thought might be just a gap year. What happened that turned into a 41-year mission? What was the moment you realized I could actually make a difference here? I was up here on vacation in in ' 84 and the expansiveness of Alaska just called to me and I was living in California at the time and you're one of many in California and I just felt like I felt called to be here and just felt like you know maybe maybe here I need to be here to make a difference. So it was on that vacation that it it just felt right. ever planned. I had not had experience with people with disabilities, but I felt called to go and I thought, you know, new experience. So I drove out to California in this little Toyota Silica that the oil rings were shot. I mean, it was one of those moments where you're like, what am I doing? But I fell in love with the work. I fell in love with the people and realized that within that mountains. Governor's wife went to the governor and said, "This is wrong." And from that, a a TERA option was born for parents to get an option to be able to maintain their income, their jobs, and get a waiver for their child to continue to live with them. And it changed the trajectory of family life for Alaskans with disabilities. where you're like, I can't do this anymore. And a par a parent would come to me and say, thank God you're still there because you know my child, you know their history. And that has become a passion for many of us that we hold the histories of the people that we support. So it matters that we stay just filling your cup every day by just showing up and doing the things that you love. Like those are some amazing things. And can we talk about this the art studio? One of the things that you So, I'm guessing you're not a plant person. Well, I love plants and and actually I shouldn't say that. I I I do take care of them, but I was given that as a thank you for uh an organization that was using a space and through the years it has grown and has, you know, these beautiful red flowers and it's a little bit of Hawaii in my office in a dark day in Alaska. It's lovely. service. So even with a government shutdown, we will be okay. But I think the the challenge is that many families don't want to go through all the hoops to get the level of funding, but they still need the support. So we're always looking for creative ways to support people without necessarily having to do the Medicaid path, but if you have an organization that has a culture and you keep teaching that culture to the next generation, then it extends on for decades. You be there for life. What does a a day-to-day look like, services, programs? When someone walks into the organization, Yeah. Uh we we talked a little bit earlier as you're continuing to scale and grow. We talked about a little bit of AI. You you mentioned, hey, good job on the note takingaking and I I had to say no, it wasn't me. It was a little AI. We had a noteaker and on on a discovery call, but where does AI playing a a factor now as you guys continue to grow? Is that something that you guys are kind of, you know, maybe dipping your toe in? Do you see a benefit on AI as you continue to grow and move into even more counties? Seriously, we appreciate you. Yeah. No, 100% agree. I I think there's a fear. I mean, right, something new, so it's kind of getting uncomfortable again with something that we don't know. But I love it. And especially in this space we talk about AI in homes. I've seen that as well where it remind you know someone They can't they can't ambulate. So somehow that makes them less. And there are brilliant people that use a wheelchair as a tool for ambulation. There are brilliant people that can't traditionally speak. you think about um so many people that we're we're aware of that have challenged the what disability looks like and what ability looks like and anytime you go to like um after the Olympics and the parolympics the the done. Someone say, "Well, are you going to retire?" I'm like, "I I my list is too long." And it's and I still am energized by the work. So, I think as long as people are energized by the work and and they're still passionate about making the difference, um, and every day we get up and we try, you know, you just we're gonna we're going to keep running. you know, immediately when you react to something, just back off and say, "Do I really know that person? Am I reacting in anger? And is that anger going to help me in the moment?" There is so many and I have to challenge myself every day because there's stuff that happens my hackles go up and I'm like wait a minute. What is that going to do to give you more energy or more more opportunities? So I think that all of us Yeah, I could love more and and maybe that would would help. But if everybody said that, well, I could love more. Yeah, there's so many things that you can do that are just so easy. I actually was talking to a neighbor recently and um he says at work people always think that he's this angry mean person really because of facial expressions and the way that he just walks around and he's not that you know and at one point in my life people used to say that too like god you're here or that we see what you bring to this this job and thank God you're still here. So I think there are a number of people at different moments that have stood up for me. I have always been one to speak up sometimes to my own detriment like that's wrong and um and I could teach because it was an opportunity to uh provide recreation programs and residential programs where you're constantly teaching, you're teaching cooking, you're teaching um navigating social skills and advocacy and all those things. So, it it's really been a nice blend to think about how you can be a teacher and a coach and a mentor within the disability space and just see people for who they are. I love this. We kind of started off. We talked about how families used to have to actually choose between parenting their child or getting support. What changed that and what role did you play in that shift? Well, we have a wonderful organization here in Alaska called the Key Coalition of Alaska. And it's a coalition made up of people with disabilities, their families, their supporters, providers, and we go to Juno, the Capitol, every year to advocate with legislators. And there was a year because in the uh for How does that make you feel? Right. You you you leave home, come to Alaska, and then this opportunity happens because you decided to have faith, take risk. What is the feelings inside as you're seeing this kind of progress? Well, I think you realize you're always all of us, no matter what passion we choose, we're we're part of something far bigger than just us. But to be part of something that is moving the mountain um step by step, I think gives you purpose and meaning and a sense of amazing fulfillment. I love that. I love the space that you're in and that you've given your life to to chase purpose and passion as I always say and not so much that paycheck and you've you've seen the shift right to to be able to integrate what's been the biggest mindset shift that had to to happen you think well I think that you know with people that experience disabilities for for so many years and even today we're still fighting that battle that people are less than and I think that moving and in Alaska, I think particularly for many years, we were at the top of the leaderboard just moving some of the things where you see people in the mentioned to me that was also fascinating. What does that space represent for both um individuals served as well as the community watching? You know, it's interesting you ask that because next week there's going to be a a focus and a and a a portion of film where the Arts and Humanities Council in Alaska is looking at how art impacts the community and they're coming to our studio. So, we've had several staff who've are artists themselves and have a passion for that and they collaborated with uh other artists in other states who have been doing this in the disability space. But recognizing that everyone has gifts and talents has really given us an opportunity to bring people into an art studio and just let them create. So we have people that love to just draw and others that paint and others that um maybe are are more textile and like to sew and things like that. So we don't come in and have them say, "Well, today we're going to be making birdhouses." It's not that kind of studio. It's you come in, here are all the supplies, what do you want to do? And at the end of the day, there may be a creation of an art piece that has eight different artists that had a a play in that piece of art. And the art I love it. I'm I am now that person that likes to give plants and um as weird as it may be for some people to receive a plant that doesn't like plants, I I just feel there's so much life into it. And I can imagine that you've kind of being watering it and really seeing it bloom just kind of bring some light into what you're doing as well, right? What happens when you continue to pour into others and see that success happen, that ROI in a sense. Exactly. Um, so you could really kind of see life play out in that sense. So I love that you're taking care of it. And how long have you had it? I think five years at this point. What? That's good time. Yes. Kudos to you. Not everyone could keep up plans for that long. Um, let's talk about it. looking for grants, looking for opportunities. In the summer, we were able to provide some scholarships for kids um to come to camp without the traditional funding and they just had so much joy and so much opportunity to connect with others and that's where philanthropic dollars can be so beneficial. How big is the organization for those that may not really understand how it's huge organization? I think you have um is it 14 assisted living or is that where you started? I can't remember. Well, that was early on. Yeah, we have um 70 I think across the state. Wow. Statewide, right? Yeah, we're in six regions of the state. Um we we employ about Well, it varies, you know, depending on the week between 450 and 500 people and support about that many as well. Wow. What do you think got you guys there? Just consistency. Just what does it take? A good team? Well, I think if you're doing good work, the the we started in Anchorage. We didn't go into any region of the state until we were invited. So, a family might hear, oh, it's so individual. So, uh we provide a variety of programs. We have residential support. So, somebody says, "Hey, I want to I want to have my own home. I want to move out of my parents' home." Um but what does that look like for you? Is that an individual apartment? Is that shared living um in an apartment or a single family home? Somebody says, "Hey, I just want to get out in the community. I want to stay with my parents or I've already got residential supports what I need but I I want to come to the studio because I think that's really cool. So we have recreation programs, we have the studio, we have uh behavioral health supports. We support a number of people that are on the autism spectrum. We have a mental health clinic for those that need that level of support. And that's open to the community, but it's heavily supporting people that are duly diagnosed. So people that have mental health challenges and maybe also have an intellectual disability. Then we have intentional communities. So we've had parent groups that have come together and said, "I want to know where my kids going to live after I die." And we've developed a beautiful intentional community in the Kenai Peninsula. And then north of Anchorage, we have what's called the Willow Ranch. four men live Yeah. Well, I think that AI can provide, you know, a lot of systems things within uh an organization just to make, you know, for instance, you create a new job and you have AI design the job description. I mean, it just cuts down the work um that you might personally invest and get a get a draft. Now, we have touched our toe um several times in just smart homes. Uh so that's AI in a that there's something in the microwave or the stove was left on or you know to turn off the lights or different things that I I hear in the in the space of AI and I think it's just pretty cool. It um I love that smart tech is is making big independent strides I would say. What's the most exciting shift you've seen recently though in terms of utilizing AI or just technology in general? Well, I think that there are so many apps that are available to people that we support to be able to self-direct and not have staff or their parents being tell telling them what to do and very tech-savvy uh people with disabilities that have taught me how to use things where you think about, oh, somebody with a developmental disability can't use technology, but oh my goodness, we have people that are not traditionally verbal that can whip out an iPad and and do so many things. Um I think that um technology also is helping people with orthopedic and and ambulation and there's just so much good that will come if we're careful and we use it well. athletes that challenge what disability looks like is just amazing to me. So again, challenge assumptions. When you see somebody that um and and we're working with law enforcement on that, you know, if somebody is not responding to you, doesn't mean they're they're being obstinate. They may have autism. They may have a mental health challenge. They may be deaf. So, um working with law enforcement to think about are you thinking about all of those things in that moment where you might be trying to intervene with somebody. And that's something that we all need to do is not just accept on face value, but to think about what might be really going on with that person. Yeah. I I I love it. I love that you've been in the space for so long and and you just continue to I would say change the way that people believe and think, right? That's the biggest thing is that mindset shift for others because if you don't experience it, if you've never seen it in person, it is so easy as you may you mentioned to make judgment, right? Cuz someone's in that wheelchair and you think they're less than. Um, and you've said it's a marathon with sprints, you know, this type of work. What keeps you running and what's your what's your vision for the next chapter? You know, I have always been uh let's live one day at a time. There's enough I mean anytime you're in a business you You just got to do that, right? You just got to try. Just never give up. That's really uh what life is about is every day you get to the blessing to to wake up, see another day of life. You just got to try. Yeah. You know, tomorrow could be a different day. Tomorrow could it be all um you know, either up or down, but if you don't try, you never know. After 40 years of of impact, long time, four decades, what's filled your cup the most, do you think? Oh, that's a really deep question really because I think that there there's this the opportunity to share this passion with people. I have really appreciated the people we support, their families, their tenacity, their gifts and talents and the staff that work here and throughout the state of Alaska, the people that share this passion. I think surrounding myself with people that bring light to the world has kept me going. And I think when you have that shared light, you just lift each other up. can do so much to bring the temperature down by being just kind and challenging our assumptions that that person in front of us is is out to get us personally or they just don't understand who we are. Be kind. It's funny you say that. I've been in Boston now for a couple days and um I'm like why people are not kind. Like it's just so weird. I don't know if it's the code or what it is, but I I walked into a store and um I was just very taken aback by I'm a very kind person. I talk to anybody and everybody and uh I walked to the store, I register and this person like I said, "Hey, this barcode is not working." She didn't she didn't say one word to me like she just took it. She looked at her, you know, her little iPad. She scanned it or put her words in and never said anything. Just handed it back to me and that's it. And I'm Thank you. Right in English. Um, I guess. Okay. Well, I say it in Spanish. Gracias. And nothing. And I'm seeing her like it's it truly doesn't take that much to just be kind. Yeah. Just a welcome, right? Hey, sorry about that. Like it it doesn't take a lot of work to be kind. It truly makes somebody's day better, right? because man you come across very you know angry and um I was like I told my neighbor I said you just got to smile more it does it actually you take more muscles to make a frown than it is to actually smile and he's like oh so you think I don't smile like clearly you don't right and it's just those simple things that really make people either approach you or not approach you, right? And as leaders, Michelle, you can only imagine that you have to be on at all times because we want people to come to us with their problems um so we could try to help them resolve these problems. As as a leader, what are some of the lessons that you thought you've had to learn through this journey that really allowed you to be who you are today, whether it's good or bad, you know, from because we always learn from leaders, good and bad. What are some of those things? Well, I think for me I I again collaboration is really important to me and always thinking about if you are a really good leader, you are developing the next generation. You are bringing out the gifts and talents of others. I think about um a conductor of an orchestra is the person who does not play one instrument. people have accepted that and when others have reacted to my standing up they have stood beside me to say thank God you said something. So I appreciate that. Yeah. And it's it's um I'm like you. I if something's wrong I'm going to call it out. And and it could be hard because you be you sometimes you look like the disgruntled employee but it's no. I have a passion for what I do. So, I love that you're that leader that stands up, you know, and calls it out when it when it's actually wrong. Not a lot of people can actually do that or respect that. So, I respect that from you. Where could people find more information about the organization? Maybe they wanted to read more about what you guys are doing, service programs. And are you on LinkedIn if someone wants just wants to reach out? I am on LinkedIn. I'm I'm terrible about social media. Just just say that. So, I'm I'm there because you're supposed to be there, but you know. Yeah. Um but yes, you could do that. Um our website is www.hopalaska.org. It's a robust website. Has a all of our programs and um information about hope and ways to get in contact. So if community working and you saw uh people with friends, you know, hanging out and you happen to have a disability, the schools were integrated and um it and it just again Alaska is a very diverse community and I think disability space was just one of the things we did to say you are equal and you are equal and you are equal and you have a voice and you have a gift and talent uh because there are many aspects of our world that people are working on those same aspects of of equality and inclusion and it's been wonderful to be part of that in the disability space here in Alaska. How long have you been in Alaska again? I might have 41 years. 41 years. And I asked that because you've told that you've had staff that stayed 20, 30, and even 41 years. What is the secret to actually keeping people that committed for that long? I mean it has to come to good leadership. Correct. Well, I think leadership is part of uh certainly part of it because you don't want to work for something. I think corporate culture has a lot to do with is gorgeous. It's just beautiful. And the idea is that that I can be identified as an artist and not as a person with a disability who happens to do art. that we did a beautiful installation at the local library and the uh senator Marowski came and the governor's wife came at the time and they were introduced as artists. There was nothing about disability and I think that that's that's the beauty of it for me is to be seen as contributing value and light to the world. Are you an artist yourself? you know, I hear Hope's doing some good things and they invited us to come into the region. Okay. And then what's your message to the next generation? I'm a big believer, right, that um it's not about us, it's about the next generation. And the work that you're doing, as you mentioned, at some point is going to be passed on. Um what's your message to the next generation of nonprofit or disability advocates who are just getting started? I think get rid of um self-will, self-righteousness. Okay. work to collaborate with others. You know, we talked about if we pull the branding down, we pulled the logos down. We all came together and we said, "This is how much money we have. Let's do the work together. Don't build silos. Break them down and realize that all of us working together can be more effective, then I went through the whole day like man like but was it me like you know so yeah be kind be kind as as easy as it is That music comes from everybody else's gifts and they have to know the people. They have to know the music. they have to know all the pieces and parts, but they're not making a sound. So, I think that that's something I've I've learned and am still learning about and really lifting lifting others up to shine. Um because sometimes you as a leader, you can like I want to control all the details. I want to make sure everything's great. You have to let people fail and fail forward. Um we all had to fall off our bikes before we learned how to balance. So, um, letting people fail with compassion and, yeah, an opportunity to learn from it because I really, when I, when I took over, I wanted to get rid of a feeling of a fear of failure. Um, that it's okay to mess up and then let's say, well, let's look at that like, how could we do better next time? I like to always say during those times where um where you failed, there's so much to really learn there, you know, like yeah, it was a loss, but there's so many lessons and we dwell too much on that loss. We don't see all the lessons that we really got from it. And sometimes easier said than done, right? We we've done this for years. You've done this for years, Michelle. There's still that times where you dwell in that, oh my god, how could I have done this? But in reality, what did I learn there's anybody listening that is in another state or place, it's like, "Oh my gosh, I'm navigating this and I need some help." please reach out because you know those of us that have walked that path already are happy to collaborate and help guide or if there's somebody listening to say what what did you say about intentional communities what does that mean I have a child and I want to think about that would be happy to dialogue I love that I love that Michelle we thank you so much for your time on a Friday today I don't know what what air but today's a Friday we're getting ready to wrap up our days what time is it in Alaska actually it's uh just about 10:30 oh you guys in the morning. So, it's 2:30 here in the afternoon. So, you're actually getting your day started as I'm kind of probably dueling dwindling down here. But, we appreciate your time as a CEO, as a leader that has given four decades to this work. Um, doesn't go unnoticed. I'm pretty sure so many people just value you and your leadership. So, we thank you guys. If you guys are still watching, make sure that you guys do like, subscribe, and comments. These are conversations that we love, real authentic um conversations, and there's so many leaders that want to get into this space, our young leaders. These are the type of conversations that we need to hear of leaders that have been doing this for decades and pouring their heart and soul into this. We thank you, Michelle, for being here. My name is Zrain. We'll catch you guys on the next one. Lers. from this? Right? And I'm a big believer. Uh it happened to me recently where I was so down on myself. I was feeling this knot in my chest and then I had to really kind of pick myself up and says, "But what did you learn Ephrain?" You know, and some people forget that part that it is completely okay to fail. Some of the best um successful people had to fail over and over and over before they became successful. So I love that you bring that up, Michelle. I leave you with this last question,

mg
guest
Michele Girault
Hope Community Resources

Michele Girault has spent 20 years building community health infrastructure across rural America.Her organization now serves 43,000 patients annually through 12 clinics in 4 states.She is a nationally recognized advocate for healthcare access and technology adoption in underserved communitie

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