ENSAYO SOBRE SERVICIOS ESPECIFICOS A QUE SE APLICAN LAS NORMAS PARA ATESTIGUAR

Where several of the above-mentioned external factors had raised the possibility of obsolescence, members of the Minnesota AIDS Project sought to clarify the reasons for undertaking a wholesale change in the organization’s systemic approach. Supporting the rationale to change were two main subthemes concerning first, MAP’s justification for continuing to exist, and second, perspectives on how MAP should position itself both as a leader within the local HIV service sector and as an attractive destination for

consumers.

Board and staff considered one scenario that would envision a phased “sunset” period and closure of the organization, but members shared a consensus that MAP’s closure could potentially harm the local community by eliminating a longstanding provider of services to clients, destabilizing the local HIV services sector, and silencing a highly regarded voice for advocacy in the arena of state and federal policymaking. Thus, the rationale for change was justified as being essential for MAP’s continued survival.

Members shared a belief that the organization would cease to exist within a few years without fundamental restructuring to replace its declining government funding with other sources of revenue. For multiple interviewees, the notion of survival was therefore closely linked to sustainability or a self-sustaining income model. Staff member Amelia succinctly summed up this sentiment: “Sustainability. We absolutely cannot continue living on government grants.” Board member Audrey expanded on this reasoning, commenting, “The vision, or the goal of the change process is to bring MAP to a place where it has the income to be self-sustaining as a nonprofit. It expands your presence in the community market, which you serve. It helps bring better services to the community, it does all of those things under that umbrella, but… I honestly think it’s about not having to nickel and dime, and taking an opportunity that’s been presented by Affordable Care and Ryan White and all those kind of things.” Beyond the financial implication, the timeliness and urgency of the current change process also caught the attention of Ava, a longtime staff member with memories of previous strategic planning periods at MAP:

Well in some ways… it’s like, oh, we’re doing another strategic plan. You know.

I think this one, though, there’s a little more of an edge to it because the need is

HIV infections are gonna drop and health keeps improving. We kind of knew there was an end to services as we know them coming, but it wasn’t, it was on the horizon. Now it’s like… down the street. So there’s more urgency to figuring out what we’re gonna be.

Positioning the organization. Multiple documents and interview participants communicated a perception that MAP had been “the model” ASO locally for much of its past, to which other organizations look to guide their own decisions, service offerings, and positions on policy matters. Joined with the responsibility to establish a new, sustainable operating model for the organization was the sentiment that MAP’s changes were necessary for the viability of the broader local HIV service sector. Board member Amber explained:

I think we are seen as a leader in the AIDS service organization community, which is another interesting spot to be in. There’s a lot of pressure, I think, that goes along with that, a lot of eyes to see what we do next. But with that also comes power, and you have to try and leverage that in a good way. If you want to stay a leader, you have to stay on the changes and you also have to be a good partner to the other organizations in the community, too. It’s sort of an interesting spot to be in.

Board member Naomi linked this call to leadership with the aforementioned matter of organizational survival: “We will become obsolete if we don’t do something, so it’s getting out ahead of the curve, trying to do the strategic plan before the other ASOs and then stand at the front and say, ‘Here, we’ll help you. We’ll share our information.’”

During formal strategic planning in mid-2013, MAP’s senior leadership consulted with leaders representing a range of organizations and interests, both locally and from outside the state, to solicit feedback on its circumstances. These informants included

heads, local ASO leaders, and local infectious disease specialists. The perception of MAP as a sector leader both locally and regionally was shared by multiple informants, who stressed the need for a community-based nonprofit like MAP to stand as a model for other ASOs to emulate. This exhortation to lead came across most pointedly in conversations with the head of another local ASO, the notes from which included the following key statements: “MAP must take the lead, put the stake in the ground and move forward on the strategic plan. The community is waiting for MAP to take the lead; we have been waiting for the past decade.”

Key to this call for sector leadership, however, would be MAP’s need to clarify its own positioning with consumers as a service provider. Concerns that Board and staff members had raised in MAP’s initial strategic planning survey would be addressed more directly as members convened its strategic planning retreat in early 2013, with top concerns/questions including best models for treating people “facing barriers to

maintaining and accessing consistent care” and finding out more about the community’s current needs. Speaking to this issue of relevance, staff member Leo observed, “There’s not a lot of organizations that do specific things in HIV, and… we have not…

communicated to the community particularly well what we do and what our relevance is in the community.”

During strategic planning, MAP invited its clients and volunteers to participate in a series of focus groups addressing perceptions of MAP in the local community, reasons why people come to MAP for services, appraisals of the quality of MAP’s services, and

affected populations. Findings from these groups were characterized as differing largely by age and ethnicity of participants, with contrasts in how individuals perceived the organization’s length of service (“was around in the beginning” versus “dated appearances/concepts”), identification with HIV-affected communities (“visible presence/voice representing HIV issues” versus “not welcoming” or “less than

welcoming” for communities of color), and service value (“referral source for accurate information for newly infected people” versus “not in line with changes in the disease”).

Perceptions of MAP as dated and out of touch with some of its constituencies were echoed by Board member Wyatt, who cited the need for MAP to update its relevance to the HIV epidemic’s most affected populations at the current time: “I think everybody’s kind of been acknowledging that MAP needs to evolve, that we’ve kind of been the model, and… the model is… you know, great for 2002. We just have to figure out what it means for 2014.” Addressing the needs of consumer needs more directly, he added:

I think to better reflect the reality of the HIV marketplace, so to speak. You know, in the past, it was easy enough for MAP just to focus on condom distribution and syringes and kind of the traditional prevention efforts. Well, I think we’re kind of maxed out on much of that. It’s very important, but I would assume we’ve reached a plateau.

Thus, as members sought to better understand the current marketplace for MAP’s services, the organization’s emerging strategic vision attempted to capture and prioritize this positioning to meet consumers’ needs, with an emphasis on promoting access to healthcare and supportive services of high quality (including HIV testing and linkages to

with barriers to health care, heightened risks for acquiring or transmitting HIV, and quality of life; and attending to the emerging needs of aging PLWH.

Technological Considerations

Three themes concerning the technological changes considered by organization members emerged from the analysis: Measurable Outcomes, Opportunities, and Barriers.

Table 7 provides a summary of data sources for the thematic evidence presented below.

Table 7: Summary of data sources for Research Question 2

Theme Number of

As members moved to consider the possibilities for reorganizing MAP’s central focus and function as a service provider, the question of how to operationalize the organization’s influence on its clients’ health outcomes and on the health of the broader community arose at several stages. From the evidence collected, two main concerns emerged with respect to evaluating services’ worth and processes for gathering evidence to determine MAP’s effectiveness and value.