Coming Out Stronger: Navigating Challenges to Build a More Resilient Organization

Milken Institute Health continues to work with employers across sectors and industries to advance public health priorities. This interview series is part of the Employer Action Exchange, which highlights ways to accelerate turning evidence into action that impacts employees, communities, and businesses. Employers are a community and a critical contributor to advancing public health priorities that protect, support, and advance people, communities, and businesses.

In 2025, Executive Insights is focusing on how employers invest in mitigating risk and building resilience for employees, communities, and their business or mission.

Sabrina Spitaletta, senior director, Public Health at the Milken Institute, and Jonathan Melk, MD, CEO, Chiricahua Community Health Centers, sat down to discuss ways leadership within organizations can protect, support and advance people, communities, and businesses.

Give us an example of resiliency in the workplace (at the individual, business, and/or community level).

Resiliency in my workplace is grounded in the deepest of beliefs that all people deserve access to health care, and that our team has the ability and responsibility to provide for this human right. Resiliency thus forms the foundation of the purpose-driven life that I am proud to live, as well as the foundation of the impact-driven purpose of the organization I have the honor to lead.

One example of resiliency was Chiricahua’s ultra-rapid response to the COVID-19 pandemic in 2020. Ironically, prevention and primary care critical to the health of our patients could have come to a near-complete halt. However, thousands of our patients were caught mid-treatment, and all of the daily reasons to see one’s primary care provider continued despite the virus. In an act of near-heroic resiliency and, literally, within a few short days, we switched our model from nearly 100 percent in-person care to over 80 percent virtual care. This involved training hundreds of staff and thousands of our patients in the blink of an eye to embrace a system of care that was new to nearly everyone involved. This remarkably successful and rapid action protected the health of our patients, the needs of our communities, and the employment of our employees during a time of great uncertainty.

As a leader in your industry/sector, what risks do you currently face, and which ones do you anticipate facing in the future that impact your workforce, business, and surrounding community?

Chiricahua is a Federally Qualified Health Center. This means that we are a “safety-net,” not-for-profit community health center that accepts federal funding under the condition that we turn no person away based on their ability to pay. As the health outcomes of the borderlands region of Arizona are impacted by a combination of remote geography, borderland stigma, poverty, and economic stagnation, it would simply not be possible to provide the level of care we do without governmental investment. New and rapidly changing threats to this funding could dramatically decrease access to health care in our region—threatening health gains, health-care worker employment, and local economies in which we invest.?

What actions can employers take to mitigate risk(s) that will protect their employees, businesses, and communities?

The Arizona/Mexico border is a land of strong opinions. In fact, it seems as if everyone everywhere has a strong opinion about the border region where Chiricahua conducts its work. In this polarizing environment, one long-standing example of how Chiricahua mitigates risk to both employees and patients is through the adoption of an apolitical stance that not only seeks to prioritize primary care to all people, but also to collaborate with any and all regional stakeholders (to include such diverse organizations as the US Customs and Border Protection, hospitals, elected officials, local governments, schools, and others). With this collaborative and non-judgmental posture, Chiricahua is seen as a critical player in solutions to innumerable community challenges and opportunities, providing us the opportunity to impact health far beyond the clinic exam room.

Could you share an example from your career journey where you prioritized or tapped into your resiliency? And what did that look like?

For years, I have diligently incorporated the principles of public health into the practice of primary health care. Under my leadership, Chiricahua has enthusiastically implemented innovative systems of community outreach, data-driven quality outcomes, and evidence-based prevention strategies in primary care. Diligent efforts were made to receive payment for these services, and I ultimately chose to “do the right thing” even when the cost was not recoverable.

However, this past year it became apparent that my public health mindset was not compatible with a financially sustainable organization. Thus, my colleagues and I have had to dig deep into our own resiliency to adapt the organization to the payment realities of the current US health care system that, in general, values illness over health. Highly effective but expensive mobile health care clinics have been curtailed, immunizations have been limited to our patients, and visit times reduced so that more patients can be seen. These and other changes have ranged from uncomfortable to painful and have challenged the commitment and demeanor of otherwise reasonable professionals.

Nonetheless, the resilience of the organization is emerging even as we “right-size” and “right-purpose” our day-to-day strategies to provide health care to more than 35,000 people. What’s more, rather than disappear, Chiricahua’s vision of “Health for All” will mature in the founding of a new supporting foundation that will underwrite critical but unbillable activities, such as domestic violence prevention and health outreach to underserved populations. Ultimately, both despite and due to the painful process of change, the organization is emerging stronger and more capable than ever.