Paula Wilson is chief executive at Valley Community Healthcare, a North Hollywood nonprofit that provides clinical and patient services to low-income, medically underserved residents. As a child, Wilson lived for a time in Sherman Oaks but spent her formative years in Lake Tahoe, Nev. What started out as a graphic design gig – she designed the Valley Community Healthcare logo – turned into a professional passion to help others. Valley Community Healthcare has locations in North Hollywood and North Hills, as well as a school-based clinic in Granada Hills. Wilson met with the Business Journal at her offices to discuss the challenges of fundraising, the looming doctor shortage and how her graphic design background has influenced her management skills. Title: Chief Executive Organization: Valley Community Healthcare Born: Berkeley Education: Bachelor’s at University of Puget Sound, California College of the Arts Most Influential People: Jane Goodall, Kahilil Gibran, Maya Angelou Career Turning Point: Watching my mother advance her career and lead an organization. Personal: Daughter of a musician. Hobbies: Ballroom dancing, hiking, learning to weave Question: What made you want to pursue a health care career? Answer: I came to this by a very roundabout way. I didn’t grow up wanting to be in health care; it wasn’t my dream. I was an artist, graphic designer, and I went to art school. I wanted to work in advertising and marketing. For about 10 years, I ran a graphic design business. I started out as a volunteer here. They asked me to help design their logo on some of the materials they use for fundraising, some marketing materials. I had a real affinity for the organization. How did that affinity develop? There was a friend of mine that was a patient here with HIV, and he was the one that connected me. He contracted HIV when he didn’t really know what it was, he was just continually sick. He somehow found the clinic. At that point (Valley Community) was this little hole-in-the-wall on Vineland and Burbank Boulevard. He got tested and was diagnosed, and ultimately over the course of the six years I knew him, he died. He was in the graphic design business, and that’s how I knew him. He was the one that said there was this really great community health center. I saw how they took care of him. I thought, oh, absolutely, I will do anything for this organization. That’s what got my heart. How does your graphic design background influence your work now? Design, at least commercial design, is all about communication. Whether it’s visual or written, I still incorporate that into the work I do. I redesigned the logo three or four years ago when we changed our name from clinic to healthcare. I’m always drawing stuff, trying to make a point with flip charts. There’s a lot of creativity in leadership. I haven’t put it aside. It’s always good to leave white space, room to allow things. It doesn’t detract from the main focus. That’s my analogy. I think some people call it breathing room – I just call it white space. The artist in me doesn’t like to control the plan. I like to collaborate. How would you describe your management style? I’m an open leader. I’m a real strategic thinker. I always try to look over the next hill and identify where the organization fits and where we need to go, and I try to communicate that back to others, to our staff. I’m pointing the direction, bringing the best resources and ideas and energies, and then letting our staff lead the way. We have almost 235 employees here. What do you consider the most important skill for running a nonprofit? People skills, and a good understanding of the financial bones of the organization, because that’s the heartbeat of the people. Then there’s finding the resources so people can do the work. As a leader of a nonprofit, you’re really drawn to the mission of the organization and that’s what gets me through a really hard day. I go upstairs and I walk through some of the waiting rooms and see the patients that we’re helping. That’s kind of what I didn’t like about advertising, because sometimes you have to work on widgets or things that aren’t really that important. Have you thought about switching to for-profit? No. I just really love this organization, I live in the community, I’m so blessed to have a job here and to be able to see our organization grow and staff that has been here longer than I have. There’s probably a dozen of us that have been here for 20 or more years. That really speaks to the organization. I call that group the ‘oldies but goodies.’ Have fundraising efforts become easier or harder? I came up through the fundraising ranks. I was the director of development for many years and that kind of segued into strategic marketing and planning. I think it’s very challenging in the San Fernando Valley because we have to compete with the west side and Hollywood, and the glitz and the glamor. We’re all used to that kind of caliber of fundraising, and if you’re not that kind of an organization or in that part of Los Angeles, it’s challenging. How about fundraising events? Right now we – the global “we” – are getting tired of events. It’s more and more challenging to get people to come to our events because the bar is set very, very high in Hollywood. You have to have the celebrity and the hotel and all that, and it’s very expensive. People are tired of doing that, and I’m hearing about non-events, or one-hour fundraising, like on your radio – they’re trying to make it in a smaller bite. Where is fundraising headed in the future? The key to fundraising has always been the connection, the one-on-one connection with relationships. For me, because I’ve been here for so long, I’ve developed a lot of relationships. For someone coming in new, I think that would be more of a challenge. (However) this organization has grown over the last year – we’ve doubled. At the heart of that was the Affordable Care Act. A lot of our fundraising efforts have focused on grant writing and of course federal funding. There isn’t really a lot of state funding, county, and then our private sector fundraising. Our private sector fundraising has been kind of flat. What’s the challenge on the private side? There’s a mindset that because we are receiving federal funding, that fills in all the gaps, and because we’re larger now, there must be funding coming from other places. We still need community support, we still need volunteers, funds for equipment and capital expansion, startup things. We used to be very tiny, and you could come in and see holes in the carpet. You could actually see that physical need. Right now, we don’t have that. We’re building, we’re redoing some of the space, but the need for more of our services is still huge. How about convincing people to donate? The other part that’s hard for us is if you’re talking to people in the hospital in terms of fundraising, we’re not seen as saving somebody’s life. We don’t have patients like in the hospital, coming in with a very serious accident. We prevent measles and strep throat and manage your diabetes. We’re not seen as saving lives. Down the line, we can get to our patients early enough and give them immunizations and the education; hopefully we can keep them out of the hospital. How does Valley Healthcare connect with businesses? There are many layers of that, but obviously fundraiser support, developing partnerships. Our board is made up of businesspeople. We’re always trying to engage the corporate world and find leaders and volunteers to serve and bring skills and expertise to the organization. What are your favorite stories about the organization? We hire, through our teen clinic, kids that are in high school. They work in our teen center, and I remember some of them. They’re grown and gone to college, and then all of a sudden 10 years later they knock on our door because they’re a nurse practitioner or a licensed professional and ask if we would hire them. I kind of feel like a mother bear, with people who have come back to the nest. How has the increase in minimum wage affected Valley Community? We had to bite that bullet. I think it was in 2016, we decided that we would get ahead of it, so we started ramping up the minimum wage staff that year. So then when we get to 2020, we would be at the rate we should be. It’s not just raising the minimum wage; it raises all of the other positions as well. If you’ve got somebody at $15 now and you’re bumping up the minimum wage, you have to adjust that as well. It has been very, very challenging. When we have to make decisions like that, it basically is taken out of patient care. It’s very hard for a nonprofit to do that and be competitive in the salary ranges that we have. You mentioned in the organization’s 2018 report that the current administration has thrown community health care centers some “curve balls.” What do you mean by that? First of all, I think community health is a bipartisan service. I felt through both the Republican and Democratic administrations, that there is that understanding. We are the safety net; we are desperately needed. We’re under threat to disappear. What’s happened recently, there are chips being taken away for programs that are “sensitive services,” there are initiatives under (President Donald) Trump that focus on the war on drugs, or opioid crisis and HIV elimination. I hope the administration puts funding behind that, because it’s all well and good to put your banner out, but unless you have the resources to address that in a different way or a larger way, just don’t talk. So in the short-term, what changes do you foresee? We’re right now doing our budget for next year, but we’re not anticipating any major changes. We’re also doing a strategic plan and we talk about strengths, weaknesses and threats, and under threats is “who knows where the politics of health care funding is going to go.” Beyond the minimum wage issue, what employment challenges are you facing? The thing that really keeps me up at night is the workforce shortage for clinicians. It’s real and it’s not going to go away for at least 10 years, because there are just not enough students in the pipeline to yield the number of doctors that the baby boomers are going to need. We’re trying to rethink how we provide care and not use the doctor’s time inefficiently. If that’s technology, if that’s having a team that does some of the work and the doctor comes in at the end, things like that. I think the face of a doctor’s visit is changing. What about telehealth? We haven’t ventured too far into telehealth. It’s very expensive. For a hospital that would be more appropriate, but that’s definitely in our strategic plan. Wearables that our patients can wear, they check vitals … communicating to your doctor via email, we’re thinking about doing telephone triage visits. All those are on our radar but none of them are reimbursable, so the old paradigm is you come in, you see your doctor, you get paid. If you don’t come in and you call your doctor, you don’t get paid. We’re stepping into the gray area; we call this a practice transformation. That’s the stuff we need funding for. We just recently got a grant from the W.M. Keck Foundation for $200,000 to fund just that kind of place, transforming a visit and making it easier, freeing up the doctor’s time that might not have been used to its greatest extent. How has the provision of HIV/AIDS services changed since you started in the 1980s? It’s a vital service and program we have right now. We call the HIV program Smart Health LA. We’re really trying to integrate a patient who is HIV positive into primary care and not isolate them. Back in the day, you had a standalone HIV center and everybody that went there, you knew, had HIV, and they were looking at a possible death sentence. Now it’s not looked at that way. There are drugs where you can manage your HIV, but you need a different type of primary care service because of that illness. We’ve expanded in providing mental health care, case management. We have an infectious disease specialist on staff. We’ve been part of the San Fernando Valley HIV Consortium for years. Are there any expansions or updates set to take place for Valley Community Healthcare? We’ve opened up a second site, we’ve doubled in the number of patients that we’ve seen. We’re about ready, come July 1, to take over the LA Valley College Student Health Center. We’ll run that and provide primary care, prevention and behavioral health services there. We’re entering our 50th anniversary next year, in 2020. That’s pretty big. Right now, we’re focused on developing our strategic plan, which we should have completed in July, and that will really map out the direction we’re going. I can tell you we’re going deep into behavioral health services, and we’re also going deeper in our maternal, child and adolescent programs. We’ve still got capacity for new patients, both here in North Hollywood and at our North Hills site, so we’re not necessarily looking to open any other sites. Once we take on LA Valley College, we’re not sure how that’s going to impact our organization in terms of capacity.