Leadership Stories

Functioning on the Edge:
An interview with Sandra R. Edwardson

Dean, School of Nursing, University of Minnesota

"Building bridges between universities and communities is not something you do once and for all. It is a continual process. We have revisited our mission five times in the two and one-half years of our partnership. As we delve deeper, we find new areas we need to learn about and adjust to before we can move forward."

"I've said many times in the last few years that this is the hardest thing I've ever done." Sandra Edwardson's frank analysis of the work she and her colleagues at University of Minnesota's Nursing and Medical schools have undertaken illustrates many of the strengths she brings to her work. Because, although it is a concise, no-nonsense, direct statement of what she knows to be the truth, she speaks in a calm voice with quiet conviction. Difficult tasks, her voice suggests, are part of the territory for those who seek to build partnerships between communities and institutions.

For the last few years Dean Edwardson has been engaged in partnership building that requires collaboration from constituents with very different interests and agendas. How does she manage her responsibilities in this process? By understanding the internal context of the University of Minnesota and the forces at work in the larger environment -- especially in the community, in health professions education, and in the public policy realm that affect both.

"You've heard that saying, 'The trouble with the future is that it comes before you're ready for it.' I view my role as dean -- and in the project -- as sitting in the catbird seat, scanning in many directions so I can anticipate what is likely to happen in the future so we'll be ready for it," Edwardson says. "I need to make sure we're tuned into what is likely to happen next."

Scanning in many directions is one way Edwardson functions on the edge. Staying alert to the external environment, monitoring the needs of colleagues and communities, pursuing objectives in the face of potential criticism or conflict — all are dimensions of the kind of leadership necessary to build viable community-institutional partnerships.

Understanding the External Environment
"We are involved in a partnership between the academic health center and a low-income, very large neighborhood here in Minneapolis," Edwardson explains. "It is the most ethnically diverse neighborhood in the Twin Cities, and in a state that does not have a great deal of ethnic diversity. The neighborhood sits in the middle of major health care institutions — only a stone's throw from the medical center — but it has the poorest health statistics in the state.

"We saw the development of the Community-University Partnership in Education & Service project as an opportunity to address the needs of this neighborhood and give our students interdisciplinary experience working with an ethnically diverse population," she says.

But addressing community health issues and educating health professions students at the same time present philosophical and logistical challenges, Edwardson admits.

"We are trying to bring together several different cultures: the cultures of medicine and nursing, the cultures of the university and the community; and the various cultures within the neighborhood," she continues. "People from outside the university community are always incredulous when you say you need to bring together medicine and nursing. They are not aware that doctors and nurses and other health professionals are educated in distinct ways."

Understanding the many diverse communities within even a single neighborhood is a challenge from the university's perspective, Edwardson believes. To join these groups in a working partnership, leaders need to appreciate the interests and dynamics of each and be alert to ways to link differing perspectives around common interests.

"Within the community, we have African Americans, Native Americans, Hispanics, and a great many Asian groups," Edwardson says.

Cultural and language barriers exist between these groups, as they do in many communities. But if connections among groups are complicated and tenuous, the community's relationship with the university as an institution is equally complex.

"The University of Minnesota has a unique role in the community. It is looked up to and feared at the same time. It is the place you want to send your child as a student and, for many, a desirable employer. But it is also a large bureaucracy," admits Edwardson.

Finding ways to bridge these perceptions was part of the early work of partnership leaders.

"One thing we learned that the community is hoping for through this partnership is to improve the lot of their own children in relation to the university. They want their children to have the vision that they, too, could go to the university and become a health professional," she says.

Building on this desire and hope for the future has been one in a series of links drawing community and university interests into project goals and objectives.

"In the beginning, I felt we were moving three steps forward, two steps back," Edwardson recalls. "Now I think it's three forward and one back."
Edwardson points to a recent example: "We are beginning to implement in Minnesota something that is working well in El Paso -- the use of promatores or community health workers. As we have gone through the process of developing this activity, the community's primary interest is in improving the health status of people in their neighborhood. At the university, we are interested in improving health status, too. But we also need to work on creating a learning experience that will teach health professions students what they need to know.

"Bringing the two goals together is challenging and time-consuming," Edwardson acknowledges. Balancing competing interests, and handling the disappointment of one party or the irritation of another, is never easy. But it is a necessary and important part of the project's ongoing work.

Managing Without Controlling
"Building bridges between universities and communities is not something you do once and for all. It is a continual process. We have revisited our mission five times in the two and one-half years of our partnership. As we delve deeper, we find new areas we need to learn about and adjust to before we can move forward. We find ourselves saying, 'Oh, I didn't know you meant that . . .'

"It can be frustrating if someone's personal understanding of what we were doing turns out to be a little off-base. Fortunately, we have a community-dominated board. They call us on things, clarify, and ask for reinterpretations as we incorporate what we are learning in the work of the partnership."

Edwardson believes linkages within the University of Minnesota foster cooperative arrangements, too. "In the health sciences, we have a very close working relationship among the deans. For example, collaboratively we put in place major incentives to encourage interdisciplinary education and research. The University of Minnesota committed funds for start-up grants that would require faculty from at least two schools to collaborate.

"At that level," she emphasizes, "it is easy to talk about this process. The desire to collaborate is not an issue at the conceptual level. The challenges come at the nitty-gritty level. The structure of curricula, clinical and classroom schedules, accreditation requirements — these are the difficult issues. We have very different models in place for how we educate graduate learners. And, although most individuals see the value of interdisciplinary education once they have some experience with it, a few have yet to see the benefits."

These difficulties would be daunting to many. But Edwardson appears to take them in stride and speaks of the ups and downs of the work in a matter-of-fact way. At the same time she underplays her role in managing, preferring to focus on the roles others play in keeping the project abreast of changes and shifting directions when needed.

"We are fortunate to have an excellent staff and board. They function as the eyes and ears of both the community and the project. Because whenever I think I've got a grasp on things, something else comes up that surprises me," she laughs. "It reminds me of the airplane analogy Covey uses. He says that airplanes are off-course 90 percent of the time, but they reach their destinations for the most part. I've had to learn to roll with being off-course -- and, at times, with failure. I've had to say either, 'How can we fix this?' or 'What can we learn from it?'"

Edwardson's personal technique for functioning in a fluid environment is to extend and deepen her own ties with key groups.

"I cultivate and maintain connections as much as possible with the community, the literature, and state and national thinkers. Serving on boards and advisory groups -- including professional organizations -- keeps me in touch and allows me to share what we are doing with others."