Public Health Leader Profile: Joy Borjes on Leading Teams Through Change
July 15, 2024 | ASTHO Staff, Center for Health Care Strategies Staff
Introduction
As a child, Joy Borjes witnessed firsthand the power of state programs to improve the lives of those they serve: Joy’s parents received government support related to their disabilities, which inspired her to become a civil servant. “I grew up seeing that government services can make a difference, and I wanted to be a part of that,” she reflected. Now as part of the Texas Health and Human Services Commission (HHSC), Joy supports programs that impact the lives of more than 7.5 million Texans every month.
In 2022, after working in state government for more than 10 years, Joy was promoted to a new position as the associate commissioner for family health strategy in HHSC's family health services division and began leading a team working on women’s and children’s health initiatives. In this role, she oversees the coordination of programs within the women’s health portfolio, which includes family planning services and breast and cervical cancer services.
Across the country, healthcare policy at the state level is often complicated by evolving dynamics, changing demographics, and emerging needs; state public health leaders must navigate the confluence of relationships, policy, and change. With help from Joy’s leadership, the family health services division has celebrated several recent successes, including the impending release of a redesigned long-acting reversible contraceptive (LARC) toolkit, strengthened partnerships with external groups, and a 65% increase in funding through the Texas Legislature for the state family planning program in 2024.
To support some of these achievements, Joy and her HHSC colleagues joined the Contraception Access Learning Community (CALC), led by ASTHO in partnership with the Center for Health Care Strategies. The learning community offered an opportunity for dedicated staff time and external support to work on improving women’s health outcomes in the state.
This leadership profile highlights lessons from Joy’s nearly 12-year career working for the state, with a focus on her successes in advancing women’s health access through strategic oversight of the learning community workgroup.
About the Contraceptive Access Learning Community
ASTHO’s CALC includes six state workgroups with representatives from health agencies and their partners. Under the learning community, state workgroups receive support in navigating programmatic and policy issues related to contraception access with technical assistance support from ASTHO. ASTHO supports state workgroups in developing individualized workplans and tailored strategies to accomplish goals focused on addressing gaps in contraceptive access and providing better care across the lifespan.
Leadership Lessons
Investing in Relationships
The learning community workgroup Joy pulled together included staff from the family health services division and Texas Medicaid, along with external advocates from the Texas Women’s Healthcare Coalition (TWHC), academic researchers, and others. For the workgroup to succeed, Joy knew the importance of cultivating relationships and fostering trust, especially with people she had not worked with before. “As we were coming together with our external partners, we had frank conversations with them about what our roles were, what our goals would be, and what capacity we had,” Joy shared.
The workgroup decided their first goal would be to redesign a 2018 provider toolkit that focused on increasing knowledge and effectively using LARCs. Redesigning the toolkit had long been a desire of the family health strategy team, but competing priorities prevented them from doing so without extra support. Because Joy had invested in building relationships with her workgroup members, she knew their expertise, passions, and priorities. Joy was able to explain the importance of redesigning the toolkit to the workgroup’s external members and increase their investment in this work. Through collaboration and with momentum and support from the learning community, the workgroup is nearing completion of the redesigned toolkit.
Key Takeaway
Successful collaboration requires both self-awareness and an understanding of others’ goals, pressures, and concerns. By proactively building common ground and relationship capital, especially in the context of cross-sector work, Joy was able to build a coalition capable of meeting this goal and future goals.
Motivating a Team Through Change
At the start of the learning community, HHSC underwent a reorganization of the commission’s client services programs, including Joy’s family health strategy team and the women’s health programs with which her team works. Simultaneously, Joy’s external partners restructured. This concurrent period of transition disrupted the work of the learning community workgroup, as members were focused on their own internal reorganization.
Leading the workgroup through these changes was difficult; the workgroup struggled with high staff turnover both at HHSC and within TWHC. The remaining members had limited work capacity, with many taking on work left by their previous colleagues. Through the restructuring and staff departures, the workgroup lost key experts and the priorities of the workgroup became unclear. In reflecting on this period, Joy shared, “I wish I had been more intentional about reaching out to our external partners in the learning community to explain what we were doing, instead of making assumptions that everyone knew. We struggled because of the change and lack of clarity.”
Throughout this period of uncertainty, Joy realized the power of leading with transparency and vulnerability. “There’s value in being vulnerable by acknowledging when work is difficult,” Joy reflected. “I don’t sugarcoat things, but even when things get tough, I’m still enthusiastic about the work we’re doing to serve Texans.” After a few months of reprioritization, Joy was able to reconvene and motivate the learning community workgroup to continue working toward its goals.
Key Takeaway
Acknowledging difficulty and insecurity can be uncomfortable, but doing so can help leaders maintain trust with their teams. Amid organizational changes, Joy’s focus on transparent communication, staying positive without unrealistic optimism, empathizing with workgroup members, and proactively focusing on controllable tasks helped her effectively navigate uncertain times.
Setting a Vision Through “Yes, and...”
Many leaders struggle to find time to plan strategically—it is easy to get tunnel vision, focusing only on the present. After the multi-organizational restructuring, Joy met with workgroup members to discuss new roles, responsibilities, and goals for the learning community. As the workgroup thought about their goals, Joy realized the potential to leverage the time and resources of the learning community to prepare for her other large focus: the 89th Texas legislative session starting in 2025.
The Texas Legislature convenes every two years to pass laws and make decisions that impact HHSC and other state agencies. For state officials, preparing for the biennial legislative session is a crucial part of their work. During the 88th legislative session in 2023, Joy partnered with HHSC’s family planning program leadership to request increased program funding. Together, they saw a 65% increase in funds allocated to the agency’s family planning programs.
Knowing that planning for the 2025 session would help both the family health services team and their partners, Joy leveraged the learning community to set a vision for the legislative session. She noted, “I wanted to make sure we were prepared for the next session instead of getting stuck with focusing only on the present one. The legislative cycle moves so fast. The 89th session will be here before we know it, and it only lasts 140 days. So, a little bit of planning—making sure the agency knows what our stakeholders will be advocating for, for instance—can go a long way in helping legislators make complicated policy and funding decisions.”
In developing a vision for the next legislative session, Joy encouraged the workgroup to collaborate in shaping their goals. She reflected, “In my interpersonal interactions, I’m a believer in the ‘yes, and’ approach, borrowed from improvisational theatre. Even in difficult moments, being able to say, ‘I see your point and here’s something I can do to build off of that idea,’ helped keep our team motivated and excited about the work.”
Key Takeaway
Vision serves as a guiding force that provides coherence and direction. Setting a clear vision helps teams define values, align on direction, and inspire working towards future goals. By taking a collaborative approach to setting the vision, Joy was able to recruit her workgroup members to get invested in and excited about their future work.
Closing
Joy’s approach to leading both the HHSC family health strategy team and the learning community workgroup highlights key lessons for public sector leaders. Under Joy’s leadership, the updated LARC toolkit will reach thousands of providers across the state, and the increase in funding the Texas Legislature provided will allow Joy and her partners to increase access to their family planning programs in 2024.
The successes of Joy’s team were driven by her approach to leadership. Joy invested in relationships by making time to talk with others in her field. She set the right goals for the right time by taking advantage of available resources and support. Finally, Joy embraced authenticity by leading with self-awareness and transparency.
This resource was developed as part of ASTHO’s Contraception Access Learning Community in partnership with the Center for Health Care Strategies and with support provided by Arnold Ventures. Its contents are solely the responsibility of the authors and ASTHO and do not necessarily represent the official views of Arnold Ventures.