The engagement at the San Francisco Department of Public Health, Behavioral Health Services spanned three years — 2023 through 2026. Three years embedded. 8,000 employees in the broader department. More than 200 fellows trained across multiple cohorts of the Anti-Racism Leaders Fellowship. The California Medical Association recognized the engagement with its Cultural and Linguistic Competency & Implicit Bias Innovation Award, Overall Program. Those are the headline numbers. They are not what the engagement was actually about.
What the engagement was actually about: whether a public-health department under operational pressure, with a chronically thin equity infrastructure and a workforce that had seen multiple equity initiatives launch and fail, could build the institutional muscle to sustain anti-racism work past the next leadership transition.
What worked
Three things worked. First, the fellowship cohort model — sixteen weeks of structured curriculum, real-world case studies, accountability frameworks, and applied practice. Cohort size capped at numbers that allow real conversation. Multiple cohorts running in parallel means the program reaches scale without sacrificing depth.
Second, the integration with existing institutional rhythms. The fellowship was not a separate workstream. It was integrated with recruitment, performance review, and the policy revision process. Leadership development happened inside the systems leaders were already operating in.
Third, the deliberate succession planning. From the first cohort, we identified internal facilitators who would carry the program forward. By the end of year three, the program was running with internal facilitation. We were no longer in the room.
What was hard
The hardest part was operational pressure. Public health departments live in crisis cycles — overdose response, behavioral health emergencies, federal funding shifts. Equity work competes against urgent operational demand on calendar time, leadership attention, and budget. The engagement could not sit outside that pressure. It had to be designed to absorb it.
What is still operating
The fellowship is in its third internal cohort cycle. The findings from the climate assessment continue to inform recruitment policy. The senior leaders who participated remain accountable for the outcomes the engagement named. None of that is extraordinary in well-run institutional engagements. All of it is rare in equity work.
