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The Catalyst

Sandra HernandezBehind the scenes, Tufts School of Medicine graduate Sandra Hernandez is quietly transforming the health of San Francisco.


Deep in the heart of the city's financial district, where towers of glass and steel frame the early spring sky, the meeting on Bush Street is getting under way. The nine people seated around the table are a funky mix of Asian, black and white participants, all types and ages, from trim young women with sparkly earrings to sedate, older men graying at the temples. Laughter erupts frequently, zinging around the small, packed, sunny room. When people speak, they are focused and sharp as razors. Not a syllable is wasted.

At first glance you may not notice the Hispanic woman at the end of the table, with hands folded prayer-like at her lips, listening intently, now and then jotting a note on the yellow pad in front of her, always steering the talk to its implicit resolution. Her voice is unexpectedly low and warm, mellow as cabernet, but firm. She's a minimalist with a bit of an edge. "So," she says at one point, "what's our deadline for getting this out the door?" The answer comes from the staffer. "And are we good with that?" she persists. "Yes? Then let's do it."

Sandra Hernandez, M'84, has been CEO of the San Francisco Foundation (SFF) for the past 11 years and the driving force behind a thorough reinvigoration of the city's and the region's chief philanthropic enterprise. The SFF is a community foundation—meaning its funds come from multiple donors, unlike, say, the Ford Foundation—that distributes some $60 to 70 million annually to nearly 800 nonprofits throughout five counties in the Bay Area, in broad categories including community health and development, arts and culture, social justice, education and environment. Of the 650 community foundations in this country, the SFF ranks in the top 10 by size, with more than $1 billion in assets.

Hernandez arrived in her current post, a job normally reserved for white men bearing MBAs, by an unusual route. She is, first and last, a primary-care physician. She came west after medical school to pursue a residency at San Francisco General Hospital and stepped into the middle of the AIDS crisis. That immersion led her to assume a series of larger and larger roles in the city's Public Health Department, culminating in a three-year stint as public health director in the late 1990s.

"I kept pushing on the walls of what constitutes public health."

— Sandra Hernandez

"I kept pushing on the walls of what constitutes public health," she says now, moving her hands slowly apart. That ever-widening definition led her, almost by default, to her present role as CEO, a step back from the front lines of medicine, working the levers of influence to determine the well-being of entire communities.

The San Francisco Foundation was floundering when Hernandez took the reins in 1997, according to Warren Hellman, former chair of the board of trustees and the man who hired her. "The place was in considerable disarray," he says bluntly. Rapid turnover of staff, endemic sloppy accounting procedures and the loss of a major lawsuit that stripped away two-thirds of the foundation's assets had left the SFF teetering. Hernandez began the process of handpicking a staff with deep roots in community activism, ultimately assembling a crackerjack 50-member team that she knew she could count on. She also balanced the books and launched aggressive fund-raising efforts.

"Community foundations can be either community leaders or pass-through organizations," Hellman observes. "Sandra made the decision early on that we would take on a leadership role." Among the projects that Hernandez tackled at the start were a complete reorganization of the public park system in San Francisco and a systemic overhaul of the city's schools. The process was anything but snag-free, given the fractious tone of local politics. But his new CEO fared well in her first challenges, he says, navigating the rapids with aplomb.

Sandra Hernandez

A counselor and clients at Homeless Prenatal, an agency founded in 1989 with the help of a $52,000 grant from the San Francisco Foundation.

Almost in spite of herself ("I operate in very political arenas, but I don't consider myself political," is her Zen-like synopsis), Hernandez quickly enhanced her reputation as a player in local politics. Two years ago, when Mayor Gavin Newsom floated the idea of creating a health-care plan that would cover 82,000 uninsured residents in San Francisco at an estimated cost of $200 million, he first created a 40-member Universal Health Care Council comprising labor delegates, hospital administrators, public health advocates and business owners to hash out the details over a 125-day period.

Can you imagine the tension in the air during these proceedings? As one man who survived the process notes, "Everyone in the room had at least a veneer of good will, but really they were there to protect their own interests."

Mayor Newsom chose Hernandez to co-chair the group. She took a leave of absence from the SFF to take on the job. A newspaper story announcing the launch of the San Francisco Health Access Plan in June 2006 shows the mayor and his aides—and Hernandez, too—looking triumphant, almost giddy at the press conference, everybody half-dancing with glee. Newsom later called Hernandez's stewardship of the process "masterful." The plan, unique in the nation, had enrolled some 15,000 residents by late March, and was continuing to enroll them at a rate of 780 per week.

Most doctors see patients one at a time, and that's fine. For most doctors, the approach of improving the world's health person by person and case by case makes perfect sense. But for some others, like Sandra Hernandez, the problem of public health broadly construed feels too big, sprawling and urgent to be handled this way. Their instincts prompt them onto a larger stage. (continued)

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Profile written by Bruce Morgan, editor, Tufts Medicine

Photos by Melody Ko, University Photography

This story ran online on June 30, 2008. It originally appeared in the Spring 2008 issue of Tufts Medicine.