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Best Practices in Health Services Integration: A Case Study
Arnie Jennerman, CPA, MBADanielle Oakley, PhDGerald Ryan, MD
Sarah Van Orman, MD, MMM
The presenters have NO actual or potential conflict of interest in relation to this educational activity or presentation
“It is no longer enough for health workers to be
professional. In the current global climate,
health workers also need to be
interprofessional.” (WHO, 2010)
Core Competencies for Interprofessional Collaborative Practicehttp://www.aacn.nche.edu/education‐resources/IPECReport.pdf
Learning Objectives• List barriers to integration of medical, mental health,
prevention, and administrative support services within college health services.
• Compare and contrast several aspects of professional culture between medical, mental health, prevention, and administrative professionals.
• Discuss the role of a public health approach as a framework for service integration.
• Describe the importance of administrative support services in service integration.
• Describe several devices and programs which can be used within an integrated health services.
Barr’s (1998) three types of professional competencies 2011 American Association of Colleges of Nursing, American Association of Colleges of Osteopathic Medicine, American Association of Colleges of Pharmacy, American Dental Education Association, Association of American Medical Colleges, and Association of Schools of Public Health.
Collaborative Competencies
Common Competencies
Individual Professional
Competencies: Complementary
Healthcare Competencies
Levels or Bands of Collaboration‐CJPeek (2005)
Evolution of University Health Services 1. Minimal Collaboration2. Basic Collaboration from a Distance3. Basic Collaboration On‐site4. Close Collaboration in a Partially‐Integrated System5. Close Collaboration in a Fully‐Integrated System
Level 1‐Minimal Collaboration (1900’s‐1992)
Counseling & Consultation Services separate in location and function from the rest of Health Services (Medical). Prevention Services minimal. Administrative support local.
– Staff from others services unknown to one another– Referrals rare– Separate record keeping systems– Cultures viewed as alien
Level 2‐ Basic Collaboration from a Distance
(1992‐2008)Counseling Services merged with Health Service (Medical). Prevention unit formed. Shared Administrative Services created. Separate locations.
– Increased recognition as part of same organization
– More opportunity for referrals– Collision of cultures– Everyone felt misunderstood
UHS Organizational ChartChancellor
Vice Chancellor for Finance and
Administration
Executive Director
Director of Clinical Services
Director of Counseling and
Consultation Services
Director of Prevention
Director of Administrative
Services
Student Relations
Level 3‐Basic Collaboration On‐site
Recognized as necessary in 2008 when Counseling, Prevention, Administration and Clinical(medical) Services were slated for co‐location• Clinical and operational need existed with opportunity to
change– Severity and prevalence of mental health increasing and impacting medical/prevention services
– Unmet campus health prevention needs– New Shared Clinical Information System‐Summer, 2008– New senior leadership with focus on integration
End Results of IntegrationAbsorption
Preservation
Best of Both
Reverse Merger
Transformation
Degree of Cha
nge in Acquired Group
Low High
Degree of Change in Acquiring Group Low High
Key Considerations1. Mission2. Strategy3. Communication4. Organizational Structure5. Fiscal6. Cultural7. Professional8. Personnel9. Transition Management
1. Interdisciplinary work groups
2. Integrated Services3. Public Health Model4. Leadership Teams 5. Strategic Planning6. Advance UHS Brand
Organizational/Administrative Barriers
• Professional Cultures• Healthcare versus Campus Culture• Role Perception Individual vs. Team Affiliation• Embrace the Mission‐”Why are we here?”• Engagement and Customer Service• Professional Development
• Improving Administrative Responsiveness
Professional Culture• Professional Culture‐ values, beliefs, attitudes, customs and behaviors
• Historical in origin‐driven by education and socialization
• Manifests as values, problem‐solving approaches and language/jargon
• Interacts with personal and organizational culture
Office Photos
Professional CultureValues• Mental Health‐confidentiality• Medical‐continuity and integration of health care services, individual patient needs
• Prevention‐speaking truth to power, population health
• Administration‐Customer service, fiduciary responsibility and risk reduction
Professional CultureProblem Solving Approaches• Medical‐”see one, do one, teach one”• Mental Health‐context is everything; relational models
• Prevention‐logic models for policies, systems, environmental change; progress is measured over years.
• Administration‐policies, cost‐benefit models
Professional Culture
Jargon/Language• Patient• Client• Student population• Customer
THE CLOSED TOE SHOE DEBATES
OD6
Slide 34
OD6 Oakley, Danielle, 5/19/2014
Key Considerations and Activities1. Mission2. Strategy3. Communication4. Organizational Structure5. Fiscal6. Cultural7. Professional8. Personnel9. Transition Management
1. Interdisciplinary work groups
2. Integrated Services3. Public Health Model4. Leadership Teams 5. Strategic Planning6. Advance UHS Brand
Level 3‐Basic Collaboration On‐site Key Activities
• New senior leaders in all position• Development of management team• Explicit discussion to prepare staff for move associated losses• Clinical Information System • SBIRT/Depression Screening in Medical Services• Expand Prevention Unit to include Campus Health Initiatives• Cross‐unit work teams‐Sexual Assault and Alcohol Workgroup• Social activities• Celebration of successes• Employee Survey
Level 3 ‐ Basic CollaborationChallenges
• Begin to appreciate others’ cultures • Recognition of others as colleagues• Opportunities for coordinated treatment planning• Services offered from a consultation framework• Increasing tension
• Prezi
On
Level 4 ‐ Key Activities• Access as service driver in medical and mental health • Initiatives related to integrated medical and mental health
services with measurable metrics‐Behavioral Health• Evaluation of governance, administrative services, and senior
leadership• Building of trust across medical, prevention, administration
and mental health disciplines from shared projects• Communications/Branding• Advancement of campus leadership on health initiatives and
first public health approaches in prevention‐alcohol through creation of the Prevention Plan
Level 4 Challenges of Close Collaboration in a
Partly ‐ Integrated System• Team care of patients/clients• Shared systems and facilities• Recognition that shared care has benefits• Turf wars emerge• Expectations unmet• Cultures clash
• Prezi
Level 5 ‐ Key Activities
• Additional organizational restructuring• Communication/Branding• Continued Public Health Approaches
– Suicide Prevention Grant– Wellness Initiative
• Quality Improvement Program
Level 5‐Close Collaboration in a Fully Integrated System
• All care providers see unique role played as part of a treatment team
• Serve as model of collaborative care for others• Collaboration yields better patient/client outcomes
UHS Organizational ChartChancellor
Vice Chancellor for Finance and
Administration
Executive Director
Director of Medical Services
Director of Mental Health Services
Director of Prevention and Campus Health
Initiatives
Director of Administrative
Services
Director of Environmental and Occupational Health
Director of Quality Student Relations
Lessons Learned
• It’s possible to never complete a merger• Honor the history and past successes• Make a compelling business case• Respect and work through professional cultural differences
• Minimal‐ but key‐ personnel changes when necessary
• Continued work is required