Shining a different light A report on the visit of Southcentral Foundation to … · 2015-10-29 · Report on the visit of Southcentral Foundation to NHS Fife/8+9 June 2010 3 The

Report on the visit of Southcentral Foundation to NHS Fife/8+9 June 2010 1

Shining a different light A report on the visit of Southcentral Foundation to NHS Fife

STEPHEN GALLAGHER says it was a “lightbulb moment” the first time he heard the team from Alaska‟s Southcentral Foundation speak about what they do. The Deputy Director of the Scottish Government Health Department, and head of the national Improvement and Support Team, spends his working life considering how NHSScotland can best equip itself to meet the considerable challenges it faces. Listening to the Alaskans was a revelation. “They turned the conventional thinking about how to achieve quality improvement in primary and community services on its head, by focusing on relationships and applying improvement science in that context,” he says. “Yes, they employed the theory – but based on a deep understanding of the communities they serve that brought true citizen buy-in. For me, what they had to say shone a different light on what we are grappling with.” Stephen‟s introduction to Southcentral Foundation came during an Institute of Healthcare Improvement conference in Berlin in early 2009. Little over a year later, he was instrumental in

bringing the North American team to Scotland to share their experience with our health system. “For a number of years now I have been conscious that our tools for continuous improvement have a strong acute sector appeal because of the high volume care processes and the availability of data there, yet landing improvement in the community and primary care is vital,” says Stephen. “The Alaskan experience shows how we might be able to approach improvement in a way that engages community-based clinicians and patients and recognises their care

context. This is important when considering shifting the balance of care and reducing unnecessary admissions and readmissions to hospital.” Over the course of five action-packed days in June, a four-person team from Southcentral Foundation (SCF) interacted with health professionals, care partners, patients and their families, members of the public and service managers from right across Scotland. Together, the SCF team (Chief Executive Officer Charles Clement, Medical Director Steve Tierney MD, Vice President of Organisational Development Michelle Tierney, and Employment and Recruitment Administrator April Kyle) addressed the NHSS annual conference in Edinburgh. They then went on to Fife to spend time working face-to-face with community teams there who are engaged in service redesign. The conversations the Alaskans took part in during their visit have inspired the Scottish participants, and set people thinking about how we might adapt some of their transforming principles to support the work that is already taking place to develop community-based care in this country. “In many ways what they had to say confirmed that our objectives are on-track, and that Scotland is heading in the right direction when it comes to mutuality and person-centred redesign,” says Stephen. “But they have also challenged us to consider whether there are other ways of approaching healthcare quality improvement in the community and with local government partners that might bring even greater benefits.” This report summarises the SCF story, and explores what happened when the Alaskan team came to Fife. During one-to-one interviews, some of the people who participated in those meetings later shared their reflections on what they heard. A few of their personal responses are also recounted here, and where permission has been granted, full versions of these will be included in an internet version of this report which will be published in due course.

Pictured above: The Southcentral Foundation team addresses NHS Fife


Report contents

Page 3 The Southcentral Foundation story Page 6 The NHS Fife perspective Page 7 - The Montrave Project event Page 8 - The West Fife Blether event Page 9 The NHS Fife response Page 10 In conclusion Page 11 Contact information Page 12 Appendix 1: The extra questions

Pictured above: Participants in the West Fife Blether event


The Southcentral Foundation story Around 20 years ago, the native Alaskan community realised that something had to be done about the desperate state of the healthcare system that operated there. People were waiting many weeks for appointments to see family doctors, A+E activity was going through the roof, and the health status of people was atrocious: few lived long enough to get old, and chronic illnesses such as diabetes and heart disease were rife. The native leaders decided to take their health system into their own control, and set about constructing a service that would meet the physical, spiritual and cultural needs of the Alaskan tribal peoples. They called it intentional design. They had the luxury of building their system from the ground up. The existing infrastructure was falling apart, and rather than rebuild what had been there before, they took a new look at what was needed and started again. First of all, they consulted the Alaskan people and developed a vision and a mission for their health system that then generated key points and clear operating principles by which it would work. The focus was to move from the traditional medical model of treating illness to promoting wellness, and there was to be a fundamental power shift. Basically, this was to be a service run for the best interests of patients, and not the professionals: the native Alaskan family structure was to be put firmly at the centre of all planning, and services were to be developed around that. Instead of deskilling people by telling them what to do and expecting them to do it, staff would support people to reach their own decisions about their health and its maintenance; native Alaskan culture would be respected, and holistic treatments offered alongside conventional approaches to care. The buildings where healthcare happened would be tailor-made to promote a positive experience, with three types of consulting rooms designed to put people at ease: places where physical examinations took place, others where individual and family conversations could be held, and sensitive information shared. Patients (termed „customer-owners‟) would be able to choose their personal doctor, who would work with a team of equals to deliver all the services that might be required, as much of it as possible sited under the same roof – from nursing and psychology to dentistry, social care and housing and even employment support. Customer-owners would build trusting, mutually-respectful relationships with their healthcare team, and be able to call on them any time they chose. It was a radical model that some said could not possibly work. Yet it did – and brilliantly. In just 10 years, the Alaska native-owned nonprofit healthcare system, known as Southcentral Foundation (SCF), had achieved a reduction of more than 40 per cent in A+E usage; a 50 per cent drop in referrals to specialists; a decrease in primary care visits by 20%; and a reduction of one third in hospital bed stays.

Pictured above: SCF’s April Kyle takes part in the West Fife Blether event


The quality of care has also risen sharply, overall health status has improved, and waiting lists are a thing of the past. Not only that, but patient satisfaction with the service they receive is running at well over 90 per cent, and staff satisfaction rates are similarly soaring. Southcentral Foundation serves a geographical area covering 150,000 square miles, and has a primary care population of 55,000, more than 10 per cent of whom are aged over 65. The organisation employs 1,400 people, and has its headquarters in Anchorage, Alaska‟s largest city. Its annual $150m operating budget comes from the State and insurance receipts. It operates a series of community-based primary care teams comprising a family doctor, supported by one or two physicians‟ assistants, a nurse and a care manager who is responsible for the co-ordination of an individual‟s care. Each team has an average customer-owner list of around 1,200 people, equally weighted for age and gender. As needs require team members can call on the services of other specialists, such as behaviour change experts who might support people to change their diet, stop smoking or take up exercise; midwives; nutritionists; pharmacists, etcetera… and all during the same consultation, if not face-to-face then by some form of telelink. The core team spends time ensuring that knowledge about customer-owners is shared among them, and good IT systems allow relevant information to be passed on as appropriate. If a patient is

admitted to hospital their family doctor will be notified by email immediately, allowing arrangements to be made to support their swift return home. Where possible, customer-owners have their questions and problems dealt with by telephone, and when appointments are arranged they are scheduled to last at least 15 minutes. Patients who need to see a member of their care team are allocated a slot on the same day. Customer-owners have

learned to trust the particular skills of individual team members. They no longer expect to consult a doctor at every visit, which eliminates a classic system bottle-neck and means that the members of a team can see and treat a large number of people at the same time. Teams are incentivised to make the most of each others‟ particular skills by being financially rewarded for collective efficiency,and the less organised are expected to keep on working until all the patients who need to see them that day are seen. Useful data is gathered to allow real-time comparison of each team‟s performance and satisfaction levels, which is shared throughout the organisation on a monthly basis to support continual improvement. At the very heart of the Southcentral Foundation model is the concept of relationships – between care providers and customer-owners, between the professionals themselves, and between the staff and the employing organisation.

Pictured above: Board Chairman Jim McGoldrick welcomes the SCF team to NHS Fife


A great deal of effort is put into the recruitment process to ensure that prospective employees, and their families, understand what‟s required of them. New recruits are put through their paces at interview to establish whether they possess the personal skills to walk the SCF talk. Staff induction is detailed and intensive: everyone has a week of orientation to learn about SCF and its processes and philosophy, as well as Alaska Native people and culture. And before they can take their place at reception, front desk personnel must undergo a further two weeks of training – followed by six months of mentoring. Basically, no-one is in any doubt that they have an important part to play in delivering and developing the SCF philosophy. Everyone benefits from ongoing training, and organisational development is employed in engaging and creative ways to continually develop the skills required to foster positive relationships. Each employee – from backroom folk to patient-facing personnel – is expected to follow quality improvement methodology, which is recognised as a whole-system responsibility, and not just the function of a few. When it comes to the direct care of customer-owners, clinicians are expected to get to know them very well. Doctors and nurses spent time at patients‟ homes, and learn to appreciate their individual family dynamics, which helps them to care for the whole person. Around two thirds of teams give out their personal contact details, and are available to take calls and respond to emails at any time. Alaska is mostly very remote and rural, and it has a hugely dispersed population, so electronic links are well used to avoid unnecessary travel to and from health centres. There are also networks of lay people who support the SCF clinicians by visiting vulnerable individuals and families in their own communities, and supporting them to stay well. SCF is continually touching base with the people it serves – using surveys, focus groups, mystery shoppers and advisory councils – to check that its ways of working are meeting local needs, and the resulting information is swiftly fed back to the service to drive ongoing improvement.

Pictured above: Following the NHS Fife visit, the SCF team met representatives of the Scottish Government


The NHS Fife perspective

NHS Fife is Scotland in microcosm when it comes to health profile. Sure, there are areas of relative affluence, where people generally stay well and live long and happy lives, but there are also many pockets of severe deprivation where prospects and outcomes are poor. In common with the country as a whole, the Kingdom‟s population is ageing fast. There are many more people than ever living with one or more long term conditions; incidence of dementia is on the rise, and the traditional models of providing care are coming under considerable strain. At the same time as the costs of meeting the needs of patients rise, so budgets are set to tighten. In Fife, as elsewhere, there is a growing realisation that if catastrophic care crunch is to be avoided, the way services are delivered will have to change. In Fife‟s communities, teams of clinicians, social care professionals and the voluntary sector have for some time been working closely together to try to anticipate and address the challenges associated with meeting the needs of patients and their carers. Locally, there is a strong desire to fulfil the ambitions of the national Healthcare Quality Strategy, and novel approaches to quality improvement are being actively explored. For instance, NHS Fife is using the innovative „Three Horizons‟ model (developed by the International Futures Forum) to explore pathways to service change which envisages a culture shift away from the traditional mechanistic throughput-obsessed approach to care towards one that fosters strong person-centred values. When the Scottish Government first floated the idea of facilitating a visit of the Alaskans to share what they have learned, NHS Fife leapt at the opportunity. A team submitted a bid to be the learning test bed for NHS Scotland, and their persuasive argument won the day. On 8 and 9 June this year, the Southcentral Foundation team spent their time with NHS Fife. They met senior managers and clinical leaders at a working dinner hosted by NHS Fife chairman, Professor Jim McGoldrick, and visited the Muiredge GP surgery in Methil to see how Primary Care operates there. Working with the Kirkcaldy Community Health Partnership, they joined a Montrave Project dialogue workshop that had been arranged to explore better ways of caring for people with dementia and frailty. And as guests of the Dunfermline and West Fife CHP, they took part in a day-long „Blether‟, a discussion about developing local intermediate care services. In all cases, the SCF team‟s involvement provoked a great deal of thought, and inspired participants to recognise the value of the important work they are engaged in.

Pictured above: The SCF team discusses intentional redesign with senior clinicians and social work staff over dinner in Fife


The Montrave Project event The Montrave Project is named after a ward at Cameron Hospital in Kirkcaldy that provided both medical and psychiatric care for older people with dementia and frailty, particularly when there were challenging behaviours. This has been temporarily closed because a service redesign pilot project within acute care has resulted in a significant reduction in admissions to the ward. The project is looking at how services need to be provided in the community to best support patients and carers, and the dialogue workshop was designed by the NHS Fife Organisational Development team to help

participants share their experiences of care in the past, and their hopes for the future.

On 8 June, in Cameron Hospital, members of hospital staff, community workers, voluntary organisation representatives, patients and their families sat in circles and listened as each group told their personal stories. One of the groups involved was the SCF team, who talked movingly about the experience of April‟s grandmother, an Alaska Native woman who had suffered a stroke. Her family doctor had been Steven

Tierney, who helped the family to come to terms with the consequences of the condition, and supported them to make the decisions necessary to support April‟s grandmother through the final stages of her life. The following day the workshop focused on what they wanted future care to look like for people with dementia in Fife: from the outputs it is clear that their deliberations were strongly influenced by what the workshop participants had heard from the Alaskan guests. The service aspirations that were expressed include:

A key person to help patients through their journey

Easily accessible services

Regular review to see that needs are being met

Psychological and emotional support for patients and carers

A change of staff attitudes to be open to suggestions and different ways of working

More trust

Inter-agency IT communication systems

Bureaucracy which facilitates, not creates barriers

Patient-held records

Improved care co-ordination and more training for carers

One-stop shop for support and advice

Care centred around the patient in their own home with good telecare and involvement

Services co-ordinated with the emphasis on physical, emotional, psychological and spiritual support

Better community involvement Summarising the impact of what they heard, the Montrave stakeholder group also made some telling comments:

- “I’m impressed that they look after people, not diseases” - “The personal experience between the health provider and the family – in my experience it’s

not like that”

- “I have that relationship already with my GP – it might be at least a bit along the same road” - “That’s how I would like my family to be cared for”

- “I love the idea of things based around relationship” - “The value of conversation that we have devalued, and the impact in relation to outcomes”

Pictured above: the SCF team taking part in the Montrave dialogue process


The West Fife Blether event The Dunfermline and West Fife CHP is well on the way to developing a new intermediate care model for the locality. The Blether, a café-style workshop held at The Vine, a popular local venue, on 9 June was a chance to bring together many of the folk involved in the redesign. Around 70 people, including community members, health staff, social care staff, representatives of privately-run care homes and health improvement workers gathered to celebrate progress and check their thinking against the Alaskans‟ experience. The participants heard two presentations then broke into groups: the output of the resultant Blethers, or conversations, illustrates the wealth of creative thinking that the SCF team inspired. Asked what they thought about the Alaskan story, people responded extremely positively:

- “It’s fantastic to see a system and a culture being customer led” - “NHS Fife should do the same – out with all of the old and start over again with the new”

- “Courageous. It’s great to see people able to admit their mistakes and allow the people to make the necessary changes”

There was recognition among the Blether participants that Alaska and Fife share some similarities in terms of approach, but that the local system could go a great deal further to promote the development of healthy relationships. Recommendations for action include:

Break down professional boundaries

Get families involved

Devolve decision-making

Limit hierarchy

Reduce the number of people involved in care and give clear guidance on who makes decisions

Eliminate duplication

Value employees Participants said they thought that there was potential in Fife for supporting people to take ownership of their own health, for reduced bureaucracy to allow staff more time to be focused on patients‟ needs, for greater flexibility to make changes as and when required, and for a culture change to boost public confidence in all staff and reduce reliance on GPs. It was observed that:

- “Clinically the NHS is very good but the relationship building is poor. It’s a very impersonal service we now have”

- “The Alaskan journey was long and difficult, but rather than just thinking and planning all the time they had the courage to start making changes and implementing new systems”

When it came to the local changes they‟d like to see in future, some participants cited:

High level of satisfaction and low level of hospital admissions

50 per cent of hospital services delivered in the community

Residents that believe in our community services

Customers in control of their healthcare, with staff used as a resource

Simplified services with greater co-location

No waiting lists In feedback, one Bletherer wrote:

- “I think we should take real inspiration from the Alaskan health service. They have achieved optimum healthcare for older people in about 10 years, where the NHS has failed to do so in 61! They seem to be much more proactive in their values, in decision-making and implementation”

Pictured above: SCF’s Michelle Tierney (right) blethering at the West Fife event


The NHS Fife response

Talking to the people who took part in the SCF events in Fife, it is evident that they have been energised by the experience. “It‟s time for positive change,” says Dr Margaret Hannah, NHS Fife‟s Deputy Director of Public Health. “We have a lot of the ingredients for success here, including the opportunities and the resources. The Alaskans couldn‟t believe how resource-rich we are in Scotland – we have highly-trained staff, and lots of them. What we‟ve got to do now is really change the way we work for the benefit of everyone.”

Margaret Whoriskey is a Clinical Psychologist with NHS Fife, and Assistant Director of the Scottish Government‟s Joint Improvement Team. “Everyone is going to have to step up to the mark – there are going to have to be difficult conversations about the problems we face, and this is a challenge for health,” she says. “Another big challenge in our system is the engagement of leaders in the softer stuff. Co-production and mutuality will mean that organisations have to organically develop and evolve. Strategic leadership has to become more touchy-feely.”

For Kirkcaldy CHP manager Fiona Mackenzie, the Alaskan experience shows Scotland where it has to go. “We are beginning to see person-centredness and patient involvement, but we are still too controlling, paternal/maternal, and professional - that‟s a big barrier to change,” she says. “We are very disease focused, and can believe that‟s what people want treated – but it‟s time to pull back, to take stock. Personally, the Alaskans have given me further strength within my own organisation not to perpetuate that model.”

The Fife Organisational Development team was very impressed with the Alaskans‟ whole way of working, and they were particularly encouraged to know that they employ the same dialogue processes. “Using dialogue at induction, as the Alaskans do, is a great idea,” says NHS Fife OD consultant Nicola Harkins. “It emphasises the ethos of the organisation and ensures that as people are brought in they understand „this is how we work, how we build relationships‟. The sooner that‟s explained the easier it is for people, and the better it is for the organisation and most importantly for patients and carers.” Social Work team manager Heather Ford is clear that the balance of care has to shift from hospital into the community. “The Alaskans came here at the right time,” she says. “There is a realisation that change is going to happen: you can‟t hide from it. But how to do it? I think it‟s about putting it back out to people and giving them ownership. The Alaskans are proud of it – they had the budget, the autonomy, and had to make it work.” Nurse Karen Adams, Montrave ward manager, has worked in hospitals throughout her career, but now sees the future as community-based. “People are hospitalised if they have social needs; if their family is in crisis or their spouse dies – but we know that hospital is not a good place for them to be, and we need to keep them at home if we can,” she says. “The Alaskans brought all that to the foreground for me. They made me more aware and hungry to do something about it.” Dr Swapan Mukherjee is a Buckhaven GP who is already planning to make changes to the way he works as a result of meeting the SCF team. “While he was here the Alaskan GP, Steve, received a text from a patient back home and he replied immediately. I thought that was so nice. I‟m thinking about introducing that system here,” he says. For community nurse Tracey Henderson, greater recognition of the value of non-medical interventions, such as social support would be a breakthrough. “We feel guilty if we chum someone to the bingo or the dancing, even though that makes them feel better, and we tend to keep quiet about it in case someone says „they‟ve clearly not got enough to do‟,” she says. “The SCF talking about taking people berry-picking was endorsement for me.”

Pictured above: Dr Margaret Hannah feeds back on the SCF visit to NHS Fife


In conclusion The energy around designing care in line with the Alaskan model is tangible across NHS Fife. The SCF‟s messages concerning family wellness, shared responsibility and quality are now being actively discussed to see how they could work in a Scottish context. The use of the term „customer owner‟ might seem strange here, but a mutual NHS is in some ways equivalent: the Alaskans have a Native Board, while NHS Fife has recently welcomed directly-elected Board members.

In Fife, the emphasis on relationships as an essential component to achieving a transformation in healthcare has already begun, with OD work using dialogue. What is needed, perhaps, is more emphasis on intentional design – ensuring that every aspect of the service mirrors the values and aspirations of Fife‟s customer owners. The Alaskans have demonstrated that a values approach, based on high-quality relationships really does work. The Alaskan experience has confirmed to those who met the SCF team in Fife that a transformative response to our current challenges in healthcare is possible. They have offered some powerful ways of changing the culture of services, and shown that a transformation of how we deliver and receive healthcare in Scotland is well within our grasp.

Pictured above: Members of the Scottish Government Health Department meet to share the NHS Fife experience


Contact information An internet version of this report, including video clips and transcripts of participants‟ interviews, will be posted on the NHS Fife website in due course. For more information about the work that is taking place in Fife, please contact:

Margaret Hannah, Deputy Director of Public Health, NHS Fife [email protected] 01592 226447 Fiona Mackenzie, Clinical Service Manager, Kirkcaldy and Levenmouth CHP, [email protected] 01592 226541 Andrea Wilson, Director of Service Delivery, NHS Fife [email protected] 01592 226521

Pictured above: Dr Margaret Hannah, Deputy Director of Public Health, NHS Fife

mailto:[email protected]




Appendix 1

Extra questions Following the visit of Southcentral Foundation to NHS Fife on 8 and 9 June 2010, some of the participants had outstanding questions. SCF Vice President of Organisational Development Michelle Tierney answered them by email: How do they have the time to be person focused and prepared?

We do not expect that this happens on one visit or interaction. Each interaction must be respectful and inviting so we do training and hire the right people. But we expect that relationship will be built over time so we make sure that customer-owners can chose the right person to be in relationship with and then that partnership is nurtured over time. Cost of shifting the model? Cost savings? We do not have a number that says what the cost was. We can say that we have been able to continue to add customer owners to the system without expanding staffing as fast. So we have been able to contain costs seeing reductions in visits per person, hospital days, admissions and emergency room and specialist visits. Do all GPs work the same system? All of our doctors are employed by our system and all of them work in the same system. How did you make the move from a more traditional system to the one you describe? How did you get sign up from all staff about approach? How to make it happen? We spent about a year talking with customer owners, employees and governance to set the system principles and then started with the change in one department and the impacts across the organization in making that one department change. By asking, then designing something, and then asking if we got it right, we developed some level of agreement amongst the customer-owners and the system on the changes to be made. Did you have the agreement of the medical model adherents and acute hospital staff when funding had to be shifted? Whenever funding shifted we talked more. There are times when we have staff who do not agree and we make sure to listen closely to their concerns and make sure we have addressed those concerns even if it means that they will continue to disagree. In the disagreement we attempt to be clear on why we made decision. What are the communications systems you use? Probably too many to name but here is a list: in person when at all possible, by phone, email, intranet, internet, social media, gatherings, conferences, surveys, focus groups, written words, advisory boards, telemedicine.

What legal systems do you follow in relation to consent sharing information? Many laws and regulations govern information sharing and privacy. We have a department that works to ensure that we are complying with all of the laws and regulations. When designing we design first and then determine what compliance issues there may be after we have a draft design. How did management get your workforce to change years of habit, how long did it take, who can you change the mindset you see here? We talked with the workforce and we talk with the workforce constantly and continuously. We make it easy by making the systems easy, explaining the whys and hiring the right people. The mindset we see in Scotland is one in which folks are ready to make a change but there needs to be some discussions on compromise, everyone may lose something to gain even more. How did you get GPs to buy into the system? We have an advantage in that the GPs are employed by the system. But again, talked with the GPs and asked what they wanted. Some GPs have left the system because they did not like the direction, but for the most part by asking and listening in the design and ongoing process it has


resulted in GPs being on board. We cannot overstate how important ongoing connection and communication of management to employees is in any system. What is the legal framework to promote individuals rights? As with information and privacy there are many legal requirements. Accrediting bodies have very specific language about rights and responsibilities for patients. We must comply with these in order to bill and collect. None of these are inconsistent with our approach. How frequently do the different departments meet? We do not have set times for departments to meet. We have a bimonthly managers meeting where all departments get together and discuss strategy and a quarterly leadership session for training and education. Departments otherwise meet as needed and we create relationship points of contact to make this easy. In other words an identified point person between departments. For departments that are connected ongoing there are written service agreements that are reviewed biannually. How do you come to a decision if there is any disagreement? We use the operational principles as the measure and if there is still disagreement it goes up the management chain. Rarely happens because folks are using the principles as a guide so we are on the same page. Over the last 25 years you have been developing your system what caused you to start thinking and doing things differently? What were the preceding circumstances that required your organisation to create a new vision? At the beginning it was because everyone was dissatisfied: employees, customer owners and management. Now it is because we can see that it works and want to continue to improve. What was the first thing you did to make the change? ASK, ASK, ASK - customers, employees, governance and leadership. What happens to the end stage Alzheimers patients who cannot stay at home? Depends on the family but most of the time they would enter a long term care facility. Alaska Native population is relatively a young population so Alzheimers is not as common in the population at this point. What is the balance of care: people living in their own homes versus people in long term care? There is only one long term care facility and a few assisted living facilities so most people will be living in their own homes or with family members. Who does this work with inpatients in nursing homes etc.? Not something that is fully developed in our system but as a general statement we could see how this could work by having some consistent staffing who get to the know the patient and the family. But this would depend on the goals of each patient. What is population of older people? 55,000 total population for primary care, 6,000 are over 65years old. (KLCHP pop 96,700 with 18,000 people >65yrs ) How many people are in the core care team? Who are they? Depends on which team, so for this answer we will focus on primary care. Team is an MD, RN-Case manager, Medical Assistant, Administrative Support. Then we add a Behavioral Health Consultant and dietitian for every 3 teams and a pharmacist and midwife for each 6 teams. Do you have district nurses working alongside you? What sort of role do they carry out? How do you care for patients with dementia who need increased input for short periods e.g. UTI? Yes we have district nurses, we call them home based nurses. They work with the PC teams to provide care in the homes for folks who cannot get in, for either short periods or longer periods. For the dementia patient the PC team may visit at home and work with the district nurse to check more frequently.


Do you have social work/welfare systems? Our system includes the social system and we also partner with sister non-profits. So we provide behavioral health support and coordination and case management services as part of what we do. Our sister non-profits do housing and job training. We employ social workers as behavioral health consultants working in primary care and as case managers in behavioral health. Medical settings here are very risk averse, was that similar in Alaska, if so how did you overcome to give people more ownership of their own care. American and Alaska system are risk averse. We always start the conversations with what the customer-owners want and how would that look and then manage the risk from there. We do not start with what someone else says we can and cannot do. We find most of our “we can’t because someone says we can’t” is mostly just a way for folks to avoid a change.

Can you share your training content re relationships? The training components are learning to share and respond to story, sharing your own personal story, techniques for good dialogue including ladder of inference, advocacy inquiry 4 practices, relational styles, 4 player model, left hand column and personal vision. I’d like to know more about the behavioral health work you mentioned briefly? How is this delivered? We have been very successful in adding behavioral health consultants into primary care. Their role is to work WITH the provider team to address concerns. They do not do therapy but meet the customer-owner where they are and address today and the here and now. They help to prepare the customer-owner to take the next step. They also work with the provider teams to determine approaches to manage relationships. Tons of work done in this area and we are getting ready to launch another new position called behavioral health aide position to be able to listen and respond to story How are services structured re. health, domiciliary care, residential care. Is it all an integrated system and is money able to shift? It is integrated to a point. We have partners for long term, hospital and residential care and that money does not shift. But we are integrated with dental, behavioral health, medical systems and those dollars can shift. How effective is your model in the community – how does it translate? There are other systems in the community that we are working with and the model is being adopted in other places. Care Oregon is a large system that has adopted the principles and is a very different system. Are there ever times when demand for individual inputs just can’t be met? We manage the supply and demand quite tightly. Currently we are able to meet the demand, and how that is done is up to the teams. Of course there are days when employees stay late but that is a rare occasion but we make sure we monitor this measure and take appropriate actions. Does this method mean that people can be kept within their own community? People can decide to stay within their community. There is an influx of people moving to the urban settings because of the economy leaving the smaller communities.

REPORT ENDS

Documents

Shining a different light A report on the visit of Southcentral Foundation to … · 2015-10-29 · Report on the visit of Southcentral Foundation to NHS Fife/8+9 June 2010 3 The