This article revisits how workers and organizational systems engage in practice change. It is rich with practical snapshots of individual perspectives from all levels of an organization. It brings a refreshing approach to the front line engaging in organizational… Vision and practice change.
- a voice at the table;
- interesting and relevant problem;
- shared vision and decision making
For me, especially exciting to see in discussion the endorsement of engaging practitioners themselves to contribute to the research on practice as a way to engage.
… The theme individual participation reflects the definition of medical engagement put forth by Spurgeon et al. (, p. 214): “the active and positive contribution of doctors within their normal working roles to maintaining and enhancing the performance of the organisation.” It is also consistent with the CFIR  domain characteristics of individuals and the multidimensional employee engagement construct from organizational research, which represents the notion of an individual being engaged in change [23, 24, 25, 26]. In contrast, stakeholders in our study predominantly referred to the action of engaging others (with the goal for individuals to be engaged) . This is an important distinction because it implies that engagement is a process or series of actions (arguably, an intervention) and an antecedent to engagement (as a state of being or mechanism). Engagement is not static but rather a process that requires cultivation over time. Like the predominant discourse throughout the implementation science literature, engagement was seen by stakeholders as inviting people to come together to participate across phases of healthcare improvement, from early priority setting to sustainment of initiatives. …
How do stakeholders from multiple hierarchical levels of a large provincial health system define engagement? A qualitative study
Lynn Sherwood’s article in Eastern OASW Summer Bulletin helps us step back, consider how we can say out loud “…the Emperor has no clothes.” She outlines the context for the individual worker within the organization and… the context of the organization in the system of care.
…It wasn’t supposed to be like this. The profession of social work began back at the turn of the twentieth century as a response to poverty and to the terrible living conditions of new immigrants to Canada. The agencies and organizations we work for have never been affluent, and we have never represented much more than a finger in the dyke, holding back the rising tides of human misery. This knowledge goes with the territory. Our focus on the relationship between individuals and their social environment, on advocacy for social change, has always been fundamental to our profession. However, in recent years ostensibly laudable expectations of efficiency, effectiveness, accountability, measurable outcomes, have devolved into an uncomfortable acceptance of “The Business Model” of providing social services, leaving us struggling to function in impossible, contradictory situations. …
See the article here https://www.oasw.org/Public/About_OASW/Eastern_Branch.aspx (scroll down to the newsletters, open then go to page 20)
From the journal of Implementation Science, https://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0607-7
…In this paper, we propose the use of architectural frameworks to develop LHSs that adhere to a recognized vision while being adapted to their specific organizational context. Architectural frameworks are high-level descriptions of an organization as a system; they capture the structure of its main components at varied levels, the interrelationships among these components, and the principles that guide their evolution.
Florence Morestin, shared this resource for ” structured approach to analyzing public policies” from the National Collaborating Centre for Healthy Public Policy http://www.ncchpp.ca/
I would like to let you know that the NCCHPP’s online training course “A framework for analyzing public policies” is now being offered for free and is offered in a format compatible with PC, Mac, tablets and phones.
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This paper shared as one of the resources was found by Vicky Ward https://kmbresearcher.wordpress.com/, who was at the Canadian Knowledge Mobilization Forum, http://www.knowledgemobilization.net/event/2017-canadian-knowledge-mobilization-forum/
PUT SIMPLY: According to an intersectionality perspective, inequities are never the result of single, distinct factors. Rather, they are the outcome of intersections of different social locations, power relations and experiences.
paper by Olena Hankivsky, PhD of https://www.sfu.ca/iirp/
see the paper here: https://www.sfu.ca/iirp/documents/resources/101_Final.pdf
Harvey Rosenthal of New York Association of Psychiatric Rehabilitation Services, Inc. summarized this New York state pilot of integrating Mental Health and Physical health care across organizations. The broader context of the report can be read below the summary.
NYAPRS Note: Provider teams that participated in an eight-month state program to help them integrate primary and behavioral health care were able to improve communication between clinicians, standardize patient screenings and reduce wait times, among other positive outcomes, according to a report released by the Department of Health Thursday. They also identified a number of common challenges ranging from a lack of interest among some clinicians to a superficial understanding of data. Here’re some excerpts from the report.
Integrated behavioral and physical healthcare will be a featured topic at NYAPRS’ upcoming April 27-8 Annual Executive Seminar, “All Hands on Deck! Ensuring a Recovery Focus in a Changing Healthcare Environment” at the Albany Hilton. More program details and registration link next week.
Eight Lessons Learned About Integrating Behavioral Health and Primary Care Services
- Integration of care is about creating a whole new way of delivering care…not just adding another service. For years, service systems have been siloed because of funding, regulations and educational preparation. The change, to focus on whole health and wellness, challenges long-held assumptions and some very real contextual barriers. As teams begin to work together, to learn from each other, and to work towards a seamless experience for the patient, preconceived notions begin to break down. Being conscious of this shift in thinking has been a critical success factor in integration.
- Having a clear vision about why integration fits your mission will help you keep at it when the barriers arise. Vision is the stabilizing force when resistance and barriers arise. Organizations that identify the “why” of practice change, that commit to this as a way of delivering service, and make it part of the organizational mission, have the resilience necessary to overcome the resistance and barriers that will arise. The question then becomes, not “whether we will do this” but, “how we will do this?”
- Recognize that culture drives practice. The transformation to an integrated practice requires creativity, courage and risk taking. In cultures where there is a top-down approach, where the contributions of everyone on the team (including the front desk, the medical assistants and others) are not recognized, the development of a team-based approach to care will be nearly impossible. A culture that recognizes the unique contribution of each team member is more likely to recognize the individuality of each patient, and to be engaging and inclusive in the care delivery system. This change requires new thinking and new practices, which in time create a culture of enhanced primary care.
- Data is the magnifying glass to identify whether what you are doing is working…for the patient and for your processes (i.e. how integration supports keeping people out of crisis). Healthcare is a demanding field to work in and each day brings another change and another challenge. Without a planned approach to collecting real data that reflects real practice and outcomes, the practice will continue to do the same things over and over whether they work or not. Data causes us to ask questions; it is in the questions that ideas for improvement of care emerge.
- Practice Champions are key and developing the overall functioning of the team cannot be overlooked. In an ideal world, everyone in a practice gets on board quickly and with enthusiasm about this change in the care delivery system. However, this is not reality and, as such, the role of early adopters and Champions becomes particularly important. The Champion is the one who keeps saying “yes we can” in the face of doubts and who continues to work toward solutions when others only identify barriers. The Champion(s) are also the people who help the team come together, who call out conflict when it exists so it can be resolved, and who keep the project moving forward.
- There is opportunity in understanding the effectiveness of leveraging staff outside of physicians and providers. The patient experience begins at the front door with how they are greeted, continues with how they are roomed, and ends with how they are checked out. At each step there is an opportunity to engage patients or to have them disengage. Often the staff who are involved in these key processes are overlooked and/or underappreciated. They don’t see their role as important and may not be treated as if it is. In an integrated practice they are critical in getting initial screenings completed, in communicating safety to patients, and in flagging for other staff when there may be an issue. They manage the waiting room and have a good sense of patient flow. For integrated care to be a success, these staff need to be included in huddles, in training and in process improvement.
- Persistence is required and tackling obstacles with small tests of change will keep you moving forward. Because there are so many moving parts with any integration effort, building a team and using data effectively to help you know what obstacle to tackle next, are key ingredients for success.
- Integration is a continuous journey, not a destination. One of the most critical hallmarks of a high-performing practice is the recognition that there is always more to do, always something to improve. The knowledge base in the field continues to expand, the team continues to improve, and the context changes – all of this requires continuous attention to growth, change and improvement
Details of Content of the Report
DSRIP: – Medicaid Accelerated eXchange (MAX) Series Program (excerpts by NYAPRS)
Integrating Behavioral Health and Primary Care Services
New York State Department of Health in collaboration with Joan King, Emmeline Kunst, essica Logozzo, Kara Kitts, Dr. Douglas Woodhouse
Over the past 12 months, we have put an important focus on leading change at the front-line of patient care –where DSRIP becomes reality. The Department of Health has been proud to offer the opportunity for Performing Provider Systems (PPS) to participate in the Medicaid Accelerated eXchange (MAX) Series Program. The MAX Series Program has put front-line clinicians in a position to lead change. By enabling change at a grass-roots level, PPSs have been able to generate impressive results – Including:
- Measurable increases in screening rates and connections to services (as these relate to integrating behavioral health and primary care services)
- Capacity building in process improvement
- Development of meaningful collaborations among partners, both inside and outside of provider sites.
The MAX Series focus on the integration of behavioral health and primary care services is important as New York’s behavioral health system is large and fragmented. The publicly funded mental health system serves over 600,000 Medicaid members, representing 12% of total Medicaid members across the State. This accounts for about $7 billion in annual expenditures or 13% of New York’s total Medicaid spend. With the overall goal to reduce avoidable hospital use by 25% through transforming the New York State health care system, DSRIP will focus on the provision of high quality, integrated primary specialty and behavioral health care in the community setting with hospitals used primarily for emergent and tertiary level of services.
This report highlights the work of 10 Action Teams who participated in the first year of the MAX Series Program, which focused on the Integration of Behavioral Health and Primary Care Services. Collectively, these 10 teams were comprised of over 100 clinicians, administrators and community providers. Over an eight month period, these individuals dedicated significant time to identify patients in need of behavioral health services; to develop innovative solutions to providing better care for these individuals; and to rapidly implement, test, and measure these improvements.
From the Ontario Public Health Association and Health Nexus
On December 8th 12:00 to 1:00pm, join us as OPHA and Health Nexus release a literature review on Intersectionality, Anti-Oppression and Collaborative Leadership in Practice. This review contains materials and resources that can assist individuals and organizations in developing and sustaining equitable, anti-oppressive, collaborative leadership frameworks to support inclusive partnerships and networks. The literature review synthesizes and analyzes a wide range of research and non research materials in order to provide greater clarity on inclusive, equitable and collaborative leadership in the non-profit sector.