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Shining a Different Light


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Gain an understanding of the practical application of relationship‐based care
and what it takes to change our mindsets as healthcare professionals to
enable people to take charge of their own wellbeing. Find out how NHS Fife has begun to adapt this idea within their own healthcare setting.

Published in: Health & Medicine
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Shining a Different Light

  1. 1. Shining a different light Learning from South Central Foundation Anchorage, Alaska
  2. 2. Outline for today <ul><li>Introductions </li></ul><ul><li>Drawing on your experience </li></ul><ul><li>3 Horizons </li></ul><ul><li>Why Alaska? 3 rd Horizon in the present – the story so far </li></ul><ul><li>What we learned and relevance to Fife </li></ul><ul><li>Questions </li></ul>
  3. 3. Fife Nuka team <ul><li>Margaret Hannah Dep. Dir. Public Health </li></ul><ul><li>Swapan Mukherjee General Practitioner </li></ul><ul><li>Fiona MacKenzie Clinical Services Manager </li></ul><ul><li>Patricia Boyle Head of Organisational Development </li></ul>
  4. 4. Your recent experience? In pairs, describe a recent health experience you have had (5 mins between you)
  5. 5. Three Horizons
  6. 6. Examples of H2
  7. 7. June 2010 - SGHD and NES invite SCF to NHS conference NHS Fife wins bid to host SCF for 2 days June 2011 - 4 health professionals from Fife were invited (and find sponsorship funding) to go to Alaska for first international Nuka conference 6 day visit: site visits, 3-day core concept training, 1.5 day conference, 0.5 community event SCF: our 3 rd Horizon in the present – the story so far
  8. 8. Quick facts Vast territorial area to cover including lots of islands Alaska is 1/6 th of the land mass of whole of North America and 20 times bigger than Scotland Smaller population than Scotland Total 710,231. Anchorage largest population centre 300,000 people. Alaskan Native people 14.80% of total SCF 1,500 staff, 50,000 patients in Anchorage area and additional 10,000 patients scattered in 50 outlying villages. Some of these are more than a 3 hour flight away at a cost of $1,000 in “gas”. SCF funding different to most USA, 90% through federal grants and Medicare/Medicaid Similar staff to patient ratio as Scotland
  9. 9. History <ul><li>1985 – SCF took on its first contract (dental and optometry) from Indian Health Service </li></ul><ul><li>1987 – assumed more of dental, optometry and added behavioural health </li></ul><ul><li>1994 – dental opened the door to the first orthodontic clinic in Alaska for native children </li></ul><ul><li>1998 – assumed full management of the entire primary care system for our area </li></ul><ul><li>1999 – assumed co-management of inpatient services for the hospital </li></ul>
  10. 10. Southcentral Foundation Current services <ul><li>Primary Medical Care </li></ul><ul><li>Dentistry </li></ul><ul><li>Optometry </li></ul><ul><li>Physical Therapy </li></ul><ul><li>Outpatient Behavioural Health </li></ul><ul><li>Residential Treatment for Adolescents </li></ul><ul><li>Residential Treatment for women </li></ul><ul><li>Transitional Living </li></ul><ul><li>Domestic Violence Prevention </li></ul><ul><li>Traditional Healing </li></ul><ul><li>Complementary Medicine </li></ul><ul><li>Home Based Services </li></ul><ul><li>Health Education </li></ul><ul><li>Elder Programme </li></ul><ul><li>Co-manager inpatient services at ANMC </li></ul>
  11. 11. Why change? Everyone was frustrated… <ul><li>Customer owners frustrated – waiting, impersonal, paternalistic, crowded, unfriendly </li></ul><ul><li>Clinical staff frustrated – too many people, not enough time, no personal relationship, too many demands </li></ul><ul><li>Management frustrated – lots of unhappy people, hard to motivate staff, poor financial performance, poor facilities </li></ul><ul><li>Payers – higher and higher costs </li></ul>
  12. 12. With this knowledge….change everything <ul><li>Project based improvement driven by individual programs or people could only tinker with the current system, not really change the system </li></ul><ul><li>1999 –when took on co management of in patient services. Board and CEO said…change everything – whole system, as quickly as possible </li></ul><ul><li>Build on existing SCF 10 years philosophy, traditions, the ways of the Alaska Native people </li></ul>
  13. 13. SCF Story …………….. <ul><li>We can only create health in relationship </li></ul><ul><li>Critical elements – honour, dignity, self worth, personal confidence </li></ul><ul><li>We will do that with intentionality everywhere in the entire system </li></ul><ul><li>We will not be ‘patient centred’, we will be individual and family controlled at every level to the extent possible </li></ul><ul><li>Journey together – shared responsibility </li></ul>
  14. 14. Redefine Work <ul><li>Move from episodic, reactive care to long-term relationship </li></ul><ul><li>Move from only one-to-one visits to use of groups, phone, e-mail, fax </li></ul><ul><li>Move from doctor-centric to team based approach in relationships </li></ul><ul><li>Move to team based meetings, problem solving </li></ul>
  15. 15. Control: Who really makes the decisions Acuity “ Control” The “System” Patient/Family 0 Low High 100 <ul><li>Control – who makes the final decision influencing outcome? </li></ul><ul><li>Influences – family, friends, co-workers, religion, values, money </li></ul><ul><li>Real opportunity to influence health costs/outcomes – influence on the choices made – behavioral change </li></ul><ul><li>Current model – tests, diagnosis, treatment (meds or procedures) </li></ul>
  16. 16. Healthcare Provider Changes for Effective Relationships <ul><li>No longer a hero but a partner </li></ul><ul><li>Control does not equal compliance </li></ul><ul><li>Replace blaming with understanding </li></ul><ul><li>Give customers options not orders </li></ul><ul><li>Provide customer with resources </li></ul><ul><li>Make it simple </li></ul>
  17. 17. Customer-owner Changes for Effective Relationships <ul><li>Be active not passive </li></ul><ul><li>Take responsibility for your health </li></ul><ul><li>Get information about your health </li></ul><ul><li>Ask questions about advice </li></ul><ul><li>Ask for options </li></ul>
  18. 18. Outcomes (1999-2007) <ul><li>19% reduction in visits to A&E </li></ul><ul><li>36% reduction in OP visits </li></ul><ul><li>71% reduction in hospital days </li></ul><ul><li>75% reduction in hospital admissions </li></ul><ul><li>Relative rise in cumulative spend per capita since 2004 is half the US average </li></ul><ul><li>SCF is above 90 th centile in standard measures of organisational performance in terms of patient safety, service improvement and staff wellbeing </li></ul>
  19. 19. What we learned and relevance <ul><li>Margaret </li></ul><ul><li>Fiona </li></ul><ul><li>Tricia </li></ul><ul><li>Swapan </li></ul>
  20. 20. Questions?