NYAPRS Note: A timely piece…please forgive some of the language.
Organizational Change: Practical Steps Towards Integration
by Nelly Burdette, Psy.D. Mental Health Weekly May 29, 2012
Over the next few months we will be featuring a series of columns by Nelly Burdette, Psy.D., director of integrated care at The Providence Center in Rhode Island, focusing on the challenges of moving toward an integrated mental health and medical care model.
Integrated care is coming to a town near you and your organization’s ability to manage the cultural change inherent in this new practice approach will be critical to your ability to thrive in the new marketplace. In a perfect world, integrated care would allow individuals with any level of mental illness – ranging from sub-clinical issues discovered in a primary care setting to serious and persistent mental illness in a chronic mental health care model-to have access to both physical health and mental health care from a holistic-oriented team in a coordinated manner.
A critical component of an organization’s success in today’s changing health care marketplace will be its ability to provide integrated behavioral and primary health care to the clients it serves. In order to successfully implement this new practice paradigm, organizations need to create a new internal culture which embraces a commitment to both the physical and mental health of the clients it serves. Creating and embracing this new culture requires organizations to embark on a number of key initiatives designed to: access the current state of your organization’s readiness to accept change; help staff accept and embrace the change; and develop the commitment on the part of clinical and administrative leadership to the integrated care model.
This article will explore some of the steps your organization should consider taking as it seeks to operationalize integrated care.
Assess Organizational Readiness For Change
How would an organization know if it were were ready for such a change? An objective approach would include conducting a needs assessment. In its’ most basic sense, a needs assessment determines what the differences or gaps are between current functioning and desired functioning.
Conducting a needs assessment is an important component of finding out the organization’s level of comfort with the integrated care concept and its initial willingness to embrace the new approach to care.
Regardless of whether the results show an organization poised for change or one that is refusing to accept the inevitable approach of integrated care, the assessment can helpinform the approaches that will be taken to get to the final destination.
The key is that a needs assessment is only as good as the questions that are asked and can take many forms.
Some organizations may want to start with focus groups that include a mixture of both staff and clients from all programs. Asking people what they want after explaining the basic concepts of integrated care can produce instant results directly from those you will be asking to make changes later. Having staff from all levels of the organizations as well as consumers participate in focus groups begins the buy-in process from the bottom-up, which is equally as important as top-down support.
The benefit of the focus group approach is that allows staff from all levels of the organizations as well as consumers to begin to develop a sense of ownership of the integrated care process. The downside is that the logistical challenges of organizing and holding focus groups will limit the overall number of people who can be involved in the process.
In addition, some staff or clients may feel uncomfortable sharing their true feelings within a group environment.
In addition to focus groups, needs assessments can also take the form of anonymous questionnaires. Questions would likely be specific to the organization, but could include questions such as, “On a scale from 1-10, how confident are you of the following: Consumers have access to primary care services; Consumers feel comfortable with their primary care services; Consumers understand what their primary care team discusses with them about their conditions, etc.”
At The Providence Center, we developed a partnership with Providence Community Health Center, a Federally Qualified Health Center (FQHC) that created opportunities for a medical clinic to operate within The Providence Center’s main location, and social workers to be placed within the FQHC to provide integrated care.
To determine how to move forward with these ventures, a one page needs assessment tool was created internally. To make participation more enticing, small tokens of appreciation in the form of gift cards were offered. A group of 20 medical providers across the FQHC were chosen based on the strongest likelihood of participation with a little less than half of the respondents participating. The information gathered through this effort helped guide our implementation plan.
Organizational change is a common component for any change that a system undertakes. While the change of the organization may and should be guided, it should be emphasized that the people within the organization are the ones being asked to make either small or large day-to-day changes in their practice.
A significant shift in roles will likely need to occur. Central to this change is the idea that all providers must take responsibility for both the physical and mental health of the clients they serve.
It is important to deliberate how and whether to change the focus of initial assessments toward incorporating medical issues. For example, additional questions can be written into the electronic health record to determine whether a client has primary care, is satisfied with their primary care services, utilizes the emergency room for medical issues that were non-emergencies and whether there are certain chronic medical diseases potentially interfering with psychiatric issues. This ensures that right from the beginning medical issues are seen as part of the patient’s care plan.
Leadership Commitment And Next Steps
Top-down support and buy-in is crucial. Senior leadership must have at least one champion (ideally more) of integrated care with other key team members being able to spread the message across the organization.
With senior leadership being active participants in adding integrated care into the vision, mission and goals of the organization, it is more likely that it will not develop as a silo program or pet project.
To promote change will require a considerable amount of visibility. Integrated care will need to be a part of everything that your staff and consumers see until it becomes a regular part of operations.
For example, at The Providence Center, monthly blood pressure and glucose screenings are hosted and a personal fitness program for clients through the InSHAPE model has been implemented. There are regular meetings between senior leadership from both the CMHC and FQHC, on the ground staff, and consumers, shared electronic health records are available for mutual clients and conversations beginning about tracking physical health outcomes.
While organizational change is the first component of successfully implementing integrated care, it must occur in conjunction with specific training programs for staff.
Nelly Burdette, Psy.D., director of Integrated Care at The Providence Center, is responsible for overseeing the integrated care initiatives between the largest CMHC and FQHC in Rhode Island.
Editor’s note: This series will involve several more excerpts and we welcome reader responses and questions. Please send comments to email@example.com.