Shining a Different Light
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Transcript of Shining a Different Light
Shining a different light
Learning from South Central Foundation Anchorage, Alaska
Outline for today
• Introductions• Drawing on your experience• 3 Horizons• Why Alaska? 3rd Horizon in the
present – the story so far• What we learned and relevance to
Fife• Questions
Fife Nuka team• Margaret Hannah
Dep. Dir. Public Health• Swapan Mukherjee
General Practitioner• Fiona MacKenzie
Clinical Services Manager
• Patricia Boyle Head of Organisational Development
Your recent experience?
In pairs, describe a recent health experience you have had (5 mins between you)
Three Horizons
Examples of H2
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 3rd Horizon in the present – the story so far
Quick factsVast territorial area to cover including lots of islandsAlaska is 1/6th of the land mass of whole of North Americaand 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
History • 1985 – SCF took on its first contract (dental
and optometry) from Indian Health Service• 1987 – assumed more of dental, optometry
and added behavioural health • 1994 – dental opened the door to the first
orthodontic clinic in Alaska for native children• 1998 – assumed full management of the
entire primary care system for our area• 1999 – assumed co-management of inpatient
services for the hospital
Southcentral Foundation Current services
• Primary Medical Care • Dentistry• Optometry• Physical Therapy• Outpatient Behavioural
Health• Residential Treatment for
Adolescents • Residential Treatment for
women
• Transitional Living • Domestic Violence
Prevention• Traditional Healing • Complementary Medicine• Home Based Services• Health Education • Elder Programme• Co-manager inpatient
services at ANMC
Why change?Everyone was frustrated…• Customer owners frustrated – waiting, impersonal,
paternalistic, crowded, unfriendly• Clinical staff frustrated – too many people, not
enough time, no personal relationship, too many demands
• Management frustrated – lots of unhappy people, hard to motivate staff, poor financial performance, poor facilities
• Payers – higher and higher costs
With this knowledge….change
everything • Project based improvement driven by individual
programs or people could only tinker with the current system, not really change the system
• 1999 –when took on co management of in patient services. Board and CEO said…change everything – whole system, as quickly as possible
• Build on existing SCF 10 years philosophy, traditions, the ways of the Alaska Native people
SCF Story ……………..• We can only create health in relationship• Critical elements – honour, dignity, self worth,
personal confidence • We will do that with intentionality everywhere in the
entire system
• We will not be ‘patient centred’, we will be individual and family controlled at every level to the extent
possible • Journey together – shared responsibility
Redefine Work
• Move from episodic, reactive care to long-term relationship
• Move from only one-to-one visits to use of groups, phone, e-mail, fax
• Move from doctor-centric to team based approach in relationships
• Move to team based meetings, problem solving
Control: Who really makes the decisions
Acuity
“Control”
The “System”
Patient/Family
0Low High
100
1. Control – who makes the final decision influencing outcome?2. Influences – family, friends, co-workers, religion, values, money3. Real opportunity to influence health costs/outcomes – influence
on the choices made – behavioral change4. Current model – tests, diagnosis, treatment (meds or procedures)
Healthcare Provider Changes for Effective Relationships • No longer a hero but a partner• Control does not equal compliance • Replace blaming with understanding• Give customers options not orders • Provide customer with resources• Make it simple
Customer-owner Changes for Effective Relationships
• Be active not passive• Take responsibility for your health• Get information about your health• Ask questions about advice • Ask for options
Outcomes (1999-2007)
• 19% reduction in visits to A&E• 36% reduction in OP visits • 71% reduction in hospital days • 75% reduction in hospital admissions• Relative rise in cumulative spend per capita
since 2004 is half the US average• SCF is above 90th centile in standard
measures of organisational performance in terms of patient safety, service improvement and staff wellbeing
What we learned and relevance
• Margaret
• Fiona
• Tricia
• Swapan
Questions?