Union In Action was forged from the elements of experience acquired over more than four decades of effort to design and implement programs and services that: a) revitalize the experience of care for both patients and professionals and b) responsibly improve the quality of care delivered to, and the quality of health attained by, patients and communities.
For all the advances in biomedical science and information technology that have occurred in that time, and for all the programs and initiatives that have come and gone, the healthcare ecosystem continues to struggle to substantially achieve these goals.
Based on our collective experience training and working in healthcare service delivery and subsequent decades studying and working in industries parallel to, and even outside of, healthcare, one thing clearly stands out as the “missing link” for positive and productive evolution of our healthcare system: the organizing principles of medicine are just not based on values that prevail towards the patient. This is not an indictment of individuals who work in the system; in fact, it is the systems in which they work that are barriers to the expression of their patient centered commitments, intent and practice.
This is the focus of Union In Action: developing programs and policies to support the the capacity of our systems of care to improve the quality of care delivered and the quality of health attained by patients and communities, and the quality of the experience of care by both patients, families and the professionals and staff involved in its delivery.
The foundation of the work of Union In Action is the concept of the ‘Health Resource-Community”. The Health Resource-Community are all those individuals, organizations, entities and environment ts (including the patient and their family) that have any involvement — actual, virtual or potential — to manage or influence variables that have an effect on patient’s health status. Our key objectives relate to orchestrating the work of the health resource-community (irrespective of any formal affiliations or lack thereof) and managing the system-level context in which they work to assure success. This includes both role-based and resource-community-based work, as well as the interaction design of the resource community itself.
Our initial focus will be in three areas:
Care Planning, Care Delivery and Collaboration as a Discipline.
PROBLEM 1: Collaboration is impossible without a “single source of truth” for patient’s health-related goals and associated plans of care, collectively developed with the patient and shared among all the members of a patient’s health resource-community.
While nurses have a care plan framework, physicians, who tend to organize their work around problem lists and order sets, have none. Traditionally, the responsibilities for clinical strategies and associated goals for any one patient are distributed among all of a patient’s primary care and specialty providers, with the plans for nursing, social work, home care and other disciplines existing independent of medical care planning. This results in lack of sharing of resources and knowledge, redundancies, mis-communications, conflicts in advice and counsel, and, sometimes, adverse events due to conflicts in treatment strategies. While the electronic medical record may aggregate the perspectives of diverse medical disciplines who operate within the same organization, it does not integrate, nor account for, the perspectives and insights of otherwise unaffiliated members of a patient’s health resource-community. This is why payers and managed care organizations that aggregate claims for services from multiple sources often have the only ‘whole view” of a patient care and health status. In their efforts to achieve their organizational goals for a patient’s health they often disintermediate the role and place of others in the patient’s resource-community.
UNION IN ACTION SOLUTION:
We have developed a universal framework for care planning that defines and categorizes a patient’s goals for their health, accounts for all the determinants of their risks and conditions and integrates the perspectives of all the members of that patient’s health resource-community
PROBLEM 2: Orchestration is difficult without a common ‘score’ that integrates the diverse voices in the patient’s resource-community. A lack of a common problem-solving framework applied across all the disciplines and roles required by the patients care plan, and a methodology for integrated resource allocation against care plan goal achievement
Each and every professional discipline (including but not limited to healthcare, education, law, finance) that is directly or indirectly a member of a patient’s health-resource community brings, and uses, a different mental model for understanding and solving problems and different tools and resources to support their contribution to the patients’ health.
UNION IN ACTION SOLUTION
We have developed a framework for problem solving that integrates ‘strategy toward goal’ with the deployment (and escalation/de-escalation) of resources that operationally realize that strategy, based on monitoring of progress towards goal.
PROBLEM 3: There is no formal discipline nor operational mechanisms to orchestrate the roles and responsibilities of all the members of a patient’s health-resource community; the linchpin competencies for genuine systems-based practice are just not native to healthcare as a discipline.
Even when everyone is at the table (or facing the patient for that matter), collaboration in healthcare is often is no more real that the parallel play of toddlers. It is the connections between the disciplines that are missing and increasingly required, to deliver effective health care. Collaboration requires the participants to a) define roles and responsibilities in the context of the goals for individual patients, and b) orchestrate their respective activities (and progress towards goals) by sharing responsibility, authority and accountability for achieving results. All the members of a patient’s health resource-community must believe that benefits of collaboration will offset costs such as loss of autonomy and “turf”.
UNION IN ACTION SOLUTION
We have developed a framework for collaboration as a healthcare discipline and the associated tools and resources for its implementation. This framework can be applied at across all the tiers of the healthcare system:
Tier 1: Individual and Family (both patient-initiated and patient-directed decisions, interactions, and communications, and shared decision making with Tier 2)
Tier 2: Health Resource-Community (inclusion and collaboration among all the individuals and roles involved in an individuals care, including, but not limited to, role-to-role collaboration among professionals, even if otherwise unaffiliated)
Tier 3: Systems and Programs (systems-level communications, including program management and implementation; collaboration and accountability among the teams and systems supporting patient care; organizational leadership)
Tier 4: Communities and Constituencies (determined by both geography and affinity and related to both transactional and reputation-related communications)
Tier 5: Social and policy environment (local and national information environment)