Without Collaborative Care, the PCMH Fails

Posted on October 11, 2012 by | 1 comment

Gene “Rusty” Kallenberg, MD

I want to tell you a story that is both personal and also parallels the evolution of primary care and collaborative care over the past decade and predicts its future.

I arrived in San Diego to take over the Division of Family Medicine at UCSD in the fall of 2001. I came from “the East” where I had been at George Washington University Medical Center and School of Medicine (GW) for the preceding 20 years.  My clinical primary care practice fortuitously shared a waiting area with the outpatient mental health team. It was a short walk to the therapists’ offices and in the course of wandering over to seek help on various patients I met a clinical psychologist with whom I developed a close working and collegial relationship.  When I needed help with a patient I would seek his counsel and/or refer the patient over to the group with an “Attention Pat” comment on the referral.  I ended up hiring him to be the psychologist in our new family medicine residency program. We did an international consultation together for an Eastern European country’s developing academic family medicine program, and he introduced me to the concept of motivational interviewing, among other things. I began to realize that without this kind of key help the practice of primary care/family medicine would be a lot harder. I began to talk with a psychiatrist who headed the 3rdyear clerkship about deeper collaboration, but then circumstances changed significantly at GW and I decided to move. Long story made short, I ended up taking up the leadership of the UCSD Division of Family Medicine.

One of the most pleasant and propitious surprises on arrival was that there was an outstanding group of academic PhD marriage and family therapists (MFT) from the University of San Diego (USD) who were in discussions with our UCSD Psychiatry Department about transferring their activities to UCSD from the Sharp Family Medicine Residency which, unfortunately, was winding down to closure. Todd Edwards and JoEllen Patterson were the dynamic duo I was privileged to meet.  Unfortunately, these discussions were mired down with our Psych folks in what seemed like a circular and non-progressing research-oriented discussion. Being the new kid on the block, I was able to ingratiate myself with the Chair of Psychiatry and got him to “let our people go” and actually set up a clinical operation where we could deliver co-located care along with directly observed behavioral science teaching sessions (fondly referred to as “BS Sessions”) within our family medicine offices.

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Posted in Education, Family Medicine Stories, Public Health

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As Rosie the Riveter Says: We Can Do It—Collaborative and Facilitative Leadership

Posted on October 4, 2012 by | 1 comment

Jeri Hepworth, PhD,STFM Past President

What a fortunate path I have been on. But it is a path that more of us can take, and that is the core message of this blog post. As a behavioral scientist in family medicine for more than 30 years, I grew up in parallel with the discipline of family medicine and have been part of the community of behavioral science faculty who help family physicians know what it means to care for real people, for families, and to do so collaboratively with other health care professionals. Over time, I felt included and valued in my department, in my medical school, and in our national organizations, especially the Society of Teachers of Family Medicine (STFM). So what a thrill it was to be elected STFM president. But it was not without trepidations.

As STFM President-Elect, I attended my first meeting of CAFM and Working Party. Forgive the funny names, but they represent the Council of Academic Family Medicine organizations (STFM; ADFM, the organization of departments and chairs; AFMRD, the residency directors; and NAPCRG, the primary care researchers). The Working Party includes the CAFM organizations, plus the American Academy of Family Physicians (AAFP), the American Board of Family Medicine, and the AAFP Foundation. Together, the organizations work to ensure coordinated positions and grapple with vision and leadership of family medicine. These meetings represent ideal examples of Covey’s work of being both important and not urgent, of taking the time to consider what family medicine is accomplishing, and very powerfully, what should be the next steps.

Not surprisingly, attending my first meetings of these groups was intimidating. But, on the first morning, I received this email from my husband, Robert Ryder: “You are not a non-physician. You were elected to represent the educators in family medicine. So you represent the future of family medicine. Go do good work.” I must say, I walked a bit taller after that email, and over the last couple of years of leadership within national family medicine, I take these statements very much to heart. And I want others to recognize these truths.

Behavioral science clinicians and educators have the skills needed for leadership in our departments, in our health care systems, in our agencies and policy-making arenas, and in our national organizations and advocacy efforts. We know how to listen and include others. We can elicit divergent views and withstand conflict. We know how valuable it is to include the views of those who feel less powerful in systems. We can tolerate the anxiety that emerges in systems under stress or facing change. We know how to help groups create goals and vision, though we sometimes need help determining whether differences actually emerged. So we know we need collaborators, and generally we know how to play well with others. If we have been successful in working in settings in which our professions were the minority, we have learned these skills. And they are exactly the skills needed for effective leadership.

I truly enjoyed giving talks as president of STFM. Unlike presentations about my work, I learned that I didn’t need to hold back, because I wasn’t talking about me. I was representing something greater than me. To be grandiose, and also accurate, I was able to talk about a future and vision of compassionate, effective health care. It wasn’t a form of bragging about my work or ideas; it became a responsibility to do the best I can to help achieve our common goals. I was given a wonderful platform and support to do so.

And the beat goes on. I will still take the opportunities to advocate for family medicine, for primary care, for integrated health care systems that are focused first on patients and families and that require the collaboration and skills of many. But I also have a commitment to encouraging others to stand up and participate in advocacy and leadership for our common visions. The Collaborative Family Healthcare Association and STFM create wonderful platforms for us to do so. Let’s not waste these opportunities.

This is the first in a series of collaborative blog posts between the Collaborative Family Healthcare Association and the Society of Teachers of Family Medicine.

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Posted in Education, Leadership

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Governance, What If…

Posted on September 17, 2012 by | 3 comments

Stacy Brungardt, CAE STFM Executive Director

Imagine an organization where an individual who works in academic family medicine knows where to turn to get his/her problems solved.

Imagine that this disciplined organization aligns products with its mission, uses data-driven strategies, and focuses on members’ needs. This organization is highly functioning and nurtures an inclusive culture that engages in dialogue between members and leaders.

Imagine an organization with sufficient resources to do its work. This organization is agile, proactively addresses issues, assesses and takes action quickly, and makes course corrections as necessary.

Imagine an organization that pursues alliances that relate to existing strategies or that form a tight fit with its mission and purpose. It is selective about determining with whom they should partner to be as effective as possible.

Imagine what we could accomplish if STFM operated like this all the time.

I do imagine this and believe there are literally hundreds of members and staff who are helping us move toward this vision.

I also believe that a strong governance structure either moves you in this direction or provides barriers that staff and members sidestep or hurdle, slowing down progress toward our vision.

Yes, good governance matters. Simply put, governance is the way decisions are made, who makes them, and under what parameters.1

Good governance can make the difference between the Society moving forward or not. It can demonstrate inclusiveness and be accountable for actions, or it can waste time and resources of the organization. By the way, we spend a lot on governance when you consider member time and STFM dollars to support Board, committee, and task force meetings and the staff time to manage these groups.

The STFM Board recently reflected on series of events related to our governance structure that have caused us to consider the best way to approach these issues.

The Board saw a convergence of activities and agreed that we would benefit from taking a more systematic approach to our governance assessment rather than trying to address each of these issues separately. We recognized the risk of each of these groups making separate recommendations that weren’t coordinated or in alignment. In fact, experts in association governance would tell you that groups who approach governance assessment elements in a piecemeal fashion generally struggle and are less happy with their outcomes than groups that approach this assessment in a way that starts globally with how the model assists their organization in meeting its desired ends.

Thus, the Board approved bringing in an outside consultant to facilitate this process of reviewing our governance structure. We will be working with governance consultant Michael Gallery, PhD, a well-respected association management professional who chaired the task force that created 7 Measures of Success: What Remarkable Associations Do That Others Don’t. This landmark research in association management applied the work of Jim Collin’s Good to Great to association management. Dr Gallery understands medical associations and association governance. (He also comes highly recommended and is affordably priced!)

What I like about his process is that he starts with the end in mind and includes operational elements such as obtaining member input, creating a communications plan for stakeholders, and evaluating any new structure we would create.

I don’t think we’re doing a bad job at governing the Society, but we haven’t taken an in-depth look at our governance structure since we created STFM in 1967. Until you spend some time thinking about what outstanding governance performance looks like, how our current structure compares, and how to address the gaps, we are likely not reaching our potential as an organization.

What if…

Reference
  1. Gallery M. Governance: a new approach to an old problem. Session presented at the American Society of Association Executives Annual Meeting, Dallas, TX, August, 2012.

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