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Advancing Healthcare Through Provider/Patient Partnerships

Posted By Tai Mendenhall, Monday, February 14, 2011
Updated: Friday, June 10, 2011

Healthcare as we know it is changing fast. As hospital and clinic systems redesign themselves to better facilitate collaboration among providers representing a variety of disciplines, our patients and their families are benefiting through increased access to coordinated and reciprocally informed services. As our training sites across graduate and medical education prepare future healers to enter these more complex work environments, we are seeing yesterday’s interdisciplinary tensions regarding whose field is better (e.g., Psychology vs. MFT) change to contemporary mutual respect and valuing of our colleagues’ contributions to a whole that is more than the sum of its parts. At the same time, policy makers, system administrators and 3rd party payers are working to advance ways to financially sustain new ideas and methods of care-provision.

Many of our efforts, however, appear to be missing something that I think is important to consider: attention to the role(s) of our patients and their families. Whether it is in the research studies that I peruse, clinics and hospitals that I work in or collaborate with, mission statements that I read on care facilities’ walls, pamphlets or brochures, presentations that I listen to, or professional conversations and forums that I participate in – almost everything that is "out there” frames professionals as the carriers of knowledge/wisdom and providers of services vis-a-vis patients/families who are relatively passive.

It is my (and several of my colleagues’) opinion that the greatest untapped resource for improving health care is the knowledge, wisdom, and energy of individuals, families, and communities who face challenging health issues in their everyday lives (Doherty, Mendenhall & Berge, 2010). Consider, for example, the following questions: How does somebody recently diagnosed with diabetes really overhaul his/her lifestyle (and stick with it) across diet, physical activity, and disease management- arenas? Where is ‘the line’ between supportively reminding someone to check blood sugars and being a ‘nag’? How can a partner avoid burning out from supporting a mate whose pain is chronic and progressive and whose complaints are never-ending? How does a partner attend to his/her own health and needs as his/her partner continues to decline? How do couples handle the sometimes intrusive roles of health professionals, social services and/or insurance companies?

Our system is set-up (and evolving) in a way that enables providers to talk with each other more than ever before, but patients still sit straight-forward in our waiting rooms reading outdated magazines in comparative isolation. Social prescripts keep their interactions superficial, and we are not allowed to encourage anything more. HIPAA laws restrict us from connecting a patient who has learned how to effectively manage a chronic illness with somebody who was just diagnosed and is struggling with a great deal of fear and ambivalence. Privacy mandates prohibit our introducing the spouse of a patient who has been taking care of her brain injured husband for 10 years to the spouse of another patient who just sustained a similar injury. Outside of structured group visits (which still tend to be top-down and expert-driven), opportunities for patients to share their wisdom are scarce.

Patients’ and families’ wisdom are similarly absent from many of our conventional methods of designing, implementing and/or evaluating interventions. We, as the professionals, decide what is important to teach, how to teach it, and what is important to measure. At a recent forum I was invited to participate in to discuss a clinic’s transformation to a "patient-centered medical home,” I was simultaneously taken-aback and not surprised by the fact that there were no patients at the table.

As large national and international organizations focused on health (e.g., Agency for Healthcare Research and Quality (AHRQ); National Institutes for Health (NIH), World Health Organization (WHO)) have systematically called for – and advanced funding to support – community driven and collaborative efforts to address complex health and social problems ill-suited for conventional top-down service delivery and research endeavors, community-based participatory research (CBPR) has been put forth as a way to partner with our patient communities – and thereby create and implement supportive care systems that neither providers/researchers or patients/families could create on their own.

Several key assumptions permeate CBPR projects, including: 1) recognizing that the community is the principal unit of identity; 2) partnership that is democratic and equitable between all project members (e.g., patients, providers, researchers) through every stage of knowledge- and intervention- development; 3) identifying and building on the strengths and resources already within the community; 4) promoting capacity-building and co-learning between and among project partners; 5) deep investment in change toward improving the lives of members in a community or practice; 6) an iterative process in which problems are identified, solutions are developed within the context(s) of the community’s existing resources, interventions are implemented, outcomes are evaluated according to what participants see as most important, and interventions are modified in accord with new information as necessary; 7) project members are both humble and flexible to accommodate changes as necessary across any part of a project; 8) disseminating new knowledge to and by all partners and constituents in the investigative process; 9) recognizing that CBPR can be slow and messy (especially during its early/initial phases); and 10) long-term engagement and commitment to the work (Bradbury and Reason, 2003; Doherty, Mendenhall and Berge, 2010; LaVeaux and Christopher, 2009; Mendenhall and Doherty, 2005; Scharff and Mathews, 2008; Strickland, 2006).

Care systems have slowly been experimenting with CBPR since the 1990s because of its ability to inform understanding of patients' experiences, generate or improve services, facilitate community outreach and engagement, enhance education and learning, and improve cultural awareness. These efforts have effected improvements in asthma, the management of preoperative fasting, patient problem-solving skills, dental and mouth care practices, overall physical well-being, patient-practitioner communication, and patient and practitioner satisfaction. My and my colleagues’ (Bill Doherty and Jerica Berge) work in Minnesota in "Citizen Health Care” (a model designed purposefully for medical and mental health professionals who work with families in community settings) has seen marked improvements in diabetes, obesity and smoking cessation (Berge, Mendenhall & Doherty, 2010; Doherty, Mendenhall & Berge, 2010; Mendenhall & Doherty, 2007; Mendenhall & Doherty, 2005; Mendenhall et al., in press; Mendenhall et al., 2010).

As we advance our efforts in collaborative and integrated care, it is important that we do not leave our patients and their families behind. Indeed, the greater vision of work done in this way is to create a model of healthcare, education, and outreach as work by and for its citizens, with all stakeholders – including patients and their families, physicians and other providers, researchers and administrators – working as active contributors.

At an early meeting in a project I am involved with that is focused on American Indian patients with diabetes, I shared how our group’s efforts were (are) advancing change in how health is embraced in the local community. One of the elders interrupted me and said, "This is for all of our people – here in Minnesota and across the country, and even the world.” As future efforts in this and related initiatives proceed, this vision of transforming health will serve as a sustainer of energy and commitment in the face of a formidable – but inspiring – mission.


Berge, J., Mendenhall, T., Doherty, W. (2009). Targeting health disparities though community-based participatory research. Family Relations, 58, 475-488.

Bradbury, H., Reason, P. (2003). Action research: An opportunity for revitalizing research purpose and practices. Qualitative Social Work 2: 155-175.

Doherty, W., Mendenhall, T., Berge, J. (2010). The Families & Democracy and Citizen Health Care Project. Journal of Marital and Family Therapy, 36, 489-402.

LaVeauz, D., Christopher, S. (2009). Contextualizing CBPR: Key principles of CBPR meet the Indigenous research context. Journal of Aboriginal and Indigenous Community Health 7: 1-25.

Mendenhall, T., Harper, P., Whipple, H., Haas, S. (in-press). The SANTA Project (Students Against Nicotine and Tobacco Addiction): Using community-based participatory research to improve health in a high-risk young adult population. Action Research.

Mendenhall, T., Berge, J., Harper, P., GreenCrow, B., LittleWalker, N., WhiteEagle, S., BrowOwl, S. (2010). The Family Education Diabetes Series (FEDS): Community-based participatory research with a Midwestern American Indian community. Nursing Inquiry, 17, 359-372.

Mendenhall, T., Doherty, W. (2007). The ANGELS (A Neighbor Giving Encouragement, Love and Support): A collaborative project for teens with diabetes. In The Therapist's Notebook for Family Healthcare, eds. Deanna Linville and Katherine Hertlein, 56-70. New York: Apex Press.

Mendenhall, T., Doherty, W. (2005). Action research methods in family therapy. In Research Methods in Family Therapy (2nd edition), eds. Fred Piercy and Douglas Sprenkle, 100-117. NY: Guilford Publications.

Scharff, D., Mathews, K. (2008). Working with communities to translate research into practice. Journal of Public Health Management Practice 14: 94-98.

Strickland, C. (2006). Challenges in community-based participatory research implementation: Experiences in cancer prevention with Pacific Northwest American Indian tribes. Cancer Control 13: 230-236.

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