What the heck is a "learning community?” The definition we
are using is: a group of like- minded individuals working
together to learn what’s working, what’s
not working, and how to change our systems
to be more collaborative.
This collaboration is necessary with patients, families, health care
teams and systems.
Management consulting guru, Peter Vaill,
describes the constantly changing world we are in as being in "constant white
water”. There are no pools to
recover and rest before the next set of rapids.
We just need to learn how to paddle the boat better through the white
water of change. Rather than just
working harder, Vaill proposes strategies of working smarter, specifically
working "reflectively smarter” and "collectively smarter”. The learning community model uses both
strategies. The integrated care "river” is moving forward all over the
country. In the aftermath of the
election and the move towards population-based "accountable care
organizations", we all need to work "collectively smarter.”
"There are no pools to recover and
rest before the next set of rapids.
We just need to learn how to
paddle the boat better through the
white water of change."
There are other organizations using this strategy. For example, The Institute for Healthcare
Improvement (IHI) sponsors ” learning collaboratives”, bringing in hospitals, clinics and other
organizations to provide technical assistance for their change efforts. The National Council of Behavioral Healthcare
sponsors learning communities among behavioral health organizations, which
provide integrated primary care health services for the severe and persistently
We need to look for partners in our local systems and in our
geographic regions to share sustainable models, influence new policies, and
collect mutually agreed upon data to discern the impact of different models of
care. CFHA has been a leader in conducting national meetings held in regions
where there is strong interest and activity in integrated care. Each of the meetings has held a local
"summit” that has brought together leaders from the region to learn together
and ideally create integrated care workplans.
We know that many folks from other parts of the country think that in
New England "good fences make good neighbors”,
but our experience with integrated care has shown this not to be
true. We have created a steering
committee and workgroups around training, advocacy and quality improvement with
representatives from Maine, New Hampshire, Vermont, Massachusetts, Rhode
Island, and Connecticut. We have had
monthly steering committee phone calls, two face-to-face meetings, and plans
for more to work on projects of common interest in the region. These projects are in the areas of training,
advocacy, and quality improvement.
There is another organization, the Family Medicine Education
Consortium (FMEC), whose mission is to move important primary care health
projects along and to promote family medicine.
The goals of FMEC and CFHA overlap around integrated behavioral health
care. The two organizations sponsored
two preconferences in the fall of 2011 and 2012 on Supporting Sustainable
Integrated Care. The 2011 meeting kicked off the New England Learning
Community. The 2012 meeting in
Cleveland, Ohio set the stage for a state-wide Ohio Learning Community and
planted the seeds to bring together the 4-5 Pennsylvania integrated care
state-wide organizations in the fall of 2013.
The Ohio proceedings included
lessons learned from providers, administrators, funders, and foundations.
Jennifer Hodgson started the meeting with an overview of the impact of the
Accountable Care Act on behavioral health integration and the cutting edge advocacy work taking
place in North Carolina. The panelists
and discussions were very dynamic. The meeting ended with learning community
strategies for the states represented at the meeting. The Ohio group has
created a listserve and is approaching a couple of groups in northern Ohio to
"house" a state-wide learning community, connecting it to the good
work of Janice Bogner and colleagues at the Health Foundation of Cincinnati
Susan Labudo-Schrop at the University of Ohio College of Medicine Family
Medicine Department (NEOMED).
One of the surprise outcomes of this Ohio meeting was
identifying the North East Learning Community Theme Song. We had not yet read Randall Reitz's blog
regarding a theme song for the CFHA. So, although we "ain't got much
money", we do have fun AND a theme song!
If you are at all curious, click here to view the original Youtube
version. We really like the chorus. It's
catchy, great to dance to. Yet we need to rewrite the rest of the lyrics As with behavioral health integration, we
aren't satisfied with the traditional organization of the song. An integrated
care transformation is needed to benefit patient satisfaction, clinical
outcomes and cost! Maybe selling the
rights to the new lyrics will bring in money to support our efforts. Stay
In southwest Virginia, another regional effort is taking place,
sponsored by Radford University and the primary care clinics in that area. Cathy Hudgins and Bill McFeature have
organized an annual conference and provided technical assistance to clinics and
behavioral health organizations in that area.
Through the North East, our hopes are to connect these
efforts: informing our care, strengthening our ability to learn from each
other, uniting to influence policies to improve care, and "taking it to the streets". We have
an assumption that there are many more efforts local and regional efforts to
promote integrated care and we hope this blog will encourage others to let us
all know what you are doing.
Bill Gunn PhD is a
faculty member of the NH/Dartmouth Family Medicine Residency in Concord, NH and
holds a clinical appointment at Dartmouth Medical School. He is a
board member of the Collaborative Family Healthcare Association. Bill is a co-author of Models of
Collaboration (2006) and The Collaborative Psychotherapist (2009).
He coordinates with Julie Schirmer, LCSW an integrated care "learning
community” in New England which meets regularly. He is membership co-chair of CFHA, and
co-chair with Nancy Ruddy, PhD of the Division 38 primary care subcommittee.
Julie Schirmer, LCSW is Director of Behavioral Health at the
Family Medicine Department of Maine Medical Center and Assistant
Director of the Family Medicine Clerkship at Tufts/Maine Medical Center
School of Medicine. She is Co-chair of the North East Regional
Integrated Care Learning Community, Past President of the Family
Medicine Education Consortium, and upcoming Director of the Behavioral
Science/Family Systems Educator Fellowship of the Society of Teachers of
Family Medicine. She is author and co-editor of Behavioral Health in Primary Care: A Global Perspective(Radcliffe, 2010).