Lessons Healthcare Execs Are Learning About Cross-Sector Partnerships
Many healthcare organizations are trying to form partnerships with people in other sectors to care for patients with complex needs. But building trusting relationships across sectors takes time and a commitment to shared project leadership. Shelly Trumbo, community integration vice president for Adventist Health in California, recently shared four key lessons learned in her work on the Project Restoration Collaborative in Lake County, Calif.
During a Nov. 5 webinar sponsored by the Camden Coalition's National Center for Complex Health and Social Needs, Trumbo described some of the challenges Lake County faces: Besides high poverty rates, residents also face fire devastation, lack of affordable housing and employment opportunities, and widespread addiction. These issues have stretched the limited resources of the response system in the rural community.
Trumbo said Adventist had been very focused on clinical population health efforts and measures. “We realized if we wanted to make a difference, we had to step outside the four wall of the hospital,” she said. That is not always a comfortable feeling, she added. It takes discipline for a health system to learn how to share power with community partners. In a sense, it is counterintuitive that the way to improve outcomes is to build trusting relationships with community partners and focus on their goals. Project Restoration came about because all kinds of different agencies and roles came together: the hospital, city and county leadership, the sheriff, jail, and faith community.
A traditional approach might be to e-mail 50 community partners and expect to get buy-in and engagement, but Trumbo said the work will only accelerate at the speed of trust. You have to invest time on in-person invitations, and do the work to define the outcomes so that they truly reflect the goals of everybody sitting around the table. “The best statement of success would be if multiple partners believe they owned or started the initiative,” she said. In fact, Project Restoration did not start with the healthcare system. It started with the mayor of Clearlake convening conversations with community leaders and happening to invite healthcare leaders to join.
Trumbo recently co-authored a paper in the Journal of Interprofessional Education and Practice about Project Restoration, a multi-stakeholder, cross-sector model of intervention. The paper notes that the collaborative “began its work by analyzing data from a range of service providers to understand the population. From that data, they identified shared metrics across sectors to measure success, created an intervention model with community agencies, and developed a centralized infrastructure to translate lessons learned from individual patients into process improvements for the community.”
“Early on, we identified outcomes that partner organizations were required to report on,” Trumbo said. “Every partner had a data point that mattered to them.”
The paper noted that the collaborative approach was associated with a 44 percent reduction in hospital utilization, an 83 percent reduction in community response system usage, and a 71 percent reduction in costs for the population. They also saw an increase in primary care visits, an indicator of improved appropriate care usage.
Trumbo ended her presentation with four lessons learned in this effort:
• Community: Hospitals and health systems have to force themselves outside the walls of the hospital or clinic and into the community.
• Constraints: The tendency is to want to go big with these projects and make bold claims about changing the trajectory for 1,200 homeless people, but Trumbo said the discipline of starting small is important. “People are often afraid to move forward when we talk about really big numbers, but what if we pilot it with one person and see what happens? Then you can frame it larger and larger. Start under the radar and manage expectations. Instead of wide and shallow, go narrow and deep. Get momentum.” Trumbo responded to a question about restraints on funding by noting that it is true that if you are going to expand into innovative spaces, you need new funding. “But we already had case managers from three agencies helping these people. Let’s just have a conversation about aligning that work,” she said. “We are doing the work already. Let’s talk about doing the work more thoughtfully.”
• Communication: She said she can’t overemphasize communication and changing the way you talk about partners. Prioritize responsiveness and follow-up. You have to check your own ego and also make sure the health system isn’t hogging the credit for any progress being made.
• Context: There is no way we can begin to address these challenges as one agency or two, she said. You have to take an ecosystem approach if we are going to make a dent.
