Integrated Care: Making it Happen

“I have been meeting with the rest of the leadership and integrating physical and mental health seems to be what we are going to be implementing first. Last week’s meeting was very helpful, and we already have started looking at the best way to get everyone’s buy-in and see how to build the best and most robust multidisciplinary team. What else do I need to know for the most successful implementation of integrating physical and mental health services in our agency?”

Doris, as usual started her meeting, providing an account to Rodis, the consultant. You met Doris in the first article, entitled, Integrated Care: Operationalizing it. In this article, Doris was feeling overwhelmed after she had been asked to lead a project on Integrated Care. She had no idea where to start. Rodis, started with the basics, the fundamentals, including operationalizing “integrated care.” Because of the lack of uniformity and of a clear definition of such an important concept, it was important for Doris to get this first step right (See above cited article for details).

Operationalizing “Integrated Care” was “food for thought” for Doris, as she put it. It led her to start to ask questions, more specific and direct questions, which then set the stage for her to continue to learn the process of such a and noble project, that of establishing integrated care services in her agency. Rodis then started to meet with Doris on the how of integration of care, on how to make it happen, beginning with the integration of physical and mental health. Rodis gave an overview on integration of physical and mental health, and started talking about two of components required for a successful implementation: 1. The need for an agency-wide buy-in and contribution; and 2. The need for a multidisplinary team (See previous article entitled, Integrated Care: The How: Making It Happen, for details.”)

“We talked about the need for convergence in your agency and the need for a robust multidisciplinary team. Let’s use the little time that we have today and delve into what you require to have a robust team as you prepare for a successful implementation of the integration of physical and mental health services in your agency,” explained Rodis.

From: Collaborative Family Healthcare Association

A team coordinator

Not a team leader, but someone to help coordinate the operations of the team. This includes scheduling of staff, services, and patients. This coordinator will have his or her hand in both worlds-that of clinical and that of administrative. A coordinator with no clinical background may not have the inclination to use the critical thinking required to solve issues that may require last minute decisions, and that may mean life and death, at times. As you move into the selection of such a person, it is important to keep in mind that it is easier to teach a clinician administrative skills, then to teach clinical skills to an administrator.

A diverse team

Diversity in terms of skills, demographics, psychographics, clinical background, interest, personal and professional development, language and cultural sensitivity. In this vein, a diverse team will include a primary care physician, who may be a family practionner, or an internist; a psychiatrist, a therapist, a case manager, a nurse, a medical assistant, a peer specialist, and social service worker, all of who will be assisting with psychosocial stressors and social determinants of health.

Leveling

A team will not be able to function cohesively unless there is gap filling and leveling. The team members with no medical background need to learn the basics of medical practice. The members with no social services background need to learn the basics of social services. They will build and develop knowledge from each other while maintaining their expertise on the team. Leveling takes places during multidisciplinary team meetings; case conferences; and formal trainings, seminars, and workshops on integrated care as well as a numerous other trainings and workshops that the team will attend together and were a system-based approach will be honed.

“In addition to the buy in from all members of the agency; and having a robust multidisciplinary team, to build the most functional team possible, it is essential to pay attention to the following three components:

1. Having a team coordinator with a clinical background;

2. Having a diverse team; and

3. Leveling.

Now it is time for us to look at the other categories of integrated care, and this will be done next time we meet,” concluded Rodis.

References:

1. Brennan BR, Brunisholz KD, Dredge C, et al. Association of integrated team-based care with healthcare quality, utilization and cost. JAMA. 2016; 316(8):826-834. doi:10.1001/jama.2016.11232

2. World Health Organization. People-Centered and Integrated Health Services: An Overview of the Evidence: Interim Report. Geneva: WHO Document Production Services; (2015).

3. Briggs CJ, Garner P. Strategies for integrating primary health services in middle-and low-income countries at the point of delivery. Cochrane Database Syst Rev (2006) 1:2.10.1002/14651858.CD003318

4. World Health Organisation. Integrated Health Services – What and Why? Technical Brief No.1. Department of Health Policy Development and Services. (2016).