From time to time I will invite guests to write for this blog. I am delighted that my first guest contributor is Bruce Swan, an executive coach with more than 30 years experience as a senior executive. While president and CEO of several health organizations, Bruce used a coach's approach to leadership. Bruce and I team up for the delivery of workshops and coaching services—and on these pages, of course—because different perspectives on leadership allow for more learning and better progress.
By developing coalitions in health care, you can enhance a system’s capacity to integrate services, reduce wait times and increase efficiency. For such coalitions to work, two ingredients are required:
As executive director of Mental Health Services for Calgary—a joint appointment between Alberta Mental Health Board and the Calgary Health Region—I had the privilege of leading a team that built a successfully integrated mental health system. We did it by establishing a broad coalition of 41 partners that provide mental health services to Calgary and its surrounding area. The partners came from education, supportive housing, health promotion, self-help groups, hospitals, medical clinics and private industry .
The task from the Ministry of Health to each health authority came in the form of two simple directives—reduce wait time and increase access.
The team’s first task was to answer the question, “Who do we serve?” This lead to numerous conversations with stakeholders, clients and service providers. Views ranged from a more narrow definition of serving the severe and persistent mentally ill, to more of a systems approach—looking at mental health from a population health perspective. The result was a new vision and mission for Calgary’s Mental Health Services namely - “A Mentally Healthy Population,” and new mission, “To boldly build a comprehensive, responsive network of mental health services with innovative stakeholder partnerships.”
By taking the population-health perspective and a system-level approach to mental health, the team could utilize Accreditation Canada’s definition for continuum of care to build a platform for the new mental health system. Using this platform the team designed and built the mental health continuum of care, which included Prevention and Promotion, Early Intervention, Crisis Intervention, Acute Inpatient, Basic Treatment (focused Core Services), Specialized Treatment (Tertiary), Rehabilitation, and Sustain and Support. The mental health continuum of care covered all age groups, from children and youth to adult, seniors and geriatrics.
The mental health continuum of care provided a road map for the participants and fostered their buy-in. They were ready for the next steps, which was to take the mental health continuum of care and overlay the various services provided by each partner. This layered approach allowed the partners to clearly see who was doing what. It also highlighted where overlap and duplication existed.
In order for this approach to work it was extremely important that each partner not be threatened with loss of funding, profile or service. The team approached the task with the attitude that the sum of the parts is greater than the whole; that we are all working together to reform healthcare in order to reduce wait time and increase access to service. The attitude was that each organization has a piece of the mental-health pie and contributes to the continuum of care for the population. Over time, what each organization would do with their piece of pie might change—due to innovation and integration—but their funding envelope would not be threatened. This built the trust needed to move forward.
What were the results?
“Until I saw the Association of Self Help plotted on the continuum of service template, I was sceptical of the integration process,” said the executive director Marion McGrath for the Association of Self Help, a contracted service. “Now I believe our association is part of the continuum. We feel we are part of the planning for the future in Calgary”.₁
The plan, in fact, allowed for better use of resources. “A shift in management thinking and practice as the Continuum of Mental Health Care has caused managers and leaders to think systemically, to recognize they are not in mental health service delivery alone, that there are other elements along this continuum that provide care and service to clients.”₂
For example, a central intake for Mental Health Services was developed as a result of this collaborative. Child and Adolescent service went from 12 intake points to one and in Adult mental health service went from 30 to one. This allowed for a realignment of resources from 42 points doing duplicate work to utilizing that resource in a different way by providing more direct service. By providing a shared care approach to family practice, where a mental health team supported the family physician with mental health clients, the number of patients admitted to hospital from doctor’s offices dropped by 50% over a period of two years.
And all this collaboration relies on good communication. “Increased communication among stakeholders, internally and externally to the Calgary Health Region, is what is working best with the model.”₃
What were the lessons learned?
Understand that it takes time to build trust when working with coalitions. The funding—how funding is allocated and how decisions are made around funding allocations—is a significant part of building trust. Transparency is the key to moving forward and getting buy-in on how funding decisions will be made. This all sounds good from a theoretical perspective, but putting it into practice is a significant challenge. We were successful in tabling a new operating budget for mental health that had signoff from all the partners. In addition, we requested new funding, the majority of which went to community agencies and supportive programs. The budget came from working through the coalition of partners, who put systems issues on the table as a priority—a process that virtually eliminated internal stakeholder competition.
1 ,2 and 3 Swan, Bruce H. A model Structure Utilizing the continuum of Mental Health Service to promote integration, build new partnerships and collaborative practices for Mental Health Service Delivery, Calgary Health Region, prepared for the Canadian College of Health Service Executives – Fellowship Thesis, 2004