In 1997, the Alaskan Congress passed a law that allowed Alaska Native people to obtain ownership and management of all Alaska Native health care services. That same year, the non-profit Southcentral Foundation took over primary care and other services located at the Anchorage Native Primary Care Centre, now serving a population across Anchorage and 60 rural villages.
During their visit, the team talked to us about their experience of this organisational change – the challenge of merging organisations (and associated relationships, culture and governance); the key elements of their delivery model; and how they measure and understand their success.
The innovative way they’d approached their mission impressed us, and I spoke to Katherine Gottlieb (President and CEO), to hear about how the team had improved the quality and adaptability of services as well as the accountability of providers and patients. Most striking for me were the lessons that we might learn regarding our approach to community engagement.
Katherine and her colleagues recognised the importance of working in partnership with all the different stakeholders they were trying to engage with and influence. They described the way they worked with clinicians from the medical centre and politicians in Congress, and particularly emphasised their engagement with local communities.
They did this in a far more interactive and responsive way than the community engagement we’ve seen through recent service reconfigurations in England. The Southcentral Foundation keep listening to what their community members are saying, go away to find ways of meeting their needs, and then return to feed back their progress. They have not always been able to achieve everything that members wanted, and had to be transparent and realistic about the limitations they were working with. But by listening, feeding back and being honest with their members, the local community understood that they were core partners in the transformation and delivery of care – ‘walking with’ the Southcentral Foundation through some challenging decisions.
Back in England, challenging decisions are being faced across the system, on a daily basis. Major service reconfigurations – such as those proposed in South London and Mid Staffordshire – are highly sensitive and attract considerable political, media and community interest, as the recent debate around clause 119 of the Care Bill showed. Alongside this, commissioners and providers up and down the country are giving serious thought to the way services are organised and delivered in order to improve quality, reduce costs and ensure services are clinically and financially sustainable.
The typical approach to community engagement on major reconfiguration is through a very formal and static process of consultation once an organisation is already in crisis, and options are limited. Local transformation or innovation is typically based on an understanding that commissioners or providers know what their population want, and they will design a model that meets these needs within the limitations of available funding and the capacity and willingness of providers.
We could learn a lot from the Southcentral Foundation about the way they have engaged with their community. In the time they spent at The King’s Fund, they never once wavered in referring to the people in their community as ‘members’. I’m not sure that we think about our communities in the same way? The health care system in this country – and all of us working within it – has a responsibility to the entire community, not just those people who happen to walk through the door. If we want to design and deliver services that meet community needs and avoid large-scale legal opposition to major reconfigurations, we need to ‘walk with’ local communities through these transformations.