Katherine Gottlieb: Engaging the community and the workforce in redesign

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  • Posted:Wednesday 18 November 2015

Ben Collins talks to Katherine Gottlieb, President / CEO of Southcentral Foundation, about the 'Nuka' system of care they use in Alaska.

This video was filmed while Ben was in Alaska as part of his research for a report.


BC: Katherine, Southcentral has developed what you call the Nuka model of care. What does Nuka mean and why is this concept so important?

KG: Well we received the title because Nuka’s being used across Alaska for giant living and breathing things like mountains and rivers and it’s a name that’s tossed around in the Alaska community for things that are loved. People always ask us what can they do? What is possible to duplicate in a healthcare system across a nation or a global world and what’s similar to us that could be duplicated? The way we built our buildings – part of our infrastructure – was to look at our community, see what was of value to them and then build the infrastructure – the buildings. So first and foremost, it would reflect our culture and as you see our buildings – if you walk around them – you’ll see our native culture in place, native arts and crafts, the colours are tied to the environment, there’s a feeling and sense of openness, very transparent, the walls are down, lots of window space and materials that are built from our environment. And the sense about that was as our community would come in to receive the services, they would feel a sense of ownership. So the beginning of a healthcare journey for our population and what we thought was help our community to own their healthcare system and if they’re going to own their own their healthcare system, they should feel it when they first walk in the door. But not only that, they should feel a sense of healing and of a sense of ownership and a sense of honour.

The buildings that were in place prior to our assumption didn’t have that sense and feeling. They’re structured around government ownership. So the colours were green and yellow, and the facilities were not… The priority was not on the facilities. So we walked in the door, it had not a good smell. The walls were cracked. Floors were cracked, and you felt like you were entering some kind of sanatorium instead of a place of healing. So one of the best comments we had back on a survey from our customer owners after we built our buildings was that they began their healing journey from the moment they stepped into a building. We were inheriting employees overnight that had worked in a government system. If you’re going to move towards an organisational structure and change of an entire employee community, somehow, someway you have to get them to look at there’s a big change happening and not bring them through that change where they’re fatigued or they get discouraged or they don't feel a buy-in into the process. And so right at the very beginning, we had our employees who transferred from a government system into our system knowing already there was change and the change and feeling and sense is that you get to have say – if you work for our organisation – in even the structure and the place you’re working, the environment that you’re in.

So we’re sitting in the traditional healing section of our primary care system and this was designed by our traditional healers. So they had input into how it felt and what it looked like.

BC: Now one very striking feature of Southcentral for an English observer is the facilities. Another really striking feature is the investments that you’ve made in staff. So I understand that staff here have eight weeks of solid training before they can join the front desk at Reception. Why have you made those very substantial investments?

KG: So we knew from customer owner satisfaction surveys what they wanted and what they wanted changed, and part of the change that our population wanted was how to be treated with respect, to be able to have say in their journey of our wellness and not be left out. Most employees that work with us are at the level of delivery of care, our doctors and nurses and proprietors in that way, and so our investment in our employees was meaningful again – just as it was towards building our building. The investment meant we were going to take employees that used to work for the government and then potential new employees and we had to set the tone for where and what they were going to do. We not only surveyed our customer owners about what they wanted. We asked employees, “What do you want? How would you like to be a part of the redesign? What would you like to see?” and gave employees options about those changes and then listened to what they had to say.

So we built means and ways for employees to be involved in every aspect of change within the organisation. How many employees or how many organisations have access to their leadership, the governance level and their CEO and their Vice Presidents with the ability to implement change within their own work environment? We didn’t ask them once. We ask them every year, “What is it we’re doing well?” listening to their feedback and then having them involved in the decision making process. We invest in employees so many ways. We provided infrastructure where they can see their measurements and their outcomes. It isn’t about asking employees to do something or achieve a mission and vision but we gave them tools on how to achieve the vision and mission so that every employee knows through a work initiative how they’re being able to do that, and then not stopping there, we keep giving data, we keep giving information back to them about what they’re achieving and how they’re achieving it.

BC: And finally Katherine, you’ve visited the UK, you know a little bit about our system. What would be the single most important piece of advice that you might give our leaders as they embark upon major transformations of their own?

KG: I would hope everybody has the same vision and knows how they’re going to achieve that through their mission and have all their leadership – whoever that is – in the room agreeing to it. For me, as you do organisational change, sustainability, paying attention, don't move from the direction you’re trying to go, back those successes as well as failures. I think feeding back to your population, your community about what you’re doing. When you go under construction and you walk into a building, there are signs everywhere and there’s signs that say, “Oops, we apologise but right now this place is under construction. Please bear with us,” and if your community doesn’t understand that you’re trying to effect change and that it’s going to take a while and they don't understand where you’re going, you lose that backing of those 65,000 voices that we have. But if they know, if your governance knows and your community knows what you’re up to, what you’re trying to achieve and you feedback little successes – even if it’s one or two or five things you heard your community say they wanted and you achieve those and you feed it back to them and your governance, the next time you ask your community, “Are you doing well? is there something else we can do?” They’re going to respond and respond and say, “We hear you. We hear you asking. We believe in you. We trust you, and we understand you’re under construction and it’s going to take time,” and then you have those moments of pause that you can have to do that reconstruction in a real good manner instead of trying to rush it, trying to change something quickly that might not work.

BC: Katherine, thank you very much.

KG: You’re welcome.


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