Ben Collins talks to Melanie Binion, Senior Improvement Advisor at 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: So Melanie, you’re a customer owner here at Southcentral Foundation, but you remember the old system run by the Indian Health Service up until the late 1990s. Can you tell me a little bit about what you remember from those services?
MB: It wasn’t a friendly atmosphere. It wasn’t very clean. It was very rundown and it wasn’t very culturally orientated and they didn’t have family medicine back there so we had to go through the ER system and you had to wait and wait and wait and we were never treated as people, we were treated as a number, and you never knew when and who you were going to be seeing because of course it’s an Emergency Room – you always had the emergencies take higher priority and you never saw the same person twice of course, and then you could be there all night. You could be there until after midnight and, you know, it would be ten o’clock, midnight, one o’clock, two o’clock in the morning and I mean if you truly want to be seen, you wait there all night.
BC: Now across Southcentral, all of the staff I meet refer to what we would call their patients as customer owners. What does it mean to be a customer owner and why is this an important concept for you?
MB: I think it’s important because we own the system. Back in the day, we didn’t feel like owners. We didn’t feel like customers. We felt like just another number as I said, right? You didn’t feel like you had a say in what was happening, and as a customer owner, you have a voice. You have that opportunity to say, “This is what I want and this is what I need,” and you’re in partnership and a relationship with your provider and your provider team to say, you know, “I really don't think that’s going to work for me. Can we do something different?” And we have that discussion and figure out what’s the best plan to move forward. And again, it’s about ownership and responsibility. We took on the system in 1999 and said that we wanted to own it and I think we need people to say that we are the customer owners.
BC: So as the customer owner, can you really influence how services are delivered and where resources are spent in your system?
MB: Yes, I believe so. We have many different ways that we do that – through listening posts and through different voices in the departments but also our employees are customer owners, right? I’m a customer owner. I work in the organisation. I work in a position where I can help drive change and I can have those conversations with department leadership, executive leadership, senior leadership to say, you know, “We need to do something different or this is going well, we need to replicate this elsewhere,” and really have that voice to make that change.
BC: How have customer owners really changed how services are delivered?
MB: So again, the services… we listened to the customer and we heard what they had to say and so we implemented many different programmes across our organisation – traditional healing’s one of them. Tribal doctors – they’re working hand in hand with our primary care providers. So again, western medicine with traditional medicine. We have a traditional healing guardian that they can easily have that conversation with customers to say, “Here’s some other ways to think about doing healthy things.” We also have the RAISE Programme. We have a tobacco-free campus. We were the one first of the facilities or hospitals in the Anchorage area to go tobacco-free on campus.
BC: And these were all ideas that came from customer owners?
MB: All that came from customer owners, and that feedback that we have and our listening posts and everywhere that we can hear, we’re listening and we do what we can.