Mahatma Gandhi’s familiar quote, challenging us to be the change we want to see in the world, speaks to both the need for a vision and the willingness to lead. But what does that mean among the chorus of voices in health care? In what direction can we set off and expect the best result?
The work at the Center for the Health Professions is characterized by articulating a vision for a sustainable and accessible health care system, optimizing change processes for lasting improvements at health care organizations, and creating an influential nationwide network of leaders. The ultimate goal, and our mission, is to transform health care through workforce research and leadership development with innovative and collaborative approaches.
In this final article of our series commemorating the Center for the Health Professions’ 20th anniversary, we have arrived at our most recent past, the previous 5 years. What have we done to meet this challenge of being part of the change that we want to see in a new era of health care?
With the constitutionality of the ACA now in the rear view mirror, the national focus turns to the opportunities and challenges before us. Expensive, unwieldy, and inaccessible to some, it is indisputable that the U.S. Health Care System needs a strategy to move us forward. The ACA focuses critical attention on the nation’s health care workforce and the role it plays in cost, quality, and access to care. Here at the Center, we have taken these challenges to heart and they have been the foundation of our work.
The ACA brings mandates, subsidies, and tax credits all aimed at increasing the number of insured in the U.S. and reducing costs to the system and the consumer. One of the critical challenges will be ensuring that we have the health care workforce to meet the increased demand. While researchers don’t yet fully understand the depth of the connections among the health workforce, access, and quality of care, we know there are data gaps, bottlenecks, and areas that need expansion, innovation, or adaptation to meet the nation’s needs. Across the country, health professionals are maldistributed, resulting in shortages in some areas and surpluses in others. Existing datasets are not standardized across the health professions and contain significant gaps. The health professions overall do not reflect general ethnic and racial diversity. For many aspiring health care workers, the more affordable training programs are backlogged, sometimes resulting in individuals spending years on waiting lists to attend. Practice models are evolving and using health workers in new ways and in new team configurations.
In the past five years, the Center has pursued research in these areas that has enriched the state and national dialogue. On a macro level, we have researched health care systems, new practice models, emerging technologies, primary and specialty care, long term care, and the needs of chronic disease care. The Innovative Workforce Models in Health Care program seeks to identify new models of care that include expanding the role of medical assistants on the primary care team, and to inspire and foster replication of these models. Similarly, the need for increased accessibility and effectiveness of the oral health care delivery system has resulted in alternative practices for dental hygienists, and the exploration of collaborative practice models in dentistry. Our work on the use of emerging technologies, including IT integration in rural hospitals, online clinical placement systems for nurses, and the effects of organizational culture on the implementation of computerized patient record and medication systems in the VA, can inform the costly infrastructure investments being made around the country.
In planning future health care policy and infrastructure development, leaders in government, education, and industry need current forecasts of workforce supply and demand and a clear understanding of the potential and actual implications of health care regulation. Drawing on years of experience, the Center has played an important role in the policy arena. Center staff were part of a team of experts that worked on the Institute of Medicine’s 2010 Future of Nursing Report, which is being used to transform state practice acts, update educational programs, and transform practice. Center staff were also instrumental in developing recommendations for updating California’s telehealth law, AB 415, which passed in 2011. The Center has established a place for itself in exploring new approaches to health professions’ scope of practice in California and beyond. Some other examples of the Center’s policy work include a 2012 report on the impact of eliminating adult dental benefits from Denti-Cal, an evaluation of California’s mandated nurse-to-patient ratios, analyses of California’s nursing shortage, an issue brief on medical assistant scope of practice in California, and the potential health care career opportunities for returning military personnel. In 2011, the Center also published a comprehensive report regarding California’s capacity and readiness for the ACA.
Our country’s growing population and increasing diversity necessitate expanding language access, improving cultural competence/humility, strengthening the capacity of existing underrepresented minority health professionals, and increasing diversity in the health professions educational pipeline to develop a workforce that can truly serve all the nation’s people. This push is especially critical as we prepare to meet the anticipated influx of new patients into the health care system resulting from ACA implementation. Very few of our dental providers, for instance, are African-American, Hispanic/Latino, or American Indian/Alaska Natives. Center researchers are involved in a groundbreaking project to study their practice profile and needs. Men of color in particular are significantly underrepresented in the health professions education pipeline. Research findings used to develop strategies for improving this situation appear in the form of an issue brief called Men of Color in California’s Health Professions Education Programs. In 2012, the Center also published a two-part guide, Bringing Equity Into Quality Improvement, to provide both individuals and organizations with practical approaches to integrate health equity into quality improvement efforts.
With a vision of where we want to be and what key pieces of the puzzle we need to get there, we come to the next logical question – who will be the leaders and the innovators to make the changes happen and keep us on the path? There are health care workers at the epicenter of where change needs to happen, ready and willing to lead the charge; they simply need the tools to do so.
Engaging a variety of key stakeholders and funders over the past 20 years, the Center has cultivated a network of health care leaders through programs aimed at training participants to create and lead change within their organizations. We have created a strategy for developing leaders around four interrelated core leadership dimensions - People, Purpose, Process, and Personal. The art of leadership development is blending these four domains into a program that meets the immediate needs of the participants and stretches them to address the longer term needs of the institution.
Building human capital in leadership is often undertaken with a team approach. The 2011 San Francisco Quality Culture Series (SFQCS) was as a year-long collaborative learning program for safety-net clinic management teams, aimed at building their improvement capacity and skills as leaders of dynamic primary care practices. Funded by The California Endowment, ACTION was a multi-year effort aimed at building the capacity of health care organizations to provide equitable care by catalyzing efforts to improve health equity with funding and technical assistance, and improving access to needed information, tools, and solutions.
Targeting the development of individuals empowers leaders to initiate and maintain organizational change through strong interpersonal skills and change management acumen often not provided in traditional health care training programs. Creating a powerful, diverse network of fellows with whom these individuals can collaborate, then elevates the scope and potential for change beyond individual organizations. One of the longest running leadership programs at the Center, the California HealthCare Foundation (CHCF) Health Care Leadership Program, is a two-year fellowship that offers clinically trained health care leaders the experiences, competencies, and skills necessary for effective vision and leadership of our health care system. Targeting emerging hospital leaders, the interdisciplinary Change Agent Program (CAP) began in 2009 with a grant from the Gordon and Betty Moore Foundation. Its mission is to equip frontline workers and managers at acute care hospitals with the change management skills needed to affect and sustain positive organizational change – regardless of their position. Community clinics and health centers are increasingly important as we seek to enhance primary care capacity and accessibility. The Blue Shield of California Foundation has partnered with the Center to administer the Clinic Leadership Institute (CLI), a multi-disciplinary program that provides training and leadership development to emerging leaders at community clinics and health centers.
Many of the Center’s leadership programs are crafted to specific disciplines. The Institute for Physician Leadership (IPL) and the IPC Fellowship for Hospitalist Leaders work to inspire and develop physician leaders. These programs create exposure to a network of colleagues from different organizations, care delivery models, and practice settings. In early studies of the nursing shortage, the Center identified institutions that successfully recruited and retained nurses and had better than expected patient care outcomes. Funded by the Gordon and Betty Moore Foundation, the Integrated Nurse Leadership Program (INLP), developed Bay Area hospital leaders and provided them with the tools to address nurse retention and patient safety through strategic planning at their organizations. Part of this effort included a two-year INLP patient safety collaborative aimed at reducing sepsis mortality rates among nine partnered Bay Area hospitals. Similarly, the Regional Nurse Network (RN2) created a network of thousands of grassroots nurses who actively share resources, teach, and learn from each other.
Though often in the background, pharmacists are responsible for developing, implementing, managing, and collaborating on many complex services and activities that contribute to quality, patient safety, and cost-effective performance of health care systems. Since 2003, the Pharmacy Leadership Institute (PLI) has provided research, networking, and leadership development training programs to pharmacists.With similar aims, the more recent Medication Safety and Leadership Program (MSL) placed an emphasis on the power of grass roots efforts by practitioners to improve patient safety. There are many other health care disciplines in addition to those mentioned here that play critical, often invisible roles in our health care system. Continuing efforts to expand this type of leadership development will be vital to maintaining momentum on changing health care from within.
At the Center, we want to see a sustainable and accessible health care system in this country’s future. The past five years have brought many changes to our economy and our health care system. So where do we go from here? The human capital to make the change we all want to see in this country exists. However, emerging leaders need our support. The Center will continue to use different modalities--reports, issue briefs, testimony, leadership development trainings, workshops, peer reviewed journal articles, networking, technical assistance, academic teaching, presentations, participation on state and national workgroups and committees –to spread best practices and inform educated debate. As we go forward, we thank our many funders, supporters, partners, and participants and look forward to many more decades effecting the changes we hope to see.