Creating a Boundary-Spanning Workforce of Health

Over the past year, our newsletters have focused on the efforts of the Foundation and state and national leaders to transform health care.  Success in these efforts will, in part, be measured by the transformation of our current and future workforce.  Recently, NCFAHP hosted a national webinar with 3RNET, the National Recruitment and Retention Network discussing workforce needs in the current environment, New Models of Care and their Impact on Rural Workforce.

Dr. Erin Fraher, Ph.D*  framed the conversation with her presentation:  “The Workforce Needed to Staff Value-Based Models of Care”.  According to Dr. Fraher, new roles are emerging to provide enhanced care functions.

Dr. Fraher suggests that two of the common new roles are:

• Roles that focus on coordinating care within a health care system
• “Boundary spanning” roles that coordinate patient care between health care system and community-based settings

Improving patient care and population health is dependent on “boundary spanning.” It’s one thing to create a descriptive title for the process and quite another to engage the workforce in the process. Change is never easy. Yet, to Dr. Fraher’s point we need to “Plan to provide a workforce of health not a healthcare workforce.” Additionally, she makes the following points regarding boundary spanning roles.

• Workforce planning efforts that include workers who typically practice in community and home-based settings
• Embracing role of social workers, patient navigators, community health workers, home health workers, mental health workers, dieticians and other community-based worker
• Integrating health workforce and public health workforce and planning

Hmmmm, this sounds vaguely familiar… Our May newsletter focused on Accountable Care Communities, which are defined as: “a collaborative, integrated, and measurable multi-institutional approach that emphasizes shared responsibility for the health of the community, including health promotion and disease prevention, access to quality services and healthcare delivery.  The ultimate goal of the ACC is a healthier community.”  (Healthier by Design: Creating Accountable Care Communities)

At the Foundation, we are impatiently awaiting the release of the Accountable Care Community model by the CMS Innovation Center.  Fingers crossed, it will provide the opportunity for uniquely partnering these “boundary spanners” together with a payment model to support the work.

Again, in a previous newsletter, Dr. Jerome Grossman and Dr. Jason Hwang’s “The Innovator’s Prescription: A Disruptive Solution for Healthcare” presents a compelling argument regarding the common sense of a “boundary spanning” workforce of health, “Consider this equation, 2 + 8,758. These numbers reflect the hours spent annually by each of us on healthcare during the year. Two hours is the amount of time people spend annually in a traditional healthcare provider’s office, versus 8,758 hours spent on self-care.”

In the article “New Project? Don’t Analyze‑Act!” from the March 2012 edition of the Harvard Business review, authors Leonard A. Schlesinger, Charles F. Kiefer, and Paul B. Brown make this point regarding new endeavors:
“We acknowledge that action before analysis, learning instead of predicting, can be, well, unpredictable—and messy. And we concede that it’s antithetical to the way most organizations work. However, in the long term, taking lots of small steps actually reduces risk, which makes such an approach ideal for tackling challenges and getting fledgling initiatives off the ground, particularly in today’s skittish corporate environment.”

Perhaps with “small steps” we can create a boundary spanning workforce of health.  This newsletter describes some of the “small steps” at the Foundation. The team at NCFAHP strives to be entrepreneurial leaders. I would also call the Fellows boundary spanners in their own communities.  Finally, from the same article:

“Entrepreneurial leaders are individuals who, through an understanding of themselves and the contexts in which they work, act on and shape opportunities that create value for their organizations, their stakeholders, and the wider society. Entrepreneurial leaders are driven by their desire to consider how to simultaneously create social, environmental, and economic opportunities. They are also undiscouraged by a lack of resources or by high levels of uncertainty. Rather they tackle these situations by taking action and experimenting with new solutions to old problems. Entrepreneurial leaders refuse to cynically or lethargically resign themselves to the problems of the world. Rather through a combination of self-reflection, analysis, resourcefulness, and creative thinking and action, they find ways to inspire and lead others to tackle seemingly intractable problems…The only way to lead in an unknowable environment is through action.”
The Bernstein Fellows are entrepreneurial leaders.  In fact, Sarah Thach is the Fellow who directed me to the Harvard Business Review article.  In closing, I think it’s only fitting to end with one of her quotes:

“Just try it…. early frequent failures keep you limber!”

Thanks Sarah, and our thanks to the Fellows current and past!

-Maggie Sauer

CEO & President