Equipping our teams with the right skills
Why training our clinicians to work in different and diverse settings matters
Learning how to work together, in any context, takes time. There are countless examples; from sports to the workplace, we all have different skills, different ways of doing things. When we join up with new people, it sometimes takes some sorting out to know how best to work together that maximizes everyone’s skills.
The purest definition of collaboration is “co” and “labor”—laboring together. It can indeed be difficult to collaborate with others when we’re all working toward different individual goals or doing things different ways. Collaboration is the cornerstone of progress and innovation. When individuals come together, bringing their unique skills, perspectives, and approaches to the table, they create a synergy that transcends individual capabilities. The beauty of collaboration lies in its ability to merge diverse talents and viewpoints, often coming up with ideas or solutions that no single person could achieve by themselves.
When we leverage the strengths of each person, collaboration not only enhances the quality of any outcome we are trying to achieve but also fuels creativity and ingenuity. Collaborative environments foster a culture of learning and adaptability that help us be our best. They encourage us to grow and improve. Embracing collaboration not only amplifies individual strengths but also paves the way for collective achievements that propel us towards a brighter, more innovative future.
Health care is a great example of where collaboration and team-based care is essential. We know from copious amounts of evidence that treating pieces is never as good as treating the whole. In fact, there’s a bidirectional relationship between many physical health conditions and mental health. However, because our hyperspecialized health system often discourages or disincentives us to work together, we’ve had to really evolve over the years to get people to pay more attention to the importance of collaborating in a team-based way.
There may be no better example in health care of where we see the need for teams to work together than in primary care. As a reminder, primary care remains the largest platform for health care delivery, and is the place that more people are likely to be seen for certain health related issues, like mental health, than anywhere else in health care. But like many health care settings, just because mental health needs are there doesn’t mean that the workforce is.
The ongoing problems to have enough mental health clinicians is in sharp relief when we consider how many times people go without care. This is why bringing mental health care to where people are makes so much sense. There’s less waiting, less fragmented attempts to communicate or collaborate, and just a better, more hopeful environment for the person. While we are still working to advance mental health and primary care integration and make it a standard of care, progress keeps occurring, including work at all levels of government.
But knowing how clinicians show up to work together - the training they need - that’s an area that we still need to pay attention to. This week, the Bipartisan Policy Center (BPC), a longstanding partner, released another report on mental health and primary care, this one focusing in on the workforce.
As the BPC report highlights, expanding this model of integrated care depends on a well-trained and supported health care workforce that knows what to do. They highlight a variety of evidence-based models, which have all shown promise and now receive reimbursement from Medicare, some state Medicaid plans, and commercial payers. The report, which is a useful addition to our policy collective toolkit, emphasizes the need to train, recruit, compensate, and adapt this workforce so they can be most effective at collaborating. The report has a variety of policy recommendations for the federal government such as focusing on training and recruitment, payment and administrative strategies, and network adequacy requirements and flexibility.
Reading the report brought me back to early in my career where I was lucky enough to train with Dr. Sandy Blount. There’s an entre history of the integrated care movement that’s worthy of telling, but for this piece, I just want to highlight some of the training work that was done to better prepare clinicians to work together. You see, Dr. Blount had recognized that there were a lot of clinicians, both mental health and medical, who didn’t have the slightest clue how to work with the other. He and I published an article, which outlined both the postdoc program I participated in as well as certificate program he had started. The certificate program was a 36 hour course that brought clinicians of all kinds from across North America to learn how best fit together mental health and primary care. If you were lucky enough to participate in one of these back in the day, you know how novel and special they were. This was before video conferencing dominated our lives, and really brought together people to learn about the future of team based care delivery. I learned a lot from this course, and still use a lot of the “work together” principles to this day.
For us to meet the moment and do all we can for the needs of our community, we have to evolve our understanding of workforce. Relying solely on our licensed workforce is doomed to frustrate us, especially when they are in the wrong places to help or ill prepared or improperly trained to work in the right settings. As we work towards a more comprehensive strategy for workforce redesign, one that focuses more on our community, we still have a ton of work to do to best prepare our current workforce to know how to work settings like primary care.
Establish a core set of competencies: When the state of Colorado received a significant grant from the federal government to integrate mental health into primary care practices, one of the first things we knew we had to do was to establish a core set of competencies for what our mental health workforce should be doing in primary care. This led to a process where we did a deep dive into the literature, e.g. what skills should mental health providers have working in primary care?, a gathering of experts to discuss the findings, and a final report that outlined what the competencies were. While we came up with eight, it was the articulation of the competencies in videos that made the difference and allowed providers and other stakeholders to see what we should be looking for in our workforce.
Clearly outline expectations: From job descriptions to educational materials, it is vital to make sure that people know what to expect from their role. Misaligned expectations have been the demise of many a integrated care team. Making sure that there is role clarity, consistent workflows, and ongoing opportunities to communicate, plan, or debrief can go a long way in helping assure sustainability. Having seen highly successful teams in action, aligning around a common vision helps all the team members know what the goals are and their role in making sure that the team gets there. Simple telling people to work together without laying out your expectations on what they do and how they do it can lead to bigger systemic problems down the road for both the team and the people the team is trying to help.
Hold people accountable to outcomes: It’s one thing to tell people what to do, an entirely different thing to have the ability to assess whether or not they did it. When we bring people together to work in a dynamic work environment, especially one that is as high paced as health care, we need to make sure that things are working and at a level of quality and consistency that makes a difference on health outcomes. Part of the drive to push us past volume (seeing more people) to value (quality and outcomes) requires us to routinely assess our providers. In integrated settings, we should be doing the same for all our providers. Simply bringing a mental health clinician, as well trained as they may be, into primary care is important but should be held to the same rigorous standards for outcomes as other facets of health care. Using data to help benchmark providers and practices on key metrics associated with quality and outcomes can be a tremendous start in holding people accountable to outcomes.
Maintenance: For many of us who were trained a certain way, learning new skills can be a daunting challenge however worthwhile and satisfying it may be. Just like we do with all licensure, there should be some clear opportunities to maintain our new skills ensuring we are up to date on the evidence, implementing skills in a consistent way, and learning from others on their challenges and successes. Of course, there are always opportunities for continuous education at almost every turn. If we are to move our workforce to a place where we are asking more of them in new settings, the maintenance of those skills should align directly with where they are working. If you are in a school, primary care, a jail or any other novel delivery setting, we should make sure that there are trainings specific to these places that are available to help maintain our competencies.
Collaboration in health care is like a delicate dance of diverse talents who are used to dancing solo. At the heart of primary care is the crucial need to address mental health. Yet, as we tread this path towards integrated care, the spotlight remains on evolving our training methods and making sure our workforce is prepared for these dynamic environments. It's about nurturing specific competencies, setting clear expectations, ensuring accountability for outcomes, and maintaining our skills—a perpetual dedication to refining our craft. These principles aren't just guidelines; they're at the heart of more effective health care delivery. Make no mistake, this is not merely about working together; it's about mastering the art of seamless and collaborative brilliance, working together towards a more healthy community.