Applying learning from Alaska's 'Nuka System of Care'

As an operational director in an acute and community health care organisation I was fortunate enough to be selected on to the GenerationQ leadership programme funded by the Health Foundation. I chose to use the opportunity to learn more about a different health care system by visiting Southcentral Foundation in Alaska to learn how they have developed the ‘Nuka System of Care’ - Nuka being an Alaska Native word used for strong, giant structures and living things.

Southcentral Foundation is fundamentally a primary care provider, with a philosophy of shared responsibility, commitment to quality and family wellness. Their mission of working in collaboration with the Native community to achieve wellness through health and related services is lived by all 1800 staff and can be seen in the way they lead, organise, deliver and develop their services.

What I love about Southcentral Foundation is their commitment to their people. They have proved for me that happy, healthy staff who are supported, encouraged and expected to take responsibility for their own contribution to the system has enabled them to deliver effective, innovative approaches to primary care that meets the needs of the population they serve in ways that we dream of in the UK.

My own local health care system has been working to create a new model of care that is not dissimilar from the work that has been undertaken 4,324 miles away in Anchorage – integrated teams, co-production, care planning and case management were all central to the Nuka System of Care. The difference however, I think, is that Southcentral Foundation have been able to adopt a clear focus on wellness, where their practitioners build meaningful relationships and partnerships with their customers, developing  trust, and therefore enabling individuals to take responsibility for their own wellness.

Southcentral’s philosophy is focused on utilising the skills and resource available as effectively as possible to work around individuals and families. Each integrated team consists of a primary care practitioner, a registered nurse case manager, a case manager assistant and a physician’s assistant with access to CBT trained behavioural therapists, pharmacists, physiotherapy and dietitians. They are organised to allow  them to offer same day access to a practitioner and if a primary care provider (GP/advanced nurse practitioner) requires support from one of their colleagues, this can be arranged whilst the customer is in the building. 

Southcentral Foundation is a non-profit organisation that is reliant on grants and billing through Medicare and Medicaid. In 2003 they had an operational budget of $3million a year. Today they have a budget of $242m. The staff turnover is 11% however this is more about growth of new posts and development of their people than of people leaving the organisation due to the lack of opportunity or fulfilment. The board and senior leadership team have been working together for many years; the last board member to be appointed was in 2010. 

They invest significantly in staff training in order for all staff to understand and sign up to the philosophy and mission of the organisation. All staff go through a three day induction programme and a three day programme called core concepts. This is no ordinary training as we know it. This is developing staff to appreciate the value of story and its relationship within the health care environment so that customers are provided the opportunity to work in collaboration with practitioners and that practitioners are skilled and encouraged to bring their whole self into the workplace.

Katherine Gottlieb is the CEO of the organisation and she has been the driving force behind the development of the approach. She developed a set of simple and transparent leadership principles which capture the essence of the model focused on OWNERSHIP.

The NHS has opportunities to develop new models of care and are being encouraged and supported by national strategy to do just that. For us to be as successful as Southcentral foundation we do however need to bear in mind some specific ingredients:

• Build relationships with communities and work with them to design and deliver new models - real engagement and commitment to listen and create the delivery focused on the needs of the customer, not on the needs of individual professions or organisations.
• Build relationships in teams and with individuals across the system that creates trust and commitment where staff feel that delivering at the top of their game is the norm and that they can’t let their team or their customers down.
• Commit to a long term mission, vision and strategic goals where everyone understands how they can contribute and feel a connection to the achievement of the goals.
• Delegate to grow – trust people to do a good job, provide them with the training to deliver, and provide clear expectations and measures so that they can see the impact that they are having.

So you may be reading this and thinking, ‘yes I do all of those things – there’s nothing to learn here’. My challenge back to you is, really?

Do your patients/ service users/ staff all feel like valued partners in care and willing to take responsibility for their own health and wellbeing?

Is the care that patients receive delivered in a way that means they can take responsibility and ownership for their wellness?

Do you know the stories of your staff? And do they know yours?

My answers to those questions currently are a resounding no… and I’m committed to changing the way I lead so that sometime soon I, and my staff, and the people that enter care in services I work with, can answer a very loud and confident yes.
 

Karen Barnett is Operational Director and Transformation Programme Lead at Harrogate & District NHS Foundation Trust and is a Health Foundation Generation Q Fellow