Realizing Well Care: Achieving a sustainable system for community-based chronic disease management and prevention
What has been most instrumental to your progress?:
Supporting workshop leaders with regular communication and a retreat has been an instrumental part of the WellConnect Partnership over the last year. A retreat was held in May 2018, where around 50 workshop leaders from an 11-county region came together for a day of networking, sharing ideas and experiences, and hearing updates on the progress of clinic-community connections. This is an important piece of creating a true community partnership, where individual leaders from individual organizations feel a part of something larger. We are a partnership of people and organizations with a shared vision and purpose, working together to form a network that can more easily and efficiently integrate with traditional healthcare. The WellConnect website and leader portal is also a key aspect of the cohesion of the partnership.
Adding to our portfolio of courses/programs to reach diverse groups with different needs has also been an instrumental part of the WellConnect Partnership over the last year. New Spanish speaking 'Living Well with Diabetes' leaders were trained and the workshop is offered in Spanish in Rice and Olmsted Counties. The Hispanic population has a high rate of diabetes and are traditionally under served in the healthcare sector, so this has been an important expansion of our programming.
Our inclusive approach is slowly creating opportunities for collaboration that we were previously unaware of. For example, involving students in service-learning projects and training nursing students as course leaders. There is a huge potential here if we could create a mechanism for directing and managing it. These new relationships identify additional resources and potential funding sources.
Key lessons learned:
We continue to learn key lessons from a set back that we had this year. In early 2018 the MN Department of Human Services shifted the funding that had supported a Coordinator for evidence-based health promotion programs for over a decade at the Area Agencies on Aging in the state. This meant that the WellConnect Partnership lost a full-time coordinator, a very crucial piece to the management of activities and momentum for forward progress. Even with this set back, we have learned that a great idea can keep people on board, but that it is very difficult to move forward without a dedicated resource for the day to day management of activities. We are moving forward knowing that sustained leadership is crucial, even if this rotates between individuals. The strength and resiliency of our multi-sector steering committee to continue with this important work during this time has been a testament to the power of collaboration around a shared vision.
Reflections on inclusive, collaborative or resourceful problem-solving:
Collaborative is the element of the community innovation process that has been most important in our work. Through all the challenges that we have faced in the last year, the WellConnect Partnership has been the textbook definition of "A true joint effort with partners willing to share ownership and decision-making as they pursue an innovation together". Upon loosing state funding for the evidence-based health promotion coordinator at the SE MN Area Agency on Aging (SEMAAA), a position that had been funded for 11+ years, the WellConnect Partnership has found themselves without a full-time coordinator and leader. In addition, with the leadership at the Metropolitan Area Agency on Aging deciding to go a different direction with their state-wide evidence-based program coordination and technology, and in so creating a second and competing system, our partnership has had its' share of challenges. But throughout, the group has not given up. New leaders have stepped up to take over critical tasks, new ideas are being generated and tested, and key stakeholders from the community, public health, and healthcare sectors continue to work together towards a shared vision.
Other key elements of Community Innovation:
We have found that having a clear vision of what we are trying to achieve is an important element in our progress toward innovation. The programs we support are about empowerment and self-management - helping individuals to recognize that they know more than they think they do, and that their knowledge and experience can be helpful to others. I think this operates at all levels within our partnership. It is important to feel that relationships are reciprocal and mutually respectful, particularly in the context of chronic illness. Another key element has been the ability to overcome challenges and be adaptable.
Understanding the problem:
The need for traditional healthcare to more closely partner with community-based health promotion programs that focus on the importance of self-management is clear. The most efficient and effective method to integrate an ongoing referral process within clinical practice is not as clear. Clinician buy-in and support is fairly easy. Integrating a standardized process into clinician's workflow is much more challenging and is the piece that we are still experimenting with.
Reaching out to faith communities was also identified as a way of promoting awareness and referrals to evidence-based health promotion programs. The involvement of three doctor of nursing practice (DNP) students has allowed us to explore this potential. I think we underestimated how busy these organizations are, and how long it would take to build up relationships that would impact behavior. We learned about the value of informational sessions describing the range of programs we offer, embedded in regular meetings with a guaranteed attendance. These have certainly raised awareness of our programs, but contact needs to be regular and sustained.
If you could do it all over again...:
One piece of advise may be the need to utilize two mechanisms for decision-making: a core group of individuals with dedicated time to commit to the process and a wider steering committee to generate ideas and create connections. The core group would need to be able to commit to spending a certain number of hours each week on managing the innovation, and meet every two weeks or so, with the steering committee meeting less frequently, say bi-monthly. This could have enabled us to be more effective in our decision-making.
One last thought:
WellConnect is in a stage of transformation. The Steering Committee is actively pursuing what is the best path for this transformation to follow. There are several options and opportunities that we are hopeful about. Patience has been a key factor as we experience set backs and learn from them.