Optimizing Workflows to Share Data Across Sectors: Promising Approaches to Improve Care Coordination
Written by Jenna Frkovich, MPH, Data Across Sectors for Health (DASH), Illinois Public Health Institute
To provide coordinated care that meets patients’ needs, many networks and communities are developing information systems to share data across clinical and social service settings. In order for these systems to be effective in connecting patients to the right services at the right time, care teams need access to relevant individual-level data that is seamlessly incorporated into their work process.
Data Across Sectors for Health (DASH), a Robert Wood Johnson Foundation funded initiative, was launched to support multi-sector collaborations in sharing data to improve health. Of the ten collaborations that have received support from DASH, five are focusing on improving care coordination between medical and community services through enhanced information sharing that helps orient care around the whole person, not just their healthcare needs. As these collaborations moved from planning to implementation, they generated several lessons related to adapting new workflows based on integrated data and developing end user trainings.
When designing a new care coordination workflow, it is important to answer the following questions:
Depending on the environment, care teams may choose to: 1) design workflows around existing technology capabilities or 2) build new technology to fit new workflow needs. It will be important to determine early on the infrastructure and data required to modify workflows. Four of the five DASH collaborations chose to create new data collection forms for their workflows, while one chose to integrate existing data sources into their system. Some common technical tools that were used to coordinate care included shared plan of care documents, automated alerts and notifications sent across systems, and analytics that draw on multiple types of data to predict risk and identify people in need of more intensive services.
Approaches that Work
Below are five promising approaches taken by DASH collaborations—all of which have unique target populations, goals, partners, and resources, yet are collectively generating lessons with respect to multi-sector data sharing, specifically for care coordination.
1. Understand what end users value and gain their buy-in early on.
Before HealthInfoNet set out to develop a new workflow for integrating social determinant data from Community Action Agencies (CAAs) into their state health information exchange, they documented how the CAAs were already collecting and using data for other purposes as part of their existing workflow. For example, they began by focusing on Head Start data that is already collected during the regular enrollment process and explained the clinical value of this data for at-risk pediatric populations. Taking time to understand the staff’s needs and how the new workflow could add value to their existing data rather being burdensome was key to gaining their buy-in. Read more »
2. Ensure community voices are heard during the process development. For Altair Accountable Care Organization (ACO), designing a new care coordination workflow began with understanding the personal preferences of the individuals served as well as those of their care team members. To inform the development of an e-Health infrastructure to coordinate mental and behavioral health services for people with intellectual and developmental disabilities, they gathered input from their clients about who should be on the multi-sector support team, what types of behavioral health events care team members should be alerted about, and how they should be guided to act on those events. Read more »
3. Choose a workflow that minimizes extra steps or makes work processes easier. The Center for Health Care Services, a mental health authority in Bexar County, TX, developed an alert system to notify behavioral health case managers when their clients arrive at emergency departments so that they can intervene earlier and prevent inappropriate hospitalization. By doing so, they automated the manual entry or list management that is often required of their case managers, saving them time to attend to clients. Read more »
4. Communicate roles/responsibilities clearly to all stakeholders. When the White Earth Nation began implementing WECARE, a care coordination database that screens families on the reservation to a wide range of community services, it was imperative that various tribal programs work in partnership when forming a comprehensive care team around the client’s priorities. Having great educators who could effectively discuss the benefits of WECARE, explain how to implement the screening, and work through any challenges with 800 staff from different community programs has been instrumental in building the momentum needed to implement WECARE reservation-wide. Read more »
5. Test and retest your process and allow for edits by people who complete the workflow. When the Parkland Center for Clinical Innovation, a part of Parkland Health and Hospital System, began recruiting participants into a program to share patient data between hospitals and food pantries, the health system originally led the recruitment effort. However, social workers found that providers were more focused on treating patients’ clinical needs and were not responsive to food security screenings. Instead, they decided to recruit participants from food pantries where individuals were more comfortable and accustomed to discussing social needs. Read more »
DASH has learned from these grantees how to design new care coordination workflows when leveraging new data sharing technologies. You can find more in-depth descriptions of these projects in our new issue brief, Coordinated Whole-Person Care that Addresses Social Determinants of Health. Additional resources and updates about sharing data across sectors to improve health are available on our website.
Jenna Frkovich, MPH, is the Communications Associate at the Illinois Public Health Institute, where she leads the development and execution of the communications strategy for Data Across Sectors for Health (DASH), a national initiative of the Robert Wood Johnson Foundation. DASH aims to align health care, public health, and other sectors to systematically compile, share, and use data to understand factors that influence health and develop more effective interventions and policies. Ms. Frkovich works to engage and grow a nationwide network of stakeholders by disseminating lessons learned, stories, and promising practices to help advance the field of multi-sector data sharing.
ASPIN Recruitment and Retention Consortium (ARRC): Partnering to improve behavioral health in rural Indiana
Written by Angie LaFlamme, Senior Program Coordinator, National Rural Health Resource Center/Rural Health Innovations
Rural Health Innovations (RHI) worked with ASPIN and their member health care organizations on collaboration in their behavioral health technician recruitment and retention efforts during an on-site visit on June 15, 2017. Clockwise from top left: Paul Conrad, Director of Training and Workforce Development, ASPIN; Robb Backmeyer, COO of Recovery Services, Centerstone; Ben Hall, Senior Talent Acquisition Business Partner, Centerstone; Chris Morrison, ARRC Project Coordinator, ASPIN; Eric McCray, Recruitment Coordinator, Bowen Center; Angie LaFlamme, Senior Program Coordinator, Rural Health Innovations; Kathy Cook, CEO, ASPIN; Amy Coplen, Employment Coordinator, Four County Counseling Center.
Affiliated Service Providers of Indiana (ASPIN) is a 501(c)(3) nonprofit behavioral health provider and education network offering access to clinical providers in over 50 locations throughout the state of Indiana. As a result of being awarded a Health Resources and Services Administration (HRSA) Rural Network Allied Health Training grant, the network formed the ASPIN Recruitment and Retention Consortium (ARRC) in September 2015. ARRC brings key partners together to improve behavioral health and well-being among Indiana’s rural communities that experience health professional shortages.
This June, Debra Laine and I traveled to Indianapolis for an on-site technical assistance (TA) visit with ARCC staff and partners, where we asked them to share information on their network’s best practices, lessons learned, challenges, significant outcomes and achievements, sustainability, and evaluation. Below are the accomplished and motivating responses we received from Kathy Cook, CEO/President, Paul Conrad, Director of Training and Workforce Development, and Chris Morrison, ARRC Program Coordinator.
Q: What are some of the accomplishments you’ve seen during this grant project?
A: There has been notable impact having stemmed from the Employee Satisfaction Surveys feedback activities and the Health Care Organization’s Recruitment and Retention plan strategies that have been implemented.
We have also had great success in our social media campaigns as well as alternative student recruitment strategies we’ve used for behavioral health student and employee recruitment. Our target marketing has been quite effective.
Our executive leadership expressed buy-in from the beginning and has been very enthusiastic about the work we’ve done in bringing key partners together to improve behavioral health and well-being among Indiana’s rural HPSA [Health Professional Shortage Area] communities.
Q: What challenges or barriers has your program encountered?
A: Student recruitment has been a challenge of ours. The level of follow-through from the applicants can minimal at times.
Navigating the many advertising/marketing mediums took some time. There was a lot of trial and error in ultimately determining which venues worked best for us in reaching our target markets.
Our rural geography has also been a challenge. We target schools in rural areas to promote the awareness of Behavioral Health Technicians. Our hope is to recruit students into the educational training programs for this profession and upon graduation, placing them into the rural area clinics and hospitals.
Q: How have ASPIN’s collaborations helped your program succeed?
Q: What lessons have you learned throughout the project?
Q: What have been some of ASPIN’s most significant outcomes?
Q: How is ASPIN approaching sustainability?
Q: On a scale of 1 (low) to 5 (high), how do you rate your network for sustainability following the grant program?
A: We rate our sustainability at a five, by expanding the ARRC Network for continued collaborative work.
Q: How are you implementing your evaluation plan?
Q: What are your major activities or initiatives for this year?
Q: What are a few of ASPIN’s best practices that you would like to share with other networks?
Why Communication Planning is Different for Networks: How your network can re-learn communication to make it successful
This article was written by Lydia Hooper of Fountain Visual Communications for the August 2017 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.
Networks are able to solve problems that individuals and organizations cannot on their own. Often when we think of them, we think about coordinated resources and activities, but we also need to think about the coordinated flow of information and ideas.
After all, the reason networks are more effective at addressing large-scale issues is that multiple clusters of expertise can inform one another in order to be both more efficient and more responsive to needs. Just as human organs are composed of cells and tissues, networks are made up of individuals and organizations working together to perform various functions simultaneously. To do so, they need to be in consistent communication with one another.
Communication in networks is different than in organizations. When we understand this, we can recognize and capitalize upon the incredible opportunities they present. Here are four ways communication is different for networks and four strategies for success.
1. Communication is multi-directional. In contrast to networks, the hierarchical organizations and systems we are accustomed to seek to maximize control and stability by having leaders decide what and how to share information, both inside and outside the organization. Unfortunately, these systems are breeding grounds for miscommunication and poor strategy because those who aren’t leaders also have valuable information that may not be fully utilized.
Networks have an incredible opportunity to re-think how information and resources are used. Instead of looking to an executive, we can look to one another and assess what our goals are and how we might each contribute to get there. Organizations that participate in networks may find that it takes considerable effort to break habits based on organizational norms such as looking for clear directions to follow. Networks that use a collective impact framework may have a backbone organization leading coordination, but this can carry with it a risk that the other organizations will easily revert to the habits of traditional hierarchies that they are accustomed to.
The solution: Develop an internal communications strategy. Sometimes networks put the cart before the horse by thinking about marketing or branding before they’ve focused on group clarity and coordination. Establishing group identity and an internal narrative will help your network progress, and it will also help those outside the network better understand what you are doing and why. A strategy should include your network’s shared goals and their coordinated plan for reaching it. A discussion about how resources will be shared should also include how external communication will be supported and executed, preparing the cart for when the horse is really to run.
It is important to remember that communication both reflects and drives culture. One network I’ve worked with developed their strategic plan together, but then months later when the network was getting disorganized and losing focus, the plan was sitting on the shelf. A different one continues to reference their shared vision, even sharing best practices with other networks.
2. More people need to reach consensus internally. The strength and potency of networks is not measured by the number of people or organizations involved, but rather by whether there is sufficient diversity of thought and experience to create new solutions and maximize their potential for success. Having many different voices at the table can invite unique challenges such as:
Knowledge-based networks are all about leveraging what “who you know” knows, but before we can do that, we must first know what each of us knows. Sharing with other network members isn’t always easy, especially because our individual need to belong often eclipses our group need to accomplish tasks. But once many voices can learn to harmonize in unison, their volume will be difficult for anyone to ignore.
The solution: Invest in building trust. Building trust takes considerable time. Networks may have to ask themselves, “Is it more important to accomplish specific tasks within a given timeframe, or is it more important to reach our goal?” Doing the latter may require sacrificing the former.
Building trust also requires leaning into discomfort and conflict, which generally we try to avoid. I have found that the simplest, most effortless way to do this is to use a visual communication tool known as graphic recording to support group members in real-time with understanding complexity and feeling included. Graphic recording is real-time illustration that organizes information during group meetings, supporting members so they can share, understand, and retain more information.
For example, one graphic recording I’ve created visually captured a meeting that was a turning point for two networks that had felt in competition with one another. While individuals arrived at the meeting skeptical about engaging in a facilitated process together, they used the visual to work through their conflicts and by the following year recognized the graphically recorded meeting as the one during which they came together as one.
3. External communication is essential. Networks present opportunities to break through former communication barriers that impede progress, but they are still at risk of becoming isolated from the input of information they need to be effective simply because our natural inclination is to associate with those we are most like.
Complex networks in nature demonstrate that long-term sustainability depends upon balancing efficiency and resilience. The hitch is that while efficiency depends upon the minimization of diversity and interconnectivity, resilience depends on the maximization of them. Likewise, communication in social networks must balance strengthening existing relationships in order to use current network knowledge and consistently creating new relationships in order to expand that knowledge.
Whether your network thinks of this as partnership building, community stakeholder engagement, or marketing, keep in mind that communication is never one-way. Networks may provide information, but they can also get the information they need, for example about the effects their activities are having or the effects they could or should.
The solution: Create new ties thoughtfully. Your network will need to apply the same patient, realistic, strategic approach that you practice internally to build relationships with external stakeholders. It is worth the careful consideration this takes in order to ensure that the work of your network stays relevant.
Respect the time and contributions of others by thinking about what matters to them. If you seek to build bridges by empowering individuals to voice their concerns, then plan to address those concerns (or better yet to give them the agency to do so themselves) so those bridges don’t then get burnt.
One network I’ve worked with is really great at using deliberate facilitative processes but is less practiced at producing early wins that keep stakeholders engaged and hopeful. Others I know can get so focused on producing certain outcomes by deadlines set by a funder, such as having a certain number of people attend meetings, that progress toward their primary goal, such as to have those people inform solutions that will work, is stunted.
4. Messaging (including data) is dynamic. While the organizations that comprise them may focus on offers of services or products that solve concrete needs, networks are in the business of sharing ideas that are often complex and sometimes invisible. Furthermore, networks themselves are fluid, and as more information becomes available messages will need to change.
Networks also have to communicate with multiple audiences, which can challenge individual organizations who may relate differently to them (for example, one organization in the network may rely upon a critical partner who is a perceived threat to another organization).
The solution: Create structures for consistent learning and reporting. As their work ebbs and flows, networks need to stay focused on what’s currently happening. Through thoughtful collection and reporting of high-quality data (both quantitative and qualitative), networks can position themselves to be able to intentionally adapt.
I admire the networks I work with who are willing to dedicate adequate thought and resources to this development. I am saddened by those who get distracted by technical tools when they can start now, even with simple paper surveys, ensuring there will be some data to show change over time.
The ones that I know are guaranteed to make a difference are those who are willing to discover what isn’t working and be open to change. That kind of resiliency is the very reason networks are capable of exceptional results.
Lydia Hooper is a consultant who specializes in helping organizations collaborate and communicate about complex topics. She has partnered with more than 40 organizations and networks, offering services and trainings in data storytelling, graphic recording, and communications strategy. You can read more blog articles and get a free copy of her ebook “Using Visuals to Support Collaboration” at www.fountainvisualcommunications.com.
Aligning and streamlining your planning efforts for long-term success
This article was written by Bonnie Noble, PhD, RN, Founder of The Ondina Group, for the April 2017 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.
We’ve all heard that familiar quote, “Failing to plan is planning to fail." This is likely a contemporary paraphrase of one of Benjamin Franklin's quotes: "By failing to prepare, you are preparing to fail." And then, of course, Winston Churchill said, "He who fails to plan is planning to fail."
OK. You get it. You know planning is important. But, sometimes it feels as if we can spend so much time planning that we don’t have time to get anything done. And, what about all those plans required when we’re seeking funding? Just the other day, a client commented on how the funding agencies “require an odd collection of similar-looking documents—Strategic Plan, Logic Model, and Action Plan.” She groaned when I replied, “Don’t forget about the Evaluation Plan and the Sustainability Plan.”
This “odd collection of similar-looking documents” each have a specific purpose and make an important contribution to program and organizational success. Moreover, it is helpful to understand how these various plans fit together in a sort of “less is more” approach that provides simplicity, clarity, and good design while streamlining your planning and writing efforts.
First, let’s briefly examine the key purpose for each one of these plans.
So, how do these plans overlap with and link to one another? The following Planning Crosswalk describes, visually, how these various plans are related.
It is important that these plans are aligned and integrated. For example, your three- to five-year program goals and strategies identified in your Strategic Plan align with the program-specific impact and outcomes in your Logic Model(s). Likewise, your Work Plan is a more detailed description of the initiatives outlined in your Strategic Plan and the activities described in your Logic Model.
The usefulness of each of these planning tools is enhanced by regularly consulting and comparing them. Developing, linking, and using these planning tools will help to ensure that your programs, and your organization, remain focused on its core mission and reaches its goals and vision.
Two important Baldridge program concepts are especially useful here—alignment and integration.
Examples of alignment and integration include linking key goals and objectives in your overall organizational Strategic Plan and your program Logic Model(s). Then, the Work Plan provides more detail on how your stated objectives will be achieved and who will be responsible for doing the actual day-to-day work. Likewise, the Evaluation Plan is a drill-down on how you will collect, analyze, and report data to ensure you remain on target towards reaching stated goals. Finally, the Sustainability Plan describes what actions you will take to ensure long-term viability of your program.
There is great value in aligning and integrating this “odd collection of similar-looking documents,” and doing so will enhance the effectiveness of your organization and its various programs. And, of course, you will more efficiently utilize the most precious resource—your time.
Bonnie Noble, PhD, RN, has an extensive background in the healthcare industry, with more than 30 years of experience working in a variety of healthcare organizations. She has expertise in many quality and performance improvement methodologies, is certified in patient safety, and is a certified professional in healthcare quality. Bonnie has served a National Examiner for the Baldrige National Quality Award and also has managed large federal contracts with the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ). She currently serves as the project director for the Mendonoma Health Alliance, a grantee of the Rural Health Network Development Planning Grant Program through the Health Resources and Services Administration (HRSA).
[i] Balanced Scorecard Institute. Retrieved March 1, 2017 at http://www.balancedscorecard.org/Resources/Strategic-Planning-Basics
[ii] W.K. Kellogg Foundation. East Battle Creek, Michigan. 2004. https://ag.purdue.edu/extension/pdehs/Documents/Pub3669.pdf
[iii] Developing an Effective Evaluation Plan. Atlanta, Georgia: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; Division of Nutrition, Physical Activity, and Obesity, 2011.
[iv] The Grant Helpers.com. Five Key Elements of an Effective Sustainability Plan. 2014. Retrieved on March 2, 2017. http://www.thegranthelpers.com/blog/bid/204687/The-Five-Key-Elements-of-an-Effective-Sustainability-Plan-for-Grants
[v] Baldrige Performance Excellence Program. 2017. 2017–2018 Criteria for Performance Excellence.
Gaithersburg, MD: U.S. Department of Commerce, National Institute of Standards and Technology. http://www.nist.gov/baldrige
By Jo Anne Preston, MS, Workforce and Organizational Development Senior Manager, Rural Wisconsin Health Cooperative (RWHC). This article (“Introverted Leaders”) was originally published in RWHC’s Leadership Insights.
MYTH: Extraverts make better leaders.
TRUTH: Both strong and weak leaders can be found in any personality style. An even bigger, and often misunderstood truth: personality traits are not the same as skill.
What does it mean to be introverted?
You might be introverted if you:
✓ Tend to prefer thinking things through before speaking vs. thinking out loud
✓ Find that situations with lots of stimuli tend to drain your energy
✓ Generally are more energized working alone or with a very small group than in an open team setting
No one is “pure” when it comes to personality style, and we are all a complex array of traits. Though it’s not static like our blood type, when it comes to navigating the energy dynamic of our internal and external world, most people lean in one direction more than another.
Stereotypes of extraverted leaders as charismatic and “verbal stand-outs” can sometimes make it tough for introverts to get noticed for leadership opportunities. It’s a little bit like extraverted kids in the classroom who raise their hand with their whole body, drawing all the attention, leaving the more deliberate and internally focused introverted students unnoticed.
When it comes to being a leader, being authentically you is a strength, notes Susan Cain, author of Quiet: The Power of Introverts in a World that Can't Stop Talking. Being “authentically you” starts with spending some time reflecting on who you are, and personality exploration is a fun and useful way to be “positively self-centered.”
Tips for improving your leadership capacity
If you are an introvert:
1. Don’t assume you won’t be a great public speaker! Strongly introverted Susan Cain's TED Talk with 14 million views is just one example of evidence to the contrary. Effective speaking takes practice, and anyone who wants to excel must do the drills. As an extraverted speaker, most of my best ideas I have learned from Cella Janisch Hartline, RWHC Nursing Leadership Senior Manager, who is an extreme introvert AND gifted speaker and educator. She is powerfully engaging, impacting learners like a force of nature, proof that introversion is not the same as talent. It is also not the same as being shy. Introversion is about how you re-energize. After teaching all day she seeks time alone, and understanding personality differences helps me to not take that personally-a huge benefit in our working relationship!
2. Be conscious of your facial expressions. A very common experience among introverts it is that people often ask them, “Are you mad at me?" The introverted thinking face can look a lot like irritation or anger. Be aware that you may feel very approachable, but it doesn’t work if others don’t experience you as such. Isn’t some of this on the other person’s part to assume good intent? Yes. And. We are still accountable for the message we are sending out.
3. Be mindful of the toll that “people-ing” takes on you. A “best use” for personality tools is understanding your own wiring so that you can meet your needs. We all need to know what kind of fuel our engine takes to recharge, and then it’s up to us to go after it. Manage your energy by:
✗ Allowing—and valuing as productive—the thinking time you need before beginning something new
✗ Asking for agendas and written material to review prior to meetings
✗ Seeking out some opportunities to work alone
✗ Asking others for time to think about or process their questions before responding
4. Reveal your thinking. Help others understand your personality and what makes you tick. People want to know what you think, and in a vacuum of information, rumors will fill in the gaps. One daily habit to develop is to ask yourself, “Who might benefit from knowing what is on my mind?”
Understanding your strengths
Skeptical of personality instruments? They can still help if you are open to asking, “What can I learn from personality awareness to make me a better leader?” With an open mind, these tools (and there are many) can help individuals and teams appreciate, rather than fight against, diverse approaches to work and life.
Rural Wisconsin Health Cooperative (RWHC) has been providing affordable and effective services to healthcare organizations since 1979. RWHC is owned and operated by forty rural acute, general medical-surgical hospitals. The Cooperative's emphasis on developing a collaborative network among both freestanding and system-affiliated rural hospitals distinguishes it from alternative approaches. RWHC offers a variety of programs and services to its members as well as to other clients across the nation.
The National Rural Health Resource Center (The Center) is a nonprofit organization dedicated to sustaining and improving health care in rural communities. Rural Health Innovations, LLC is a subsidiary of the National Rural Health Resource Center.