Flip No. 23

Build a health care system based on community values

Take a look at the Nuka System of Care at Alaska’s Southcentral Foundation.

By Flip the Clinic

While health care centers all over the country are experimenting with ways of putting a patient’s needs at the center, few organizations have taken the idea as far as Alaska’s Southcentral Foundation. Southcentral Foundation began a complete system transformation in 1997. In fact, in the Foundation’s Nuka System of Care, the transfer of power and control from the provider to the people receiving services is so fundamental to the system’s design that patients are given a title with more authority. They’re called customer-owners. This important detail is indicative of just how deeply the organization has focused on aligning health care delivery with the needs, values, and priorities of the 63,000 Alaska Native and American Indian people it serves.

What do customer-owners want? A primary focus on building and maintaining relationships. In keeping with the community’s values, the whole system was transformed on the principles of shared responsibility for health, family wellness (including the mind, body, and spirit), and a commitment to quality in support of the workforce.

One of the Nuka’s operating principles is to foster and support relationships between the customer-owner, the family, and the provider.

Here are five ways that Nuka includes families to better support the community’s health.

1. The system designs its services around care for the family or household. Customer-owners are in control of how the system is designed and their individual health care needs. Providers gain a better understanding of how a customer-owner’s community influences their overall health.

2. Many clinical rooms are de-medicalized and are big enough to accommodate entire families. Some are designed with wider doors and extra chairs. Talking rooms (without exam tables) are used for many visits.

3. Team-based approaches are used throughout the organization. In the clinic, all health care team members sit together when they’re not with customer-owners in an effort to coordinate the care, do more non-visit based support, and better communicate about their customer-owners’ health.

4. The system invests heavily in staff training, mentoring, and support. The ability to retain staff over time is important in building trust with customer-owners and their families. The training also re-focuses staff on the core competency of building a relationship with patients—a relationship that allows the staff to be a part of the health-related decision making that occurs every day.

5. Waiting areas have outside facing windows and comfortable seating arrangements meant to encourage gathering.

Case Study

Designing a health care system from the ground up allows for a radical rethinking not always possible with incremental change. At Southcentral Foundation, this paradigm shift has resulted in dramatic improvements sustained over a period of more than 12 years. Southcentral’s complete system redesign has decreased ER and Urgent Care by more than 50 percent, cut specialty care needs in half, reduced primary care visits by 20 percent, and improved health outcomes overall. Nuka’s innovations have earned Southcentral Foundation a Malcolm Baldrige National Quality Award from the National Institute of Standards and Technology.