Those of us who have spent our lives writing college papers, news dispatches, reports, grants and articles all know that the best way to sound smart is to quote someone else. Especially if that person is dead. Death awards a few more credibility points to the quote, and more importantly that person can’t come back and tell you that you took their words out of context.
So, with that, I giggled a bit last week during our most recent Primary Behavioral Health Integrated Care Training Academy when Dr. Dennis Freeman, our CEO, quoted Aristotle on one of his slides when discussing culture. Come on, sing along – you know the one:
“The whole is greater than the sum of its parts.”
Dr. Freeman shifted it up a bit in his remarks, though, by inferring that a health center’s integrated care culture is greater than the sum of primary care plus behavioral health.
Now – let me clarify that Dr. Freeman is a wise man in his own right, and doesn’t need to be quoting Aristotle for any added credibility. He’s like the World’s Most Interesting Man – Aristotle would quote him in a presentation. I should also add my annual performance appraisal is due this month.
The inference is dead on, though. In the last couple of years while working with groups all over the country, we’ve probably spent as much time talking about culture and leadership as we have about H&B codes, the role of a behaviorist, or value-based contracting. You can pull up the website of any health center or mental health clinic in the country and read a darn fine mission statement. A group of executives, consultants and board members probably sat around a table and word-smithed that thing to a brilliant sheen over a couple of days and bottles of aspirin. What is impossible to ascertain over a website, though, is the culture – its texture, content, accessibility, breadth, depth, and temperature. It’s a living thing that requires nurturing and attention; when it’s starved, it will eat your mission for lunch all day, every day.
It’s why when Dr. Freeman talks about an integrated practice simply being more than the sum of primary care and behavioral health, he’s referring to the missing quotient. Culture. Without a culture of integration – of serving the underserved, of mission-minded providers, of inclusiveness, communication, cohesiveness and coordination – you simply have primary care and behavioral health. Or co-location. Or what well-meaning people sometimes call a “one stop shop.” Wal-Mart is a one-stop shop. You can buy a set of tires and a bag of frozen peas there. Is there any reason or ability to coordinate those services? Or is it just a matter of convenience? There’s nothing wrong with that concept – but it’s not an integrated service, is it?
Integrated care is transformative. It involves and/or impacts every department and person in the organization. The culture is really the sum of:
- Mission and values
- Workforce development
- Training and information sourcing
- Strategic planning, operations/implementation
- Financing and sustainability
- State, payer, and policy advocacy
- Data management
To underestimate the importance of culture is a fatal flaw in your transformation. It has to be led from the top. The recently deceased Theodore Hesburgh, the former president of the University of Notre Dame, said when discussing leadership “you can’t blow an uncertain trumpet.” (I get all kinds of credibility points for that one!)
As you begin or continue your journey to integrated care do yourself the favor of zooming out. Look at the landscape. Take a honest reading of the temperature of your culture – ask open questions of the staff, have critical conversations, talk to your patients. And then choose to take the right path. Do you want to sell frozen peas and tires, or do you want to offer well-coordinated, orchestrated, high-quality, efficient patient care?
After all, it was the great American philosopher Yogi Berra who said that “when you come to a fork in the road, take it.” And mind you – Yogi is still with us to certify that!