PSU and OHSU Students Challenged to See Where Fit in Healthcare Transformation
When the Coos Bay Coordinated Care Organization or CCO was just starting, a call came from a nurse about a diabetic homeless alcoholic smoker with ulcers on his ankles and feet. The doctor wanted to amputate but the nurse in the emergency room stopped the doctor, called in the CCO caseworker to “bargain with the doctor and make changes in the living environment” said Judy Ortiz, director of the School of Physician Assistants’ Studies at Pacific University.
A homeless shelter took the man for longer than usual, arrangements were made to change his dressing “and the guy quit smoking,” she said. “The ulcerations healed, and he still has his legs.”
Ortiz was part of a panel telling Portland State University and Oregon Health & Science University students from the Institute for Healthcare Improvement’s Open School they need to collaborate, know what others do and focus on improving health of populations to succeed in the changing world of healthcare.
“Be assertive and be patient,” said Graham Bouldin, senior project manager, with Health Share of Oregon, the largest of the 16 CCOs told the students. Everyone in the healthcare system is “being challenged to change from as many directions as possible,” and change doesn’t happen overnight. Many feel “change fatigue” – a condition that occurs “when everything you knew is undermined by a new paradigm,” he added.
To cope, he suggested the students develop soft skills. “Very few things are worth burning bridges for,” he said. Keep relationships working, assume best intensions and don’t be afraid to innovate.
He also suggested students embrace data as a means of understanding how change is working.
Jo Isgrigg, executive director of the Oregon Healthcare Workforce Institute, said data analysis is the hot commodity to meet the need for valid and reliable measurement. “How do we know if we’re meeting our goals?” she asked.
Isgrigg also reminded her audience that “when one component changes, it changes other parts of the system.” She pointed out that only 69 percent of Oregon high school students graduate, saying, those without a diploma “are not likely to get a good-wage job if they get a job at all,” and “if a person doesn’t have a safe and clean place to go home to, that person’s health is not going to be very good.”
Noelle Wiggins, director of the Community Capacitation Center with the Multnomah County Health Department, has been working with community health workers since 1986. “A big driver of healthcare transformation is that what we were doing wasn’t working very well,” she said. “Even to improve individual health, we have to improve the health of populations.”
She challenged the audience to consider the influence on health of joblessness, education, respect and dignity. “Recognize that people – especially those affected by inequities – are the experts.”
While working with Latina farm workers who did not speak English or drive, Wiggins suggested they might need a support group to deal with their isolation and depression. No, said the community health workers, they needed a cooking class – which also taught nutrition.
“You get to bring your whole self to the table,” Wiggins told the students. “If you are a member of a privileged group, you get to practice cultural humility…which is absolutely what we need in the healthcare system today.”
Jan can be reached at [email protected].