Collaborating Across Disciplines

1. Collaborating Across Disciplines A Guide for Healthcare Professionals

2. Who's In the Room (and Who Isn't)? • Social workers • Mental health clinicians • Nurses • Substance abuse professionals • Consumers • Peer providers • Direct management • Higher-level administration • Primary care providers • Psychiatrists • Teachers

3. Why Do We Need Collaboration? • Providers are treating people without all of the information they need. • What meds is this person taking? • What is their history? • I don't know the significance of the condition they are reporting. • Different providers trying to treat the same condition differently. • Primary care doctor giving Xanax to newly sober alcoholic while counselor tries to treat addiction. • People don't always know where to go to get care.

4. Behavioral Health Disintegration: How Humpty Dumpty Fell • Since the 1930's, healthcare in the US has been shaped and reshaped by insurance companies and federal programs trying to cut costs. • The push to separate (or "carve out") various health services has been about third-party payers trying to save money and providers competing with each other for healthcare dollars. • Funding streams and reimbursement codes allow payers to control how much money they'll pay for different services.

5. Putting Humpty Dumpty Back Together Again • The 1999 Surgeon General's Report on Mental Health calls the system fragmented, inefficient and inequitable. Recommends "carving in" and integration. • Managed care has tried to force cooperation through payment systems. • Huge obstacles remain. • Still difficult to get paid to collaborate. • Hierarchy of professions breeds resentment. • People don't understand each other's disciplines which leads to sharply different perspectives. • Providers don't know how to find each other.

6. Collaborating in Oregon • What are the experiences around collaborating of the people in this room? • What have been some of the obstacles?

7. Financial Obstacles: Getting Paid to Collaborate. • Carve-out funding only pays providers for energy they spend on their speciality. • Administration will need to reimburse for time spent collaborating or referring. • This will likely change over time as pressure to provide integrated services grows. • Higher-level administration can start multiple pilot projects and evaluate them to find new ways of organizing care.

8. What Management Can Do About Hierarchy • Understand how each discipline contributes. • Set the tone. • Treat all members of treatment team as valuable contributors. • Discipline providers who are disrupting collaborative environment. • Particularly those discounting or devaluing the perspectives of people from traditionally lower-status professions.

9. What Higher Status Professionals Can Do About Hierarchy • Be a human first, and your role second. • Educate yourself about other professions. • Always assume that you have something to learn from everyone.

10. Learning From Each Other • One of the most important principles of effective collaboration is becoming a “learning organization.” • Committing at every level to treat all of your relationships as learning opportunities.

11. Obstacles to Communication and Learning • Disconnection from Core Needs and Values • Criticism (negative value judgment). • Demands (attempt to control another). • It doesn’t matter what the other person says, it matters what we hear.

12. Translating • We can learn to translate criticism and demands into core needs and values. • When we think in terms of needs and values, it is easier to feel a sense of connection. • Feeling a sense of connection makes it much easier to learn from each other.

13. Moving Forward • Work places can create ongoing study groups. • Learning each other’s disciplines. • Effective communication. • Management might have to remove or streamline workload in order to increase time for professional development.