Ryoka Kim, Ph.D., L.P .
Erin O’Connor, Ph.D., L.P.
Scott Nyman, Ph.D., L.P., ABPP
Launching a new partnership is exciting and filled with potential. In the era of the Patient Centered Medical Home model, successful partnerships are becoming a necessity for health psychologists to survive and shine (Fisher & Dickinson, 2014). However, we often find ourselves left on our own when it comes to relationship-building in professional practice. Our Behavioral Medicine Education (BME) department was recently approached by a local Cancer Institute to form a clinical partnership in creating a new psychosocial service for their surgical oncology patients. As we began implementing this new service, later named Integrated Cancer Care (ICC), we learned to adapt a business mindset as well as maintain political sensitivity to move things forward.
The first question to answer involved funding our service. Thus far, we have been able to offer ICC with no expense to the patient. Our BME department is funded through Graduate Medical Education. As such, we successfully sought and received administrative approval to devote time to ICC without relying on patient billing, provided we could demonstrate educational benefit to the resident physicians. We created a psychosocial oncology curriculum for the family medicine residency, addressing cancer survivorship concerns (Bober et al., 2009), as well as communication challenges between primary and specialty care (Blanch-Hartigan et al., 2014). The family medicine residents were then scheduled to work collaboratively with us in ICC.
In cultivating this three-way partnership between the BME, the Cancer Institute, and the Family Medicine Residency, we learned a great deal regarding both challenges and opportunities. The following sections summarize some important lessons learned and helpful pointers we recommend when forming a new collaborative clinical partnership in your health systems and communities.
Initial Stage: In the early stages of partnership-building, close observation and research play an important role.
1. Be visible and act fast
- If you or your department is not well-embedded within the potential partnering organization or hospital, start networking through committees, board meetings, or other hospital-wide services (e.g., consultation-liaison services). Spend time in the physician’s lounge and get to know their practice or interests away from the busy patient care areas. Offer curb-side consults when appropriate.
- Get your elevator speech ready to sum up what you do (yes, we are different from psychiatrists or social workers). Many health care professionals may not know the distinctive quality/roles of health psychologists. Highlight how we can benefit their practice.
- Once you see a partnership potential, get into their calendar ASAP! Setting up a meeting can be challenging, especially when multiple providers are involved. Consider flexible form (e.g., shorter duration, lunch meeting, being added to their administrative meeting agenda, etc.).
2. Do shadow
- We initially spent a large part of our time shadowing the oncology team and learning about their workflows, personalities, and patient populations. These insights allowed us to make pertinent suggestions as to which patients might benefit from ICC and how it could improve their practice.
- Pay attention to their bottom line: Slowing down the flow of medical operations will never be welcome. Stay attentive and flexible to gauge when the team would be more receptive to your services (e.g., joining an oncologist for a collaborative medical appointment and remaining after with a patient to further address psychosocial needs).
3. Understand the organizational chart
- Understand who does what and who reports to whom. Identifying the right personnel for each task will save you and the team time and frustration.
- Be aware of the political climate or historical context of their departments/practice. We cultivated a strong relationship with a pre-existing social services team, who had more than 20 years of experience at the Cancer Institute . Securing buy-in from well-respected players on the team will open many doors.
4. Know your stakeholders and their outcome metrics
- Who are the key stakeholders and what do they care about? Know the specific target metrics required maintaining funding or accreditation status (e.g., Commission on Cancer, ACGME milestones for residency programs, etc.). Attend their meetings (e.g., budget, board, etc.) to learn of their latest priorities. Suggest expanded ways to capture “successful practice,” such as improvement in patient satisfaction, no-show rates, and/or treatment adherence.
5. Space/logistical issues
- Space in a medical office is a scarce commodity. Check on the availability of space for you to provide services. Make a list of necessary equipment (e.g., phone, computer, EMR, etc.), including which department is responsible to supply associated costs.
Middle Stage: Once you are oriented and have set your performance targets, the next step is to create stability. Examine how your service is best utilized and trim out any excess.
1. Keep it simple and consistent
- Medical teams are already bombarded with checklists and guideline updates. Simplifying your service protocol may increase the likelihood of referrals.
- Create consistency. It can be as simple as offering fixed hours of operation (e.g., “I’m here every Monday morning”). In our case, ICC was offered by Health Psychology Fellows, who rotate every six months. The Cancer Institute team appreciated having a designated faculty to oversee the entire ICC project.
2. Data is your friend
- It is important that you establish and implement a data tracking protocol. Medical centers often employ administrative officers to keep track of outcome data. Make sure that they know what variables need to be collected about your services and how. If administrative resources are limited, consider assigning the task to a student.
- Examine the data regularly and take timely actions when needed. Seek suitable opportunities to share results and enhance your practice (e.g., monthly e-mail updates regarding utilization status / common referral reasons, budget meetings, etc.).
Maintenance Stage: Given the ever-changing nature of medicine, the maintenance stage of a clinical training partnership involves a continuous improvement model, including troubleshooting and feedback-based updates. Here are a few examples from our experiences:
1. Decreased Referrals
- Remain engaged. It is okay to keep reminding the medical team about your service. For example, give them a “heads-up” that their two o’clock had a positive distress screening at last visit, and the patient would benefit from meeting with you. If your referrals become narrowly-focused, refresh their memory about the wide array of concerns you can address.
- Consider additional referral sources. We began participating in monthly interdisciplinary meetings with supportive care staff including nurses, physical therapists, dietitians, and radiation technicians. This was a great place to learn the specifics of each practice as well as common challenges encountered that may prompt a referral. Soon we began receiving ICC referrals directly from the supportive care staff and vice versa. Make sure to update your referral sources if they have specific questions or requests.
- If you are working in a high turn-over environment, introduce yourself and your service to new members.
2. Securing your service sustainability
- Seeking diverse and sustainable funding resources remains important to survive through unpredictable political and financial climates. Extending partnerships to medical education programs or research projects may increase funding opportunities.
- Consider using Health & Behavioral Codes for sustainable billing structures. Although we are currently not billing for ICC, we have been compiling documentation necessary for service reimbursement as a potential option. Even if we may not bill for services in the future, the data can still be useful to demonstrate the value of our services.
The benefits of a transdisciplinary approach are continuing to gather recognition in the modern healthcare environment. Although such collaborations require careful planning, thoughtful relationship-building, and ongoing maintenance, health psychologists have so much to offer to make these ventures successful for patients, learners, and organizations.
Fisher L., & Dickinson W. P. (2014). Psychology and primary care: New collaborations for providing effective care for adults with chronic health conditions. American Psychologist, 69, 355-363.
Bober S. L., Recklitis C. J., Campbell, E. G., Park, E. R., Kutner, J. S., Najita, J. S., & Diller, L. (2009). Caring for cancer survivors: a survey of primary care physicians. Cancer, 115, 4409-4418.
Blanch-Hartigan, D., Forsythe, L. P., Alfano, C. M., Smith, T., Nekhlyudov, L., Ganz, P. A., & Roland, J. H. (2014). Provision and discussion of survivorship care plans among cancer survivors: results of a nationally representative survey of oncologists and primary care physicians. Journal of Clinical Oncology, 32, 1578-1585.