Healthcare leadership needs a makeover. The current rates of burnout and turnover in healthcare (including integrated care) are not sustainable. We need leaders who empower others. Empowerment helps staff to work to their full potential, participate in decision making, take ownership for tasks that utilize their expertise, feel valued, and feel committed to their team’s success. Leaders provide the scaffold for their team members to set and reach goals, take risks, and grow in their roles in a supported and safe environment. Empowered people lead to empowered systems.
Integrated care has often been established by sliding in through the crack of a struggling system with the goal of improving patient care and system functioning. This often inorganic and backdoor approach to working behavioral health into pre-existing systems has left parts of our field underdeveloped. Often the nuances of integrated care are neglected in favor of filling knowledge gaps with information generalized from the healthcare field rather than drilling down and detailing the specifics of each nuanced element.
Leadership in integrated care is an underdeveloped area. The practice of integration has outpaced our ability to identify the competencies and best practices of effective leaders and managers in integrated care. Here we review a few empowerment leadership competencies or strategies for integrated care that can increase system functioning, physician engagement, consultant capacity, and spontaneous, sustainable development. As you read through this, we ask you to think about, “where does your leadership land on this spectrum, and how might it evolve?”
One foundational leadership strategy useful in integrated care and system’s change is job enrichment, which is an intentional increase of a staff-person’s contribution through additional job activities aimed at making the job more challenging and gratifying. For BHCs, the challenge takes the shape of adding the responsibility to partner with their primary care providers (PCPs) or any other care team member to create a professional development goal, coach them toward change, and do so through spontaneous teachable moments. This can significantly reduce the need for cumbersome, non-individualized learning strategies, such as the dreaded lunch-and-learn.
Consultants are masters at assessing readiness, evoking change talk, and partnering for the purpose of behavior change with continuous monitoring and feedback already built-in by way of their presence within the clinic. Utilize your resources! If encouraged by leadership and their peers, learning opportunities need not be separate from clinic processes, rather development can be an integrated process within the practice setting. In real time, within the clinic, consultants teach integrated care elements experientially. As unfamiliar as it might initially seem, this strategy actually holds the potential to increase consultant job satisfaction, improve the level of system functioning and integration, and foster that experiential knowledge across the team. But what are they going to do when they get there?
How can care team members truly understand primary care behavioral health? Live it. When strategies of the PCP-consultant relationship structurally mimic the functions of the consultant-client, consultant-peer, and even the consultant-leader relationship, we achieve parallel processes. We can then confidently say the consultant is psychologically in the state they are working to evoke. Integrated care processes work in the professional development realm since they are person-centered and based on a desire to improve functioning. Fidelity to consultation strategies is functioning at the level of parallel processes, and it starts with a commitment to espouse and live these values.
This strategy emphasizes an experiential appreciation for the processes we enact. For example, the consultant may plan to run an experiment, behaviorally activating, to coach a struggling PCP regarding behavioral medicine strategies as a way to start the PCP visit. The desired outcome is to demonstrate how this can reduce the time spent with the patient and subsequent prescription writing, while leaving the patient feeling heard and with an action plan. When the consultant has time they can reflect on the plan, experiment, observational and other experiential data obtained, and then plan again. Or even better, the consultant can meet with a leader or peer consultation group to drill down on these variables in new and exciting ways aimed at furthering the empowerment opportunities.
Leadership must shift toward thinking a BHC will rise to the occasion of a new challenge
Coaching for Capacity Development
Enthusiastically championing job enrichment and parallelling strategies paves the way to attune attention on capacity development, which is that intrapersonal knowledge and expansion upon one’s own potential. Just as we expect consultants to believe the most important resource is within each of their systems and patients, the integrated care leader must believe their role is central to optimizing and developing the capacity within each of their consultants. What consultants are doing with their care team members and/or patients need occupy only a portion of a leader’s attention, while asking what change within the consultant will be necessary to actualize those goals substantially increases the change potential. Of course, the use of a parallel process would be great here such as goal setting, experimentation, and building self-efficacy.
Throw out those notions that consultants are overwhelmed in learning this new modality or are frazzled by the fast-paced nature of primary care, and remind yourself about how important challenge is to getting someone into flow. Leadership must shift toward thinking a BHC will rise to the occasion of a new challenge; we accomplish this by recognizing and structuring our leadership to celebrate the adventurous spirit that stepped-up to the plate, willing to be disturbed, and being the change.
The Community of Practice
Encouragement and leadership need not solely come top down as many consultants will not have the luxury to shape their leader, saving that for a separate discussion. Consultation needs to be an ethical consideration for all behavioral health professionals practicing within integrated care. The community of practice (CoP) is a consultation and coordination space providing consultants or any other group of interested professionals a space to come together and review their practice, encourage and provide feedback to one another, which serves to develop their leadership and interdisciplinary skills in a safe space. You are probably thinking the aforementioned sounds similar to a parallel process, and you are correct! The community of practice is meant to be a space for like-minded professionals within a discipline to come together and collaborate to think critically, plan, and coordinate efforts to steer the field in an intentional direction, hopefully forward. This aspect of empowering professionals by holding space solely for their development is needed.
Primary care is a newer approach to behavioral healthcare and newcomers ought to have the encouragement to develop their practice through consultation groups that are slightly more intentional and mirror processes similar to the clinical practice strategies. Live the values! Developing the practitioner’s skillset is the art of developing the self-supervisor or even better the self-leader, which pays dividends to clinics, systems, and our field. Providing experiential opportunities for each consultant’s development through participation in a CoP catalyzes growth in many directions all leading to sustainability.
Pulling the leadership strategies together, the result is an empowerment protocol for sustainable growth capable of increasing the level of integration at any clinic or community in some meaningful way since the efforts are individualized, spontaneous, and conducted organically and feel effortless to those involved. Additionally, this serves to establish the consultant as a self-directed leader of the clinic. Consultants, like any one of us, cannot unlearn what is already known. Once allowed to function as the provider’s and system’s professional (not personal) consultant, we naturally continue to do what and when possible to grow this field one individualized strategy at a time. Consultants need a leader that can frame their support in ways that plant a seed with the potential to continue evolving long after that consultant’s presence.
Empowerment leadership bears potential for reducing burnout and turnover. The next step begins with you! Consider joining a Community of Practice or starting a quality improvement project in your organization. Once BHCs are led to greater autonomy, power, and contribution within their role, the growth potential is exponential. Empowerment leadership in integrated care will benefit all members of the system: patients, staff, clinicians, and even you, the leader.