Creating a culture of collaboration in LTC

With the need for states to rein in healthcare budgets, we are seeing a rapid move toward managed long-term care in states across the country. These changes are forcing many LTC providers to adapt to a new healthcare environment. For some this means rapid growth; for others merging with competitors or larger healthcare systems. No matter where you sit, change is probably the order of the day.

In New York, where PHI sponsors Independence Care System (ICS), a managed LTC program for adults with disabilities who want to live at home and participate in the community, the state is moving rapidly to enrolling all Medicaid LTC participants in managed care plans. As a result, ICS is expecting rapid growth, along with the need to bring on several new partners with different expertise and different company cultures.

In managing this transition, ICS has been very intentional in developing a culture of collaboration. At the center of their model is the Interdisciplinary Care Management Team (ICMT). Each ICS member is supported by a team that includes nurses, social workers and a member-services coordinator, along with resource specialists in behavioral health, wound care and rehabilitation. The team also includes a senior home health aide, who provides guidance in addressing issues around personal care and support services.

To develop its collaborative model for delivering quality person-centered services, ICS began its implementation of the ICMT with a pilot project. The first ICMT worked with a PHI organizational change consultant who helped participants develop the skills they needed to work as a team, rather than as individuals representing different disciplines. Eventually, they began to see how their different perspectives could be managed to more effectively to meet the clients’ needs. No one had to be RIGHT—rather by listening to each other they could begin to see how to build a care management plan that successfully incorporated the concerns of the nurse with those of the social worker and the rehab professional and so on. Team solutions to problems became more creative and effective than when individual team members had to try to solve problems on their own.

The pilot ICMT shared several “lessons learned” as ICS began to roll out this new approach to care management throughout their organization. Each team member talked about how at first they thought only they knew the how best to fix a problem. But now they could see how the multiple perspectives of the team formed a much more complete picture, making it easier to find solutions that addressed underlying problems.

What made it possible to get to this point, they noted, was the trust they built as a team through team-building exercises and learning PHI coaching skills of listening, self-awareness and nonjudgmental communication. All of the members noted that they are “fixers,” usually wanting to jump to a solution rather than listening carefully to various perspectives. Learning these skills was crucial to fully examining the various perspectives and finding collaborative solutions that worked for ICS members.  

What ICS leadership now realizes is the importance of communication and team-building skills to their entire organization. As they move forward with new collaborative relationships, not only those in care delivery, but all employees are learning new skills that should help them adapt to a rapidly changing healthcare environment.