This is a well under appreciated problem and one that many organizations simply take the approach of either just raising salaries or accepting high rates of turnover. Neither of these strategies work long term and fails to recognize the economic costs of mistakes, poor morale and training costs. Another opportunity to is to create engagement through several mechanisms. One is to develop common goals and share them daily huddles that are lead by front line leaders and actively seek input from the workers. Group incentives for meeting these goals helps further this engagement. Another approach is to develop a clear clinical ladder for people in these role.
Not surprisingly we have had similar challenges and have taken a like approach of getting all of the stake holders in a room to design care pathways. This sets forward a “playbook” that defines the individual roles and allows each group to understand what they do affects the individual patient. They key to being successful is to ensure there is one overall coordinating group, understanding the key driver of each group (& where possible letting them retain a piece of this if it make sense in the model) and tracking outcome data.
Let me begin by commending you on your efforts. This is an amazing program and a true commitment to the community to which you serve. Community building is a challenging effort and to be successful requires a tremendous amount of partnership with the community. By analogy, the REACH program(https://housingpartnership.net/about/members/reach-community-development-inc) has done a lot of this type of work in rebuilding communities. What they have learned is that there is a strong need to develop multiple community partners, ensure that the community has input into programs (they actually say drive the programs) and where possible have their programs play a role in their internal spaces. Another approach is well trained community health workers who are influencers in their communities can be very effective at outreach. We are currently working through this model as well.
This is an interesting and challenging problem that many academic medical centers are facing and failing at. The ability to address the problem is highly constrained as the levers of control are limited. As a single institution it is unlikely that one would have the ability to meaningfully address the regulatory framework. Given that the regulatory framework is not going to change, there are only two remaining strategies that I see that remain to preserve one’s margins: 1. Fully embrace the role as a safety net hospital and innovate in this space to make this group profitable (bundled payments, upside risk models, etc.) or 2. compete on quality and directly link this back to the payers. Both strategies have challenges.
I find myself in a very similar circumstance as head of a very large ob/gyn community based department. I became very interested in the concept of AI in predicting poor maternal outcomes based on both the desire to improve outcomes but also the global lack of energy in this issue in my space. To resolve this I have partnered with our EMR vendor (Cerner) who has a division called Cerner Intelligence. They have data scientists and are interested in developing and equally important, implementing these models into their EMR. To date we have developed and are now validating models of maternal transfusion >4 units prbc, unintended ICU admission, and readmission. The great part of this arrangement is because our data is remotely hosted they do all the heavy lifting and I can just direct the science. This work has actually garnered the interest of 3 other university systems and we are working to incorporate their data and willingness to publish. Hope this helps-Matt