For too long, the typical health care delivery “team” has been based on a model with the physician in the center, surrounded by support personnel who take cues from this central authority, according to Andrew Morris-Singer, M.D., president and founder of the nonprofit Primary Care Progress. For health care delivery to improve, he said, the different professionals on a team need to rely more on each other – and that means building strong, trusting human relationships.
“If you don’t have connections with people, you don’t feel safe asking for help,” he explained. “People don’t feel free to say something if they saw something.”
Morris-Singer, a nationally acclaimed expert on relational leadership in health care, was keynote speaker during a Jan. 27 leadership summit sponsored by the Ohio University Heritage College of Osteopathic Medicine Office of Rural and Underserved Programs. “Finding Your Voice as a Leader: Working in Interprofessional Teams,” featured a day of interactive workshops for Heritage College students and other health professions students at OHIO, drawing more than 200 attendees at all three Heritage College campuses. The event was fully funded by the Osteopathic Heritage Foundation, whose $105 million Vision 2020: Leading the Transformation of Primary Care in Ohio award to the college in 2011 was the largest single gift to a college or university in Ohio and the largest in support of primary care.
The medical profession seems to have reached broad consensus that health care delivery must change, especially toward more inclusive teamwork. Morris-Singer touted a “snowflake” model, with circulation of knowledge and responsibilities among all team members rather than command-and-control feedback just between the physician and each auxiliary member.
Failing to empower all team members leads to bad patient outcomes, Morris-Singer suggested. He cited the case of his mother, hospitalized with an atypical pneumonia that was somehow missed by multiple doctors until almost too late. She wound up “on a ventilator, struggling for her life, essentially because she didn’t have primary care,” Morris-Singer recalled. “She had no one to follow up, no one to coordinate her care.” This experience, Morris-Singer said, helped inspire him to become an activist for better teamwork in medicine.
But while everyone talks about improving teamwork, he said, many obstacles stand in the way. Many problems in health care boil down to “people problems,” he suggested – which call for “a people-oriented approach to change.”
Enter relational leadership. As described by Morris-Singer, this method lets a leader foster leadership skills in other team members by connecting with them on a personal level, drawing out their deeper motivations for doing their jobs and harnessing those drives.
Doing this takes work and happens in steps. “There’s no express elevator… We all have to take the stairs,” Morris-Singer said. The good news is that the impacts on patient outcomes of decentralizing a team’s responsibilities are real and measurable, in terms of shorter hospital stays, fewer ER and urgent care visits, and lower costs.
After Primary Care Progress’s portion of the summit, students chose from a number of breakout sessions facilitated by personnel from the Heritage College and other colleges within Ohio University. Topics ranged from making a difference in underserved communities to interprofessionalism in group practice and hospital medicine.
The summit took almost a year of planning by the Office of Rural and Underserved Programs, led by Administrative Director Dawn Mollica and others. Randall Longenecker, M.D., assistant dean for Rural and Underserved Programs, who offered direction on designing the day, said its message was particularly important for students who plan to practice in medically underserved communities.
“Relational leadership is key to effective primary care in any setting, but especially in underserved communities where ‘all hands are needed on deck,’” Longenecker explained. “Traditional hierarchical structures don’t work very well there, and interprofessional teams emerge as much out of necessity as out of design.”
The physicians and other health professionals who function best in that type of setting, Longenecker suggested, are those who “learn how to collaborate and optimally channel their own skills and passions as well as those around them in meeting the needs of those communities.”
Heritage College Executive Dean Kenneth Johnson, D.O., called the event a great success. “Our college is committed to transforming the way primary care is delivered, and events like this provide our students with tools they will need to help drive that transformation,” he said. “Watching how they responded to Dr. Morris-Singer’s message tells me they really ‘get it’ – they’re ready to go out and make change happen from the inside out.”
A number of medical students, as well as a student from the College of Health Sciences and Professions, played a significant role in organizing the event, and according to Longenecker, were instrumental in recruiting participants. The Heritage College Leadership Committee “helped plan and advertise the leadership summit, including both the portions with Dr. Morris-Singer and the breakout sessions,” according to committee member Mary Mezher, OMS II.
Alyssa Gerth, also a second-year medical student, was involved in planning on behalf of the Rural and Urban Scholars Pathways program, Student National Medical Association and Student Government Association.
“I worked with my faculty mentor, Dr. Sharon Casapulla, to develop a workshop called ‘Exploring Your Strengths – From the Inside Out,’” Gerth said. “This workshop provided an avenue for students to engage with one another through activities, online assessments and dialogue to identify ways to use their strengths to navigate their biases.”
Students seemed quite responsive to Morris-Singer’s lively, often funny presentation, and clearly came to the summit ready to learn ways to be better leaders.
"My initiative for leadership is empowering families like mine to get through the struggles and to see their health care team as a source of empowerment,” explained Suma Kolla, OMS II and member of the Pediatrics Club. “Something to rely on to get through their daily lives.”