In today’s interconnected world, the strength of our relationships and how we interact with each other is paramount, especially within the healthcare ecosystem. This is where the concept of relationship-centered networks becomes crucial.
What exactly are relationship-centered networks? They represent a methodology where organizations and community members unite to pursue shared objectives in health improvement. The “relationship-centered” aspect emphasizes the development of enduring and robust connections within partnerships, coalitions, and collaborations across diverse networks. These networks, as fostered by organizations like the California Health Care Innovations (CCI), encompass community health centers, community-based organizations, government bodies, multisector partnerships, and individual community members.
It’s widely recognized that healthcare services alone are insufficient to achieve health equity and justice. A significant portion, up to 80 percent, of the factors influencing health – such as socioeconomic status and environmental conditions reflected in zip codes – lie outside the direct realm of clinical care. Research has consistently demonstrated that health outcomes improve markedly when health systems collaborate with community-based organizations to deliver comprehensive social services, moving towards a more holistic, person-centered care model.
CCI is deeply committed to bolstering the healthcare safety net by fostering robust relational connections throughout the health ecosystem. This strategic approach aims to tackle the fundamental determinants of health disparities, ensuring care is truly person-centered. CCI supports organizations through various means, including facilitating the recruitment of care coordinators and community health workers, promoting integrated care models, and providing trauma-informed care training to staff. These initiatives empower healthcare providers to work more effectively with communities, fostering a healthier future for all. This holistic approach resonates with the principles often highlighted in resources like SCAN Foundation whiteboard videos on person-centered care, which emphasize understanding the individual within their broader context.
At CCI, we firmly believe in the following core principles:
- Cultivating relationships is essential for empowering communities and amplifying their collective voice.
- Advancing health equity and justice necessitates building relationships grounded in trust, dignity, and mutual respect, moving beyond transactional interactions to genuine partnerships.
- A long-term perspective is vital to comprehend the dynamics of partnerships, acknowledging past challenges and collaboratively forging a stronger path forward.
- Healthy relationships and robust bonds are constructed upon a foundation of understanding power dynamics, clearly defined intentions, and, most importantly, deeply listening to the authentic needs and desires of the community.
Here are key insights CCI gained in 2023, demonstrating the power of relationship-centered networks and their impact on person-centered care:
Cultivating a Healing Organization: The Foundation for Person-Centered Care
Sherry meets regularly with therapist Alvin Fong at the Chinatown Service Center in downtown Los Angeles. (Credit: Harrison Hill, CHCF)
Sherry’s journey at the Chinatown Service Center perfectly illustrates the impact of relationship-centered care. For years, Sherry, a 32-year-old housekeeper working six days a week, had neglected her health due to the pandemic, relocation, and demanding work schedule. Beyond logistical barriers, Sherry was battling depression in silence. A routine primary care visit took an unexpected turn when the mention of a Pap smear triggered an emotional breakthrough, leading to tears. Crucially, Sherry’s primary care physician, recently trained to identify behavioral health needs in primary care settings, recognized the severity of Sherry’s screening score. Instead of a standard referral, the clinic staff demonstrated a person-centered approach by immediately connecting Sherry with the center’s integrated service coordinator.
“Sherry later recounted, “Suddenly, this person appeared, assuring me I could see a therapist quickly and that she would facilitate the process. I had been feeling deeply unwell, even suicidal at times, for a long time. I had no one to confide in. But that day, for the first time, I felt hope. I felt someone genuinely wanted to help me.”
This vital integrated service coordinator position was established through a CCI program designed to assist community health centers in expanding and enhancing behavioral health services, with a strong emphasis on health equity and aligning behavioral health resources with social needs. This program has significantly improved patient access to essential behavioral health support. The Chinatown Service Center, for instance, witnessed a remarkable 50% increase in annual referrals from primary care to behavioral health, with depression screenings now consistently conducted during 90% of primary care visits, a substantial rise from 74%.
This success story highlights a key principle for CCI: to effectively heal communities, organizations must prioritize internal healing first. Relationship-centered networks necessitate inward-facing efforts to foster stronger internal bonds among colleagues. This involves creating new roles with seamless interdepartmental transitions, promoting enhanced communication, and implementing comprehensive staff training to ensure a unified, person-centered organizational culture.
This principle is further reinforced by another CCI initiative focused on advancing trauma- and resilience-informed pediatric care models. This program aims to provide young children and their families with the necessary support to thrive. An in-depth look at UCSF Benioff Children’s Hospital Oakland reveals how clinicians are integrating screening and treatment for “adverse childhood experiences” (ACEs), alongside addressing upstream social determinants of health such as domestic violence, food insecurity, and unstable housing. This mirrors the holistic approach advocated in resources discussing person-centered care, including potentially SCAN Foundation whiteboard videos, though specific videos were not directly mentioned in the original article.
Similarly, LifeLong Medical Care recognized the critical need to cultivate a supportive environment for its staff by providing spaces for reflection and support groups, especially for clinicians of color. Highland Hospital also prioritized staff wellness initiatives. Dr. Robert Savio, former chief of pediatrics at Highland, emphasized the role of CCI’s learning collaborative in strengthening team rapport and trust:
“It has helped us rebuild in the context of a global pandemic, which strained our clinic bonds due to masks, altered routines, and reduced eye contact. Engaging in intense, emotional discussions has brought us back together as a cohesive team.”
Nurturing internal relationships has empowered health centers to become stronger partners for both patients and community-based organizations, enhancing the delivery of person-centered care. The Children’s Health Clinic reminds us that those closest to the problem are often closest to the solutions. As one California clinic employee shared, “Everyone a patient interacts with in a clinic can influence their experience – from front desk staff to providers to nurses. Everyone plays a therapeutic role. You don’t need to be a therapist to be therapeutic.” This sentiment strongly aligns with the core principles of person-centered care, where every interaction is seen as an opportunity to support the patient’s well-being.
Echoing the insights from behavioral health initiatives, CCI discovered the value of integrating dedicated personnel to support both staff and patients throughout the ACEs screening process. Community Medical Centers incorporated a bilingual case manager, while Bay Area Community Health Center recruited a pediatric care coordinator. These roles not only streamline screening administration but also facilitate connections to vital community resources and services, further enhancing person-centered care. Dr. Tracey Hessel, associate medical director at Marin Community Clinic, explained:
“This program has fundamentally changed my approach to work. I feel much more integrated within a team that considers not just the child but often the entire family. This feels incredibly hopeful and much more impactful than solely focusing on illness. While addressing illness remains crucial, broadening our scope in this way is far more powerful.”
Reimagining Partnerships for Enhanced Person-Centered Outcomes
In the realm of multisector partnerships, considerable effort is often directed towards enhancing technical and tactical skills across diverse community-serving organizations, emphasizing the “multisector” aspect. However, CCI’s 2023 initiatives underscored the critical importance of the “partnerships” component, demonstrating that relationship-building is integral to systemic change and community health transformation, ultimately leading to more effective person-centered care.
As CCI concluded its program on strengthening partnerships to prevent domestic violence – reflecting on the key learnings from this collaborative and hosting a summit to disseminate these findings – a crucial insight emerged: the how of the work is just as important as the what. This emphasis on process aligns strongly with the principles of person-centered care, which prioritizes the individual’s experience and preferences in care delivery.
At the partnership summit, community leaders advocated for transforming the operational approaches of clinics and non-profits. They urged partners to prioritize listening, involve community members in decision-making, and cultivate strong relationships. Jenée Johnson, program innovation leader at the San Francisco Department of Public Health, stated, “Suffering is universal. But we must remember that pain and sunlight foster growth and connection.”
Johnson cautioned that an excessive focus on productivity, neglecting the relational aspects, can be detrimental. A singular focus on output, she explained, “can manifest as workaholism and diminished empathy…Therefore, organizational transformation must begin internally. You cannot give what you do not possess.” She recommended creating both formal and informal “healing spaces” to promote social connection and psychological safety, and to actively involve clients and patients in problem-solving, fostering a truly person-centered environment.
Timiza Wash, chief program equity officer at WEAVE, advised attendees to move away from “the super-hero complex” and adopt a leadership style rooted in listening to youth, adult allies, and community members. “Connect with individuals who may not yet recognize their potential to be changemakers,” she concluded, emphasizing the importance of inclusive and person-centered approaches to community engagement.
Participants in CCI’s programs demonstrated that building successful, healing partnerships hinges on investing initial time to develop a deep understanding of each other and shared values, transcending mere organizational roles. They emphasized the need for partners to add value, not extract it. Embracing vulnerability, transparency, and honest communication emerged as essential daily practices. While encouraging creative risk-taking and innovative collaborations, it’s equally important to provide space to navigate setbacks and challenges collectively, reinforcing a person-centered partnership dynamic.
As Emma Fay, program coordinator at the Community Action Partnership of San Luis Obispo County, aptly stated at CCI’s summit: “Collaboration moves at the speed of trust.” This underscores the foundational role of relationships in achieving meaningful and sustainable outcomes in healthcare and community initiatives, all geared towards better person-centered care.
This understanding underpins CCI’s involvement as an implementation partner in a California-wide initiative aimed at advancing population health management to eliminate health disparities and improve community health. CCI will leverage its expertise in relationship-centered networks in this collaboration with 32 community health centers, Regional Associations of California, California Primary Care Association, Department of Health Care Services, and Kaiser Permanente. This initiative to transform care for Medi-Cal beneficiaries will enable CCI to advance its strategy by building upon established foundations with community health centers. CCI’s reputation for meeting organizations where they are and tailoring support to their specific needs will continue to foster a knowledge-sharing culture, ensuring that no organization operates in isolation or needlessly duplicates efforts, ultimately promoting more efficient and effective person-centered care delivery across the state.
Thinking Outside the Box to Enhance Connections and Person-Centeredness
Over the summer, CCI and its partners revived the spirit of innovation summits at “The Crossroads” in Chicago. Co-hosted with AllianceChicago and ILN, the event convened safety net leaders from Illinois, California, Florida, and beyond to explore unconventional approaches. The central questions were: How can we leverage the best pandemic-era experiments and innovations to address current challenges? How can we use creative disruption to shed unnecessary elements? And crucially, how can we generate novel ideas and strategies to improve overall health and well-being, ensuring more person-centered care?
To stimulate creative thinking, attendees participated in field trips to observe cutting-edge organizations outside of healthcare facing similar challenges. The premise was that stepping outside conventional workflows and norms can spark creativity and insightful problem-solving. A fresh perspective is often the catalyst for finding effective solutions to persistent issues, and this approach directly supports the development of more innovative and person-centered care models.
In another pioneering convening last fall, CCI and collaborators brought together Medi-Cal managed care plans, healthcare providers, and community-based organizations from across California. The goal was to exchange insights, share innovations, and develop strategies to enhance the uptake of Medi-Cal’s ambitious new enhanced care management (ECM) benefit, a key component of CalAIM. This hands-on learning event provided a platform to celebrate successes, troubleshoot obstacles, and share narratives to inspire new approaches for coordinating and funding non-traditional health care services like food and housing. Furthermore, CCI introduced human-centered design methodologies to help attendees better understand the experiences of CalAIM implementers and to reimagine future possibilities, all with the aim of improving person-centered care within the Medi-Cal system.
One of the tools employed was “journey mapping,” an engaging and insightful activity that helped attendees identify and strategize around critical touchpoints in the community-based referral process. Belén Arangure, ECM program manager at Northeast Valley Health Corporation, noted, “It wasn’t until I started collaborating with other ECM providers outside my organization that things really clicked.” Kristy Garan-Martinez, senior director of ECM at Inland Empire Health Plan, shared, “I feel like I can phone a friend when I need to share ideas, discuss state guidance implementation, and overcome barriers.” These collaborative approaches are essential for developing more effective and person-centered care models.
Throughout its 2023 convenings, CCI’s addiction treatment program integrated partnership building, equity considerations, and medications for addiction treatment (MAT) care. Participants were introduced to “systems thinking,” a framework for understanding complex challenges through the lens of relationships, and polarity mapping exercises (mapping common tensions). These methods strengthened partnerships between clinics and community-based organizations by helping them understand and resolve potential conflicts, ultimately enhancing the person-centeredness of addiction treatment services.
Another valuable approach learned from an indigenous participant is “yarning,” an Aboriginal Australian method of knowledge exchange that emphasizes narrative and deep, non-judgmental listening, mutual respect, and personal story sharing. This approach fosters deeper connections and understanding, crucial for person-centered care.
In late 2023, CCI and Community Clinic Association of Los Angeles County co-hosted a “design dash” for street medicine teams across Los Angeles. This rapid introduction to design thinking methods explored strategies to maintain care continuity for street medicine patients. The event was marked by laughter and joy, indicating the success of this novel approach in fostering collaboration and sparking new ideas. One attendee remarked, “We accomplished more here in a single day than in an entire year of remote collaboration.” Such innovative and engaging methods are key to advancing person-centered care in challenging settings like street medicine.
Digital Transformation: Enhancing Accessibility and Person-Centeredness
Digital transformation is fundamentally changing healthcare by integrating technology across all aspects of care delivery.
The COVID-19 pandemic accelerated this shift, dramatically increasing the adoption of digital tools for patient visits, clinical decision support, administrative systems, and more. This transformation holds immense potential for enhancing person-centered care by improving accessibility and efficiency.
Today, CCI is guiding the safety net through this significant technological evolution. Providers working with CCI have utilized telehealth to bridge the digital divide and extend care to patients in remote rural areas. Telehealth has reduced patient travel and wait times, and many providers report improved efficiency without increased costs, while maintaining or even enhancing care quality. Furthermore, digital tools have enabled the delivery of timely online counseling for individuals facing addiction, depression, and other mental health challenges, significantly improving access to person-centered care.
CCI has actively documented and disseminated these success stories through publications, podcasts, and videos, recognizing the power of storytelling to accelerate adoption and adaptation of digital health solutions. A mini-documentary about the Community Clinic of Maui (Malama I Ke Ola Health Center), showcasing how CCI support enabled the addition of a nurse to its street medicine team using telehealth to connect unhoused patients with clinic physicians, gained international recognition in 2023, winning six media and film awards, including two Telly Awards. (CCI deeply mourns the devastating wildfires in Lahaina, the community served by this clinic.) These stories highlight the tangible benefits of digital transformation in enhancing person-centered care and reaching underserved populations.
At CCI, we believe:
- Accessing healthcare should be seamless and user-friendly.
- Community members must be actively involved in shaping digital health solutions.
- Safety net providers are uniquely positioned to demonstrate the role of digital tools in addressing health inequities and promoting well-being.
- Staff satisfaction and retention will improve with successful digital tool adoption, leading to better patient services and more person-centered care.
Here are key lessons CCI learned in 2023 regarding digital transformation and its impact on person-centered care:
Expanding Availability and Accessibility for Person-Centered Care
In 2023, CCI observed that digital tools are empowering the safety net to deliver greater value to community members, particularly by facilitating quicker and easier access to care for historically underserved and marginalized populations, thus enhancing person-centered care.
For organizations seeking inspiration to enhance and expand virtual visits, CCI offers the Virtual Visit Journey Map, a valuable resource providing guidance for each step of the patient journey in virtual care. As healthcare systems continue to adapt to virtual care models, CCI has collaborated with program participants to compile resources for effectively engaging patients in this digital modality, ensuring a person-centered virtual care experience.
In 2023, CCI’s Connected Care Accelerator program served as a testing ground and support system for California organizations to rapidly design, test, scale, and disseminate new strategies to improve equity in telehealth access. Key learnings revealed that many opportunities to enhance telehealth equity lie within the provider domain. Workflows need to incorporate screening for patients’ digital barriers and offer a range of virtual visit options suitable for telehealth. Bridging the digital divide requires implementing user-friendly technology platforms and providing robust support for both patients and providers facing language or technology challenges, all essential components of equitable and person-centered digital care.
Complementing virtual care initiatives, CCI expanded a national community focused on increasing access to video visits, particularly for individuals experiencing economic disparities, housing and food insecurity, institutional discrimination, or violence. While video visits are not a singular solution for health equity, they offer significant potential to overcome barriers to care and improve healthcare delivery, especially when implemented with a person-centered approach. The Accessible Video Visits Guidebook, a digital learning tool, provides practical changes, how-to guides, and checklists to enhance video visit utilization. It features telehealth experts from the safety net, many of whom have piloted solutions through previous CCI programs, and tools to identify both provider- and patient-centered innovations, all aimed at making virtual care more person-centered and accessible.
CCI’s work in refining digital workflows also emerged in a California multimillion-dollar “test to treat” program supporting providers in accelerating the delivery of life-saving COVID-19 treatments. Leveraging government investments to expand COVID-19 treatment access, CCI aimed to ensure that these investments also fostered digital transformation to strengthen primary care overall. Participants are now applying these new workflows to improve access to care for a broader range of conditions and diseases, demonstrating the lasting impact of digital transformation on person-centered care.
For example, Nobility Health ensured comprehensive staff training on a new electronic health record system and migrated all historical data and processes. By strengthening digital workflows, they implemented a process to contact patients within 24 hours of a positive COVID-19 test, increasing the proportion of eligible patients receiving therapeutics within 48 hours from 40% to 70%. Subsequently, Nobility expanded this model to incorporate screenings for Hepatitis C and sexually transmitted infections, including HIV and syphilis, showcasing the scalable and adaptable nature of digital workflows in enhancing person-centered care.
Reducing Administrative Burden for Improved Person-Centered Interactions
Administrative burden is a major contributor to burnout among healthcare professionals, encompassing tasks like scheduling, charting, reporting, and patient communication. Digital tools offer significant potential to enhance efficiency and alleviate staff burden, freeing up valuable time for more meaningful patient interactions and more person-centered care. While many safety net organizations are beginning to explore these benefits, CCI is actively supporting this transition.
CCI’s Technology Hub program assists safety net health systems in vetting, piloting, evaluating, and disseminating innovative digital health solutions aimed at reducing administrative burden and enhancing person-centered care. Altura Centers for Health sought to streamline its referral management process by implementing automated solutions to create a more self-sustaining system.
Contra Costa Health Services experienced a surge in patient portal usage during the COVID-19 pandemic, leading to a massive increase in password reset requests. Faced with limited staff capacity and high costs for outsourced support, Contra Costa implemented an AI digital assistance program. This AI assistant successfully deflected up to 80% of password reset calls by offering self-service text message instructions, empowering patients and reducing administrative strain, thus indirectly contributing to a more person-centered service delivery.
Matt White, director of innovation at Contra Costa, noted, “We could now offer self-service, provide support outside call center hours, and empower individuals to participate more actively in their health management, discovering tools they may not have known existed.” This shift towards self-service digital tools enhances patient autonomy and convenience, key aspects of person-centered care.
CCI’s innovation community in Colorado is also making strides in this area. Gunnison Valley Health, in addition to in-person translators, adopted online interpretation services for Latino patients speaking Cora, an indigenous language from Mexico. Patient feedback highlighted the positive impact, with one patient stating, “I want to thank the hospital for all the support, the translators are excellent, beautiful people with human warmth.” Addressing language barriers through digital solutions is crucial for equitable and person-centered care.
Northwest Colorado Health, serving a vast rural area, integrated financial aid application processes into its systems, ensuring sustainability regardless of staff turnover and improving access to financial assistance for eligible patients. WellPower and Jefferson Center piloted an AI documentation assistant that converts behavioral health conversations into clinical insights, potentially reducing provider notetaking burden and allowing for more focused, person-centered patient interactions.
However, CCI also learns from initiatives that face challenges. Pueblo Community Health Center explored innovative ways to better serve deaf and hard-of-hearing patients, aiming for more person-centered communication. While experimenting with tablets and speech-to-text software for real-time closed captions at reception, issues with transcription accuracy, data security, and battery life led to the unexpected discovery that simple, low-tech whiteboards and markers were more effective and appreciated by patients. This example underscores the importance of patient feedback and iterative refinement in implementing digital solutions to ensure they truly enhance, rather than hinder, person-centered care.
These highlights represent just a fraction of CCI’s work in 2023. Explore our “Keep Exploring” section to delve deeper into our stories and resources!
