Texas Rural Health Policy Network: Collaborating to Make a Difference

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Texas Rural Health Policy Network Collaborating
to Make a Difference

• Presented By David Pearson
• Rural Health Trifecta
• August 6, 2008

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Why Collaborate?

• In the long history of humankind (and animal
  kind, too) those who learned to collaborate and
  improvise most effectively have prevailed.
• Charles Darwin

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Bioteams (taken from www.bioteams.com)

• In biological teams "Teamwork" is used
  extensively for critical activities such as
  responding to a threat or exploiting an
  opportunity.
• All forms of teamwork and collaboration are
  needed in a team
• Solowork
• Crowdwork
• Groupwork
• Teamwork

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The right tool for the right job

• Solowork is a valid and useful activity in teams
  - in certain situations it is simply the most
  efficient way to get things done
• Groupwork lends itself well to asynchronous
  communication methods
• Crowdwork may point to poor team role definition
  which wastes team members time
• Teamwork (in the biological sense) seems to be
  relatively rare in organizational teams. It
  requires more co-ordination between team members
  because different individuals need to do
  different things at the same time.

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Solowork

• Goby and Shrimp
• The goby and the shrimp can't survive for a
  moment without each other.
• The shrimp is the homemaker, digging the burrow
  and getting the food.
• But it's almost blind, so the goby keeps guard.

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Groupwork

• Starlings
• When twilight arrives starlings turn into
  daredevil stunt artists.
• They flock to stay alive. Dusk is when the
  peregrine falcon is after them.
• By teaming up with ½ million others and flying as
  one, the starlings confuse the falcon.

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Crowdwork

• Ants
• Army ants work in teams a million strong.
  Together they're five feet tall.
• They're blind, so the recruits lay down a scent
  for the others to follow.
• When it's on the warpath the army can kill up to
  20,000 animals in one day.

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Teamwork

• Meerkats
• Meerkats take it in turns to keep watch.
• They also work together to kill deadly snakes.
• And when the rest of the gang is out looking for
  food, babysitters stay behind to look after the
  pups.

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SB 10 State Healthcare Reform

• The uninsured was a consensus issue
• Support came from all stakeholders piling on
• Buyers remorse set in
• Already given our consent
• Making changes midstream is more difficult
• Lessons learned
• Should have asked better questions
• Collaboration up front may not have been
  necessary
• Teamwork was essential to force changes later

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ORCA Sunset Process

• Agency review by Sunset Commission was
  unfavorable
• ORCA staff and board contacted stakeholders
• Many rural health providers/organizations
  testified
• A coordinated effort to reach out to key
  legislators
• Sustained message of support for leaving SORH
  alone
• Lessons learned
• Start as early as possible
• Strength in numbers
• Do whatever you can (phone, fax, email, meetings)

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Physician Self-Referral Issue

• Very Divisive, two-sided
• A pocketbook issue, win-lose
• Not even all hospitals can agree on the solution
• Legislators dont like to make hard votes
• Not likely to be addressed legislatively any time
  soon
• Lessons learned
• Legislators like negotiated solutions
• Sometimes, both sides can look equally bad
• Some issues take many years to resolve

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Shortage Area Designation Rule

• Researchers spent nine years developing
  methodology
• It took only 60 days to derail it
• Provider associations and state government
  officials
• Analysis, messaging, outreach were all
  coordinated
• Comments were shared freely among all
  stakeholders
• Lessons learned
• Collaboration was necessary to understand the
  issue
• Collaboration resulted in multiple solutions
• Increased awareness yielded increased
  participation

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Tort Reform Yes on 12

• This initiative started years in advance
• Put into action when the political stars aligned
• Stakeholders had skin in the game -
• Fight didnt end after the legislative session
  was over
• Constitutional amendment election cost even more
• Lessons learned
• Big victories sometimes require an investment
• Commitments should not be not one-size-fit-all
• Every single effort counts

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Medicare/Medicaid Reimbursement

• Every day occurrence for hospitals, other
  stakeholders
• Avoid the time to make the donuts mentality
• Extra effort is required each and every year
• Prepare to address funding issues with hard data
• Explain the same issue from multiple perspectives
• Lessons learned
• Be consistent when it comes to the true impact
• Dont talk about money alone
• Talk about access and affordability

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Rural Health Policy Forum

• Previous legislation has promoted rural issues
• Summits held to determine issues and priorities
• An omnibus rural legislative package could result
• Maintaining open lines of communication
• Increasing awareness and understanding on issues
• Lessons learned
• Stakeholders can register their policy
  initiatives
• Others can make connections and build consensus
• It is easier to herd cattle than cats

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Beware of Pitfalls

• In most cases, quality beats quantity
• Be sure to ask plenty of questions
• Choose areas of collaboration carefully
• Build as much consensus as possible early on
• Be sure to follow through
• Show appreciation to everyone

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Opportunities Are All Around

• Be creative when considering potential
  collaborators
• Maintain an awareness of other issues and
  priorities
• Look to see how to leverage the power that others
  have
• Understand and play to each others strengths
• Consider a financial commitment for bigger issues
• Be sure to build upon your prior successes

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Collaboration Doesnt Always Work.
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But When It Does, Good Things Happen.
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Thank You For Your Time!

• For answers contact
• David Pearson
• dpearson_at_torchnet.org
• or
• Don McBeath
• don_at_torchnet.org