Caroline Bouchard

Creating change out of fear

On September 13, the Albany College of Pharmacy and Trinity Alliance hosted a ribbon cutting ceremony for the Collaboratory, an innovative space designed for learning and promoting health within and across the community.

The Delivery System Reform Incentive Payment Program (DSRIP) is about changing the health care system to promote health in ways that are smart, compassionate, and intuitive. One glaring question is how. How do we change? How does one individual change an organization? How about a whole system?

It’s tempting to look at the global picture and give up or assign blame for our health system’s shortcomings. In a way, you wouldn’t be wrong to do so. The problems are complex and intertwined. Many of the breakdowns are not directly in any one person’s control, and it’s easy to see gaps that occur because of a ‘bad’ process elsewhere.

So how do we begin the process and remain interested, engaged, and energized? Recognizing these tempting reactions is a reasonable start. That is, notice the reactions that say there isn’t enough time, attention, or money to make a meaningful difference, or that the power is with someone else, somewhere else. But if you believe that all people have inherent value, and we only stand to gain from unlocking and growing our collective potential, then you can look at these reactions head on and move past them.

During the ceremony, faculty spoke about when the Collaboratory was just an idea. Fear was one of the first emotions to arise. There wasn’t enough time. The space didn’t make sense and needed too much work. The task was too daunting and everyone was too busy teaching. The idea was pushed aside.

Fear, cynicism, doubt— these will inevitably rise. All of these can accumulate within any of us as we experience disappointment, hardship, and failure. But these reactions block the potential for opening, growth, and success. If we are to claim our intrinsic power and begin the incremental work toward system-level change, the key is in first identifying these barriers so we can move past the fear of disappointment, hardship, and failure. What results will be totally inspiring.

After recognizing these blocks, the next step is to consider what is in one’s own control. What is in the control of my organization? What can we do differently to improve the patient experience, streamline communication, connect with other organizations in the system, create healthy spaces, and create joy in our work? What can we do differently right here, from this small point within the larger system? Change can happen through incremental adjustments that begin in the actions of individuals. This means that transformation of the greater health care system begins with you and/or your organization. And this applies to every individual in the system, including members.

When you begin with, “I’d like to do X, but I’m afraid of Y,” acknowledge this response, then let it go. Do not make decisions based on your apprehensions. Go back to your team and think about solutions again. Think about what you contribute, what you bring to the table, what you can do for others. Remember, the others include Medicaid members, your colleagues at work, your partner organizations, and other organizations in the system.

When figuring out what you want to contribute, go to the source of value and identify your power and your own incredible abilities.

The Collaboratory was something that the College faculty thought was worth pursuing. This pushed one faculty member to meet with the head of Trinity Alliance in the space that had been bounced around as a potential location. It was right next door to dozens of Albany residents. It wasn’t pretty, but it could be fixed. There was a consensus that the goal was to be interactive and participatory community members and to have pharmacy students connect and learn the wealth of knowledge outside the College’s traditional walls. The two organizations decided to work together. With the partnership, time was made, money was raised, more people were recruited, and an idea came to fruition and has now been launched.

We can all do this. With all of us examining what we can contribute, identifying solutions, and moving forward past fear, we will collectively build a system that makes all of us healthier, wiser, more resilient and maybe even creates delight.

Everyone has something to offer

Humans are inherently valuable. Everyone has something to offer. Every person you pass on the street. Every colleague you encounter in a meeting. Every acquaintance. Each of them has value, and the value is inherent. Sometimes what can be offered is not obvious. It can be couched in or covered by fear, and when people are afraid, they struggle to be the best versions of themselves. When people are scared, they can behave erratically. But the value is there. I believe this about people.

What would it mean to live/work in an environment where people are understood to be inherently valuable with resources to give? How do we create a context that grows the abundance of human talent and energy that exists all around us?

This is what DSRIP is about for me: The creation of healing, health-promoting space that can acknowledge fear, help process it, and address the root causes driving it, allowing the individual to emerge with the incredible resources they offer revealed. How can we take our current structure, which focuses on intervention, and shift to creating a container that naturally, by design, promotes health? Let’s transform from clusters of healthcare providers to a health-promotion framework.

What DSRIP has done is give us the opportunity to prioritize what change is important and make that change a reality. I believe what is important is focusing on everyone’s inherent value. We all have this incredible opportunity to make real, positive, impactful, life-improving change. We can create a system where working in health care is uplifting, fulfilling, and energizing, where the system is simple to navigate, practically designed to make life easy for patients and providers, and to make improving one’s health a reality.

This opportunity is precious. We have so many resources to do real work and make real changes. But what does this even mean? “Patient centered-ness.” “Health promotion.” What do these terms mean for a Medicaid member? Do they mean evening hours at a PCP’s office? Maybe. Maybe they mean steady income with honorable, fulfilling work. Maybe they mean being treated like family during an office visit, or being able to get groceries without needing to worry about bus schedules. Maybe they mean having stable housing and housing that is clean and free of mold. Maybe they mean stable community connections that are nurturing, can support one even through crisis and prevent future crises from happening. Maybe they mean walking around one’s neighborhood and being edified by the environment or having easy access to fresh, affordable fruits and vegetables with the time and means to use them. Or maybe they mean being able to wake up sick, concerned, or with pain, and be seen the same day, even if you have not seen the doctor in several years.

People matter. Not in the abstract. In concrete, practical reality. People matter and they matter equally. And because all people matter, why not work to improve the health of the particular subset that faces barriers stemming from a lack of funds. These barriers tend to overlap in a knotted mess. Education, health, employment, income, environment, social connection, all of these societal components intertwine to impact human health, as health impacts these other components. This reflects social justice, or injustice. What we have is an opportunity to untangle the knots. This means unlocking the beauty of human potential and the dream of a world created when happy, fulfilled, healthy people can bring their full selves forward.

This process begins with being willing to change. To change the self and to change the every day. If you work in the system or are served by the system and set your mind, intention, and dialogue to focus on creating healing spaces for people who are scared, sick, angry, without means, or burned out, then you will see change and be part of it.

To me, this is the opportunity that DSRIP presents and one that I have embraced in my role as Medical Director here at Alliance. For our partners, what opportunities do you see in the DSRIP program? For community members, what other values should drive our work?  What is the change you want to see?