Over the last 40 years in Alaska, there has been a transition from federally run healthcare service to a tribally owned and run service.
I am very proud of our culture of collaboration in Counties. Sure, we disagree, argue and debate, but, more than anywhere I have ever worked, we muck in together and amazing things happen every day. That gives me hope that we can make some of the “step changes”, the truly transformational change, we need to continue to deliver world-class healthcare for our population. Hope is good, but I wanted evidence! Can many “tribes”, many groups, many organisations come together, collaborate together, to deliver a totally new model of healthcare delivery? Well, that is what we saw in Alaska.
I asked tribal members why make such a change? I received some very clear answers:
“For reasons of pride and practicality”.
“Desire to Control our own health care”
‘Desire to “provide culturally appropriate health care”
‘We want to build health program’s “around the family, which is central to Alaska Natives”
We had a great visit to the Family Medicine facility at the Alaska Native Medical Centre in Anchorage. Some key take away messages for us:
- All population members are enrolled onto a list
- Each list is looked after by a team of family care providers who are colocated together, and form a very tight unit.
- The facility is warm and welcoming with different rooms. For example you can be seen in a single “talking room” or a family room.
- The lead for each team can be a GP or a Nurse practitioner
- Each team consists of GP/Nurse practitioner, case manager, admin person, data person, behavioural health specialist and nutritionist.
We talked extensively about this model, and it was very well received by everyone we met.
Some might have said collaboration was going to be impossible. 229 individual tribes, all with different culture, different traditions, different strengths. Tribes from all over Alaska – a country that is challenged by geography (it’s huge!) challenged by climate (-60 degrees to +30 degrees), by poverty (thousands of native Alaskans still have no running water or sewage disposal).
From a tough start, warring amongst themselves, these 229 tribes now work together. The model is working in consensus-“Built on trust”. We were privileged to be invited to join a “Mega meeting” where the leaders from the tribes across Alaska met with the State and the National health officials. I sat with tribal members and asked how they made this collaboration work. It apparently wasn’t built overnight! The description was of a consensus model of decision making, with a process that runs from 8 am to late every day until consensus is achieved. There was also a clear recognition that they needed to stand together. As one tribal elder told me, you “Don’t pull a fast one, as it is a long term trust relationship”. Other hosts described how a “rising tide will lift all the ships”, linked to a vision that they are much stronger acting together, not for short term individual gain.
Truly transformed care is possible, as our Alaskan hosts have shown us.
As a result of these new friendships, some of our hosts will likely attend the APAC conference in September this year, and will certainly join with us to run an International Indigenous Population Healthcare summit here next year. Do look out for and ask questions of our Alaskan friends at APAC in September.