When Washington state reported the first death in the United States because of COVID-19 in late February, the Washington Health Alliance, a regional health improvement collaborative (RHIC), and its members – 185 state, county and private employers, union trusts, health plans, hospitals and physician groups, government agencies, community based organizations, educational institutions, pharmaceutical companies and individuals – were “activated.”
The plans and processes WHA members developed – from setting up testing centers to establishing surge hospitals and delivering PPE to healthcare workers – set a precedent for regional health improvement collaboratives across the country to respond to their own communities’ needs and to do so quickly.
The example of Washington Health Alliance is meaningful for a few different reasons:
- It brings the focus on the critical role of “value networks” in the area of health and healthcare improvement. Fjeldstad et al. (2020) defines value network as “a configuration that facilitates flexible interaction among people, places, and things (eg, patients, clinicians, researchers, organizational entities, and databases). A network is composed of nodes or “actors” and the links that connect them.”
- Regional health improvement collaboratives (RHICs) “promote self-organizing behavior … to respond quickly and nimbly to a variety of needs because [their] resources can be (re)configured as needed.” (Fjeldstad et al., 2020)
- RHICs efficiency and effectiveness is most apparent when they are a part of a network of similar organizations outside of their region or scope of work. The Network for Regional Healthcare Improvement (NRHI) provides both the “commons” (Fjeldstad et al., 2020) – repositories of shared resources – and the infrastructure for RHICs to connect, collaborate, and accelerate their work.
1. Activating a value network in a time of crisis
Activating a network and value-creation is dependent upon bringing “the right people together with the right information, with the right technology in the right way, and at the right time” (Fjeldstad et al., 2020). Networks thrive when professionals and organizations who participate have a shared purpose, provide expert knowledge, and support co-creation. A crisis such as the COVID-19 pandemic and its multi-dimensional impact played a crucial role in not only activating but increasing collaboration among organizations with a vested interest in the common good.
How do networks create solutions in a time of crisis?
If a value network has the ability to self-activate and be flexible in finding solutions to immediate needs during non-critical times, this ability is not only put to test during a crisis, but it is also enhanced and strengthened, and the outcomes have much broader impact. Since COVID-19 interrupted our routine flow of life, a myriad of digital, social, and educational value networks were activated to seek and find solutions within a limited time frame with resources readily available. If we summarize how networks create solutions in a time of crisis, it comes down to:
- Networks, with a focus on learning, provide a system for improvement and new knowledge in real-time (Clancy et al. 2013);
- Networks foster increased collaboration;
- Networks are formed around common interests and bonds which strengthens relationships and commitment to the mission;
- Working together to integrate resources for mutual value creation, is inherent in a network (Fjeldsdad et al., 2020, Greer et al., 2016).
2. Regional health improvement collaboratives (RHICs) are “actor-oriented networks”
“An essential strength of collaborative improvement networks is that they are composed of multiple stakeholders: patients and families, clinicians, and researchers who use data to learn from each clinical encounter to improve patient outcomes. Although each stakeholder group brings a different strength and perspective, all are aligned on the goal of improving care and results for children and families” (Clancy et al. 2013). Similarly, RHICs are independent non-profit organizations governed by multi-stakeholder boards that include health and healthcare providers, payers, patients, purchasers, and policymakers with an aim to improve the health of communities by improving care, lowering costs, and improving quality.
RHICs emerged in the early 2000s as Quality Improvement Collaboratives (QICs). They were established to respond to the dire quality and safety gaps rampant in healthcare delivery. Today, there are more than 30 RHICs, and they are jumping in to address uncovered gaps as we navigate the many challenges associated with coronavirus.
RHICs across the country are taking swift action to support key stakeholders responding to the emergent community needs resulting from COVID-19. These regional entities are critical to identifying urgent and unmet needs, convening stakeholders across healthcare and other sectors, building will among local leaders, and acting quickly to implement solutions that are based on data and evidence, carefully measured, and are watchful of quality and safety.
Why are RHICs able respond quickly and effectively during the COVID-19 pandemic?
RHICs possess key attributes that allow them to move quickly in crisis:
- Maintaining trusted relationships across stakeholder groups and sectors by acting as a neutral convener;
- Bridging the gap between healthcare, public health, and community health leaders and programs;
- Convening with a purpose of problem solving;
- Having diverse expertise in a range of health and healthcare focused topics;
- Having sophisticated data and measurement capabilities;
- Being sense-makers during challenging times;
- Developing resources when gaps are identified.
As RHICs navigate difficulties, networking with like organizations to learn quickly, share experiences, and have access to sounding boards becomes critical in advancing their efforts.
3. The Network for Regional Healthcare Improvement is the infrastructure that brings national visibility to regional efforts
The Network for Regional Healthcare Improvement (NRHI) is a national non-profit membership organization with a mission to support local leaders in their efforts to address regional health issues related to patient outcomes, care delivery, quality, and cost. NRHI supports and spreads regional collaboration across the United States. The network reaches approximately 70% of the US population. NRHI provides the “commons” – repositories of shared resources – and the infrastructure for RHICs to convene and participate in shared learning, consensus building, and exchange of research, evidence, and best practices allowing for greater collective impact.
In the past three months, NRHI members are being activated by the dire nature of COVID-19 and its impact on communities, health systems, and vulnerable populations. NRHI responded to the crisis in its own way – by convening the conveners to share experiences, work on projects, and offer shared resources.
COVID-19 Research Study/Convening the Advisory
In early March, NRHI responded to a request for proposal specific to critical considerations for off-site testing of COVID-19. NRHI was able to quickly engage its network to respond to and secure the contract. In four weeks, NRHI and a research lead, Qualidigm (an NRHI member), with support of an NRHI member advisory group comprised of nine NRHI members, produced a key considerations report from a well-planned, rapid-cycle assessment. The project not only uncovered promising off-site testing practices from regions across the country, but it also brought to light the heroic efforts in addressing emergency disaster preparedness, social inequities, access to care, rural issues specific to COVID-19, and mental health support for care providers among others.
Nancy Giunto, President and CEO of Washington Health Alliance served as an advisor on the project and presented during the unveiling of the results. “This is remarkable work done in very short order. We may be ahead of the country because many of our testing sites have been operating for some time, that’s where our experience can help others” (WHA newsletter 5/2020).
National Visibility of Regional Efforts: Collaboratives in Action Webinar Series
In early April, when everything felt chaotic, NRHI set to be the platform where RHICs would disseminate timely relevant information and resources as well as regional solutions and stories of hope. The webinar series – Collaboratives in Action: Responding to COVID-19 – initially planned to be 4-5 webinars and to end at the end of May. Yet, RHICs continue to reach out with requests to participate and share how they are offering service during this crisis. NRHI opened the webinars to anyone with vested interest in finding more effective and efficient ways to combat the pandemic. Since the true nature of value network is not only to provide the infrastructure for its actors to collaborate, but also to preserve and disseminate shared resources, NRHI set up a web page with webinar recordings, members’ stories, and updates on the off-site testing project.
RHICs’ impact varies from a broader metropolitan area to a few states and even some of the American territories. Their scope of focus is often very different, and the COVID-19 crisis called upon them to focus on finding specific solutions for the dire needs in their communities. Examples include:
- The Health Collaborative, Cincinnati, OH- Emergency Disaster Preparedness
- Greater Detroit Area Health Council, Detroit, MI- Distributing PPE & Supporting the Development of Off-site Testing in Community Settings
- Stratis Health, Minneapolis, MN- Navigating Rural Health Issues and Creating Pathways Forward
- Institute for Clinical Systems Improvement, Bloomington, MN- Addressing Mental Health Support for the Healthcare Workforce
- New Jersey Health Care Quality Institute, Princeton, NJ- Publishes Brochure “Advance Care Planning: Preparing for the Unexpected”
The importance of convening local leaders across stakeholder groups and sectors must be underscored as we work in a systematic and unified way to address the path forward from the COVID-19 pandemic. Regional health improvement collaboratives have the capabilities to build key partnerships and create answers quickly during a crisis. The Network for Regional Healthcare Improvement provides the infrastructure and resources so its members can learn from one another, quickly adopt solutions, and commit to problem solving together.