Health Integration Transformation Executive Summary.  As presented with my public comments regarding the steering committees Board Priorities and Operational Framework strategic plan. 

The Health Integration Mental Model Framework highlights theory, dynamics and multiple phases associated with large scale systems transformation.  Supported by relevant research the final report represent a systemic process to organize, prepare and implement a comprehensive integrated system of care and service reimbursement mechanism.

A mental model is an explanation of someone’s thought process about how something works in the real world. It is a representation of the surrounding world, the relationships between its various parts and a person’s intuitive perception about his or her own acts and their consequences.  Mental models can help shape behavior and set an approach to solving problems and doing tasks.  This mental model framework represents a non-threatening approach toward integration of Los Angeles County systems of care.  The framework embraces Institutional theory and social marketing technique to establish measurable benchmarks during health integration implementation.  The framework and its content lends itself to collaboration building, knowledge sharing and education to develop new partnerships to sustain community health and well-being.

Integration of the county mental health, public health and health systems will include developing a team of professionals to become familiar with whole-systems thinking, large group facilitation processes and social marketing communications.   Successful integration of the county’s system of care inclusive of board priorities require the expert team to gain understanding of each organizations structure, culture, funding streams, program categories and communication methods.  Equally important is maintaining exceptional community relations to engage and prepare contract providers with community-based organizations during implementation while embracing public opinion.

Sponsors of whole-system transformation understand integration requires one-third of stakeholders to embrace a conceptualized vision demonstrating how the emergent system will increase population health outcomes.  Stakeholders currently include county employees, commissioner oversight groups, contract providers, community activists and each agency Director contributing to the Health Integration, Strategic Priorities and Operational Framework final reports.  As a vision of what a community-based health and human services system of care resembles, the mental model framework becomes a living strategic plan guiding its organizational design, planning and coordinated implementation processes that link administrative, service and program functions of the county’s three systems. The following summary points shed additional insight into system change elements that enable restructuring of the county’s system of care.

System and Community Dynamics: System & Community Dynamics represent real examples of administrative issues and citizen concerns that justify model building, analysis and evaluation of joint solutions.  With as many constantly evolving dynamics related to institutional transformation, becoming an expert takes 10 years and requires the acquisition of 50,000 chunks of knowledge.    Differentiating stakeholder concerns will reveal gaps in services and policy leading to the integration of innovative practices that close systems and community gaps in pursuit to streamline services.

System and community dynamics often remain unmanaged until issues become extremely challenging to resolve without systemic change.  This Health Integration Transformation framework establishes protocols and processes that mitigate conflicting system and community dynamics that threaten the health and well-being of citizens within Los Angeles County.

Whole-System Transformation: Whole-System Transformation (WST) embraces the thoughts, opinions and interrelationship among the internal social structure of government agencies, external ecosystem of community-based organizations and providers in concert with general public opinion.  WST procedures facilitate multiple processes and phases that enable stakeholder readiness that develop holistic themes centered on vision-based leadership, collateral leadership, power sharing, and process-based leadership. WST methodology allows cross-sector collaboration to share information, resources, activities, and capabilities by organizations in two or more sectors to achieve jointly an outcome that could not be achieved by organizations in one sector.  By engaging diverse opinions, environments, influences and skills, individuals participating in WST processes may reach comprehensive and thoughtful resolutions that exceed the expectation of a few decision makers.

Cultural and Linguistic Competence: Imperative to reducing health, education and economic disparity is the institutionalization of cultural and linguistic competence. As a non-threating action to organizing the internal social structure for health integration is the sharing of culturally competent strategies implemented by each agency to inform continuity of care across the provider network.

Social Marketing: Social marketing should not be confused with traditional marketing considered strategic Social marketing is a promising method to assemble and engage the internal social structure with its external environment to initiate decision making about the system’s core support and work processes during the planning of social change.  Social marketing in essence represents the mental model’s Blue Print that incorporates vision, processes and change mechanism’s that will enable civic engagement during health integration transformation.  Social marketing toward social change is beneficial to gaining institutional legitimacy by influencing a renewed belief among citizens in their perceived value of health and human services delivered in historically underrepresented communities.

Open System Structure: The open systems structure will remove traditional barriers to services and shift public perception creating acceptance of a system of care co-designed by the community intended to serve.  The open systems approach to health integration establishes ideology in which the internal social structure intentionally engages the external social environment.  An open system structure allows for shared decision making and accountability among qualifying stakeholders providing system oversight and designating by consensus a Health Agency Director with the responsibility of reporting to the Board of Supervisors on behalf of his/her constituent delegates.

Evaluation: A dual evaluation approach using design and implementation feedback will analyze perspectives of different stakeholders evaluating the system from multiple levels of scale (Gregory 1996a).  Health Integration Transformation will emphasis evaluating Goal seeking and Systems-resources. As the system undergoes redesign with sustainability in mind, systems-resource evaluations adapt to internal and external system interactions as participants will have different views about how the system evolves and processes that govern the emergent structure.

Health Integration Transformation Implementation Phases:

  • Phase I – Pre-Planning for Health Integration Transformation (Gathering Stage) 3-4 Months
  • Phase II – Preparing Internal Social Structure & External Ecosystem (Envisioning Stage) 3-5 Months
  • Phase III – Community Integration & Reconstruction (Mastering Stage) 12-14 Months
  • Phase IV – Health Integration Implementation (Renewing Stage) 2-3 Months
  • Phase V – Evaluation & (Scale) Continuous Improvements
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