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Turning an ‘Uh-Oh’ into an ‘Ah-Hah’

July 27th, 2017 / Diana Nguyen

Two summers ago, I had one of my big “uh-oh” moments while I was interning at a local community health center. Before you start jumping to conclusions and thinking of all the things that could have gone wrong, let me just say that it isn’t as dramatic as you think. In fact, this “uh-oh” was more of a realization that this was a complex issue—one that I didn’t know how to fix.

At the time, I was assisting my supervisor in leading “cultural humility” trainings for the clinic staff. The intention of the trainings was to demonstrate the value and benefits of building more personal relationships with patients. The idea was simple: a more personal relationship would lead to open conversations. Open conversations would uncover information about the patient’s social and cultural background. Thus, hearing about the patient’s personal background and experiences would allow the clinician and other clinic staff to provide more culturally-appropriate care and referrals. As someone who is interested in the social determinants of health, I thought this sounded great.

That was the case until one training session, in which a clinician voiced his frustration. He asked, “How can clinicians even learn about their patients’ non-medical issues, if they barely have any time to address their clinical issues in each visit?” That’s when I looked at my supervisor, waiting to hear her answer. She suggested using the alternative payment methodology (APM), a pilot to motivate clinics to provide value-based care (vs. traditional volume-based care) through a capitated payment model. I didn’t tell anyone at the time, but I was just as dissatisfied with that answer. I thought to myself, “Would that really change anything considering the issue was the amount of time allotted for each patient visit? Is there a more immediate and efficient solution for clinics to gather this information, without taking time from patient visits?”

Fast forward to today, I am now working for CCI as a program coordinator on the value-based care programs, where I’ve gained some insight on these questions. I’ve learned that the collection of social determinant information can be done on both an individual and population level. After reviewing grant applications for our new ROOTS program, it’s clear that more and more organizations are moving towards implementing data collection tools, such as PRAPARE and homegrown assessment surveys. Moving towards this system would allow data to be captured efficiently and more widely across clinics. The beauty of all of this is being able to use the data to support collaborations outside of the clinic that would improve patients’ overall health and well-being—beyond medical needs. It’s exciting to see this type of data-driven work happening, yet I can’t help but think back to my experience two summers ago.

When is it appropriate to be discussing patients’ social and cultural experiences during a patient visit vs. collecting the information through a tool? Is it still worth discussing complex social situations with patients if providers aren’t equipped with the time or resources to support their patients? Beyond that, how does a provider even gain the patient’s trust within a 15-minute visit for the first time?

All of these questions feel daunting and impossible to address, but my recent CP3 planning call with a health communication expert and practicing physician has helped me understand that we are continually developing strategies for addressing these issues.

If you’re struggling with these questions at your clinic or if you have some answers, let me know! Email me at Let’s get to that “ah-hah” together.