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We challenge the belief that people resist change while embracing the idea that change is necessary to lead. Cultivating leaders to orchestrate conflict with deliberate intention is a skill leaders can learn. Yet, skill alone is insufficient to lead. Using three models, Communicative Intelligence, Adaptive Leadership, and Adaptive Schools, we tell the story of how we developed leaders to think adaptively and communicate authentically to collaborate across diverse communities to bring their visions to fruition. This chapter describes the models and their integration from three perspectives illustrating how we focused the cultivation of leaders. First, the personal development of their dispositions related to communication, collaboration, and systems thinking. Second we worked on developing the skills to build relationships and think politically. And third, we focused on identifying and implementing systems to address the critical issues facing their schools.
This study examined effectiveness of an integrated care program on emergency department visits within a longitudinal sample of patients with both primary care and…
This study examined effectiveness of an integrated care program on emergency department visits within a longitudinal sample of patients with both primary care and behavioral health diagnoses.
Patients with co-occurring disorders enrolled in an integrated care clinic and were followed over time to determine whether participation in the clinic, including engagement in wellness/peer services, predicted decreases in Emergency Department (ED) use. Associations between socio-demographic characteristics of patients and ED use were also analyzed.
After 6 months, clinic patients had decreases in ED use that continued for twelve months, albeit to a lesser degree. Demographics and program services were not related to ED use; however, multiple associations existed between high ED utilizers, severe mental illness (SMI), substance use disorders (SUD) and non-retention in services.
The study lacked a comparison group and there was no distinction between avoidable and unavoidable ED visits. A small sample size across time points led to inconclusive post hoc findings.
This study explored effectiveness of primary care integration into a behavioral health clinic for persons with multiple morbidities. Although initial decreases in ED visits were present, results indicate that these models may not be effective for persons with SMI or SMI/SUD who are already high ED users. This study provides support for integrated care in reducing ED use among persons with multiple morbidities and calls for further research on designing effective integrated models for persons with SMI and SUD.
The purpose of this paper is to describe and analyze a teleconsultation modality based on a simple telephone call, using either landline or mobile phone, made available to…
The purpose of this paper is to describe and analyze a teleconsultation modality based on a simple telephone call, using either landline or mobile phone, made available to more than two million people. Telecommunication systems are an increasingly common feature in modern healthcare. However, making teleconsultations available to the entire population covered by a public health system is a challenging goal.
This retrospective longitudinal observational study analyzed how this modality was used at the primary care level in Galicia, a region in the Northwest of Spain, in 2014 and 2015, focusing on demand, gender and age preferences, rural vs urban population and efficiency.
Of 28,472,852 consultations requested in this period, 9.0 percent were telephone consultations. Women requested more telephone consultations (9.9 percent of total consultations) than men (7.7 percent of total consultations). The highest demand occurred for the over 85 age group for both men and women. In both years, 2014 and 2015, the number of telephone consultations per inhabitant was higher in urban (0.53 and 0.69) than in rural areas (0.34 and 0.47). In 10.9 percent of cases, the telephone consultations required further face-to-face consultation.
Conventional voice telephone calls can efficiently replace conventional face-to-face consultations in primary healthcare in roughly 10 percent of cases. Women are more likely than men to use primary care services in both face-to-face and telephone consultation modalities. Public healthcare systems should consider implementing telephone consultations to deliver their services.