Clinical Management Theory Part II

In Southcentral Foundation’s Nuka System of Care, health care is provided through integrated care teams consisting of a primary care provider, nurse case manager, certified medical assistant, and case management support. One of the key elements of SCF’s integrated care teams is that everyone on the team works at the top of their license—meaning all but the most critical tasks are handled by non-providers to maximize efficiency and free providers to focus on the tasks only they can perform. Most day-to-day clinical tasks are handled by certified medical assistants, and nurse case managers focus on panel management and chronic disease management. To support care team members in working at the top of their licenses, and to give the Alaska Native community more of a voice in how the organization is run, SCF employs non-clinical workers as clinical managers.

In some health care organizations, high-performing providers are often promoted to management positions. However, this can lead to problems as it prevents the highest-performing providers from continuing to offer the same level of clinical care. SCF has addressed these problems by having non-clinical personnel in management positions in clinics. This works because managers do not interfere in medical decisions or the relationships between integrated care teams and customer-owners. Rather, they work in partnership with care team members, to facilitate the building of relationships and offer support in whatever ways are needed to allow them to focus on offering high-quality health care.

SCF has developed career ladders for employees with exceptional managerial skills, to get them into positions where those skills will be most useful. These employees can come from a wide variety of backgrounds, and they can bring fresh perspectives to the clinic and help in innovation. Also, one of SCF’s main goals is to increase the number of Alaska Native and American Indian people throughout the workforce, so having non-clinical personnel as managers providers additional opportunities for the community to have a voice in how SCF is run.

Clinic managers perform many duties at SCF. For example, they inform care teams about new clinical practices, policies, regulations, or customer service standards that may impact the provision of care. They develop relationships with other SCF departments to ensure that care teams can collaborate smoothly with other areas of the organization as needed. They monitor outcomes and work with care teams to ensure that high-quality relationship-based care is provided. And they perform many other functions to support the provision of care.

SCF also offers training programs to assist its managers while working in partnership with clinical teams. Core Concepts with its focus on communication and storytelling is one example of this, but SCF also offers courses specifically for managers to help them develop the skills they need to support people they manage more effectively. Ensuring that managers have the communication and relationship-building skills they need to manage effectively has been important in supporting the high-quality level of health care the Nuka System of Care has become known for.

For more information about SCF’s use of non-clinical personnel as managers for care teams, or how SCF supports its managers, feel free to contact the SCF Learning Institute.