What I Learned in Anchorage: Putting Relationship at the Centre of Care
Sarah Yardley is an Associate Professor of Palliative Medicine at University College London and a Winston Churchill Fellow. She attended SCF’s Nuka System of Care Conference in 2025 and has written the following blog based on her experience. We are honored to share her thoughts with you.
When I arrived in Anchorage, I came to learn how Southcentral Foundation’s Nuka System of Care turns a big idea into everyday practice: relationship first, structure in service of relationship. The days that followed reshaped how I think about meeting the needs of people living with serious physical and mental illness together — not as parallel tasks, but as a single, relational craft.
This blog shares a few scenes from my time with primary care, behavioural health, case management, and leadership teams. The thread running through all of them is simple and striking: shared team‑based rhythms that make warm human connection the default. It’s not an add‑on; it’s how the work is designed.
Same‑Day Support, Everyday Mental Health
I watched behavioural health clinicians step into rooms within minutes, introduced by a familiar primary care colleague. No forms. No triage queue. Just a warm handoff that made help feel normal. Staff described this as “emotional first aid”, brief, containing, and relational, offered before a crisis gathers pace. Co‑location, shared workspaces, and clear communication routes make these transitions fast and calm. (Visitors to Nuka will recognize these improvement principles from SCF’s blogs and conferences.)
What stood out? The language. People are customer‑owners, not passive recipients of care. Choice is explicit (who would you like to see? what would help today?), and the team knows the person’s story across time. Familiarity lowers anxiety; predictability becomes safety.
Daily Huddles: Small Rituals that Do Big Work
Primary care, behavioural health, case managers and others checked the day’s plan, named pressure points, and aligned on who needed attention now. A few minutes of shared context that prevented hours of friction later.
I saw this again and again:
- Clear roles plus flexible help. Boundaries are known; stepping in is expected.
- Real‑time problem‑solving. People walked to a colleague rather than waiting on messages.
- Leadership walk‑arounds. Leaders were visible, curious, and supportive, modelling the culture they wanted to see.
The result was not just smoother flow; it was meaningful containment for teams and customer‑owners. A predictable rhythm lowers the collective “threat level,” so decisions improve. That insight, relational predictability as safety, is critical to good care.
Case Management as Relational Glue
Case managers were everywhere: on the phone arranging follow‑up before worry escalated, in the huddle clarifying plans, or literally walking with a customer‑owner between rooms so trust and context travel together. In my Churchill Fellowship report I call this a “warm handover,” and Anchorage showed me what it looks like when you scale that habit across a whole system.
What impressed me most was how case management anchors continuity: one relationship spanning appointments, locations, and transitions of care. It’s simple, human, and powerful, especially for people living with complex mental health conditions alongside advanced illness.
The Built Environment as a Care Tool
Nuka’s open‑plan team spaces make it easy to see, ask, and support. I watched a primary care provider glance up, catch a behavioural health colleague’s eye, and invite a same‑day check‑in for someone who looked distressed. Two people who know each other well doing the right thing quickly. Space communicates values. Here, it says: we see each other; we solve things together. (SCF’s resources often point visitors to the role of design in making relationship the path of least resistance.)
Customer‑Owner Voice in Operations, Not Only in Stories
Beyond clinic rooms, customer‑owner voice was visible in how improvement priorities are chosen and how success is judged. Measures matter, but they’re used for learning, not blame. Teams ask what the data is telling them about people they know, and adapt accordingly. That stance, data in service of relationship, aligns with the Nuka longstanding emphasis on whole‑system learning and local problem‑solving.
Five Insights I’m Taking Home
Anchorage offered many insights; these five feel transferable anywhere:
- Make help easy to accept. Normalize behavioural health as everyday primary care. When help is immediately available and introduced by someone familiar, more people use it earlier.
- Use small rituals to create big safety. Daily huddles, warm introductions, and brief debriefs reduce distress and error because everyone shares the same context.
- Design for proximity. Plan spaces and schedules so teams see and support one another in real time.
- Let relationships cross boundaries. Encourage trusted supporters, case managers, peer workers, chosen family, to travel with the person through transitions.
- Measure for learning. Keep sight of the person behind the metric; use data to guide curiosity, not punishment.
Gratitude — and an Invitation
I am grateful to everyone who welcomed me: primary care, behavioural health, palliative care teams; operational leaders; customer-owners, and the many people who let me sit in, ask questions, and learn. Your relational courage and practical kindness will stay with me.
And if you want the broader context for why this matters for people living with complex mental health conditions and serious illness, my report (Rewilding Healthcare) shares findings and practical ideas from North America and Australia that I believe can complement Nuka’s relational foundations.
Thank you — for the hospitality, generosity, and wisdom.
