The Culture of Improving Population Health – Who’s Listening?

The Culture of Improving Population Health – Who’s Listening?

The Affordable Care Act has set the course signaling landmark changes that include many areas of health care. Payment reform, health insurance mandates, population health, transparent sharing of health information, accountability related to health outcomes, efficiencies in managing health care delivery, and access to health care in the right setting at the right time, are just some of the areas where fundamental change is taking place. Prevention and palliative care have moved to the forefront.

The river of our health care delivery system is roaring and whitewater abounds. It’s a frenzied environment reflecting urgent efforts. Already we are hearing mantras becoming part of the mainstream: ‘Know your Number’ and ‘Choosing Wisely’ are just two of the best known.

It turns out there’s a lot to hear, but the question is, who is listening?

What’s the difference, you ask? Hearing is the process of receiving auditory stimulation. Listening is the process of interpreting or comprehending the stimulation. Understanding the difference between these two words and processes is key to engaging patients and colleagues in the process of change. Authentic, attentive listening requires being still enough to understand.

I wonder about the impact of all of the efforts taking place across Maine. We all want sustained improvements in health care systems and changed behaviors that lead to better health outcomes and better population health rankings. But will we get there without acknowledging the value of attentive listening in the process of aiding one another?

In parts of Maine where the factors that influence the health of a population- called ‘social determinants’- are positive and resources are more plentiful, early data reflect improved population health. Conversely, where the local economy is poor and the social determinants reflect risky behaviors, the same data show only marginal gains. Instead of becoming discouraged with these early results, we should embrace the opportunity to serve and listen more meaningfully.

In Downeast Maine, the region served by Eastport Health Care, many communities are doing just that. In our region of the state, where population health outcomes are poor, there is a palpable “culture of relationship” unfolding. “Community Circles”* convene every six weeks. The Circles are building understanding and helping produce concrete action related to topics such as integrated behavioral health, gay-straight relations, and health and wellness activities. Organizations representing diverse sectors: health, education, business, social services, arts, government, and law enforcement, and consumers of all ages, are coming together around common tables.

The Community Circle’s engagement model includes a minute of stillness that supports an environment of attentive listening. The result has invariably been more responsive, solution-focused conversations among participants. Collaboration is rapidly becoming our standard way of doing business. Collaboration is yielding cooperation and information-sharing (where permissible) in the spirit of aiding the whole.

The Community Circle approach is being used in the MEHAF Healthy Community grant to the Washington County Network (WCN). Nineteen organizations are members of WCN. Over the next eight weeks, we will use the Community Circle model to solicit direct input from community members about their priority for improving the health of the people of Washington County.

Just this past month, Eastport Health Care hosted an important meeting in Washington County. Organizations across the county met to conduct an organizational cross-walk with an overarching goal of better understanding the landscape and to collaborate or complement strategic efforts aimed at improving population health. Using the Community Circle model of engagement, the participants gained awareness of their respective missions and strategic priorities. Equally important, they began to see where redundancies or supplanting efforts exist. All present agreed the Community Circle approach was an illuminating experience, and all agreed to reconvene. My sense is, through attentive and responsive listening, Washington County will achieve full collaboration and will establish the strategies required to improve its populations’ health.

These examples highlight an exceptionally exciting time of change. How can I support and contribute to our collective work?  I think I can best contribute by focusing and coaching on the value of sixty seconds of stillness in this increasingly hurried environment in which we are striving to create transformative change. I'll tie the imperative of relationship as core to any change. Authentic relationships emerge only when attentive listening and understanding are fully present.


*A Community Circle is a venue for bringing a group together to converse about a specific topice. A facilitator guides the peer-led discussion using open-ended questions. There is a defined aim- for example, the Integrated Behavioral Health Community Circle aims to improve care for vulnerable individuals in Washington County. The Circle model is peer-driven and focuses on developing solutions to important topics. It was developed and initiated in Downeast Maine in March, 2011.

Holly Gartmayer-DeYoung is the CEO of Eastport Health Care, a federally-qualified health center with locations in Eastport, Machias and Calais, and a MeHAF Community Advisory Committee member.


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