Healthcare professionals are exhausted. And it doesn’t have to be this way.
I’m a psychologist by training, and I study Intentional Community. Quite literally, community shaped by design, rather than by default or by drift.
My experience is that in the fields of mental health and primary care, providers are asked, and heroically trying, to meet unmeetable needs – to single-handedly generate and deliver enough care, resources, support, and (yes) even love – to meet the needs of our patients and our communities.
We are doing so in tightly-timed individual visits, in resource-strapped clinics, with ever-growing responsibilities and ever-tightening constraints. Predictably, clinicians are fatigued. Then demoralized. Then despairing. Then cynical. And that’s not good for anyone involved.
My experience is that the task as it’s currently defined is impossible. The problem is structural and systemic, not personal, and certainly something that no amount of “self-care” will undo. Trying to generate health solely by providing 1x1 health care is inherently extractive and exhausting. Further, 1 on 1 sessions, shrouded in veils of confidentiality, privacy, and even shame don’t necessarily build resiliency, community strength, or capacity. Instead, they further segregate our healthcare (literally, caring for our health) from our daily lives and communities.
An alternative: Clinic-Community Integration 2.0
Clinical care needs to be one small part of comprehensive and generative ecosystem of support for wellbeing. Resilience is a team sport, and a resource that is generated in relationships! As a field, we need structures that liberate, animate, and activate the power of community – where support and care are generative, mutual, and self-sustaining – not extractive.
The good news is that humans are hardwired to do this. In a social context where joy, respect, inclusion, accountability, support, curiosity, and generosity are modeled and designed-for – we enact these very behaviors and qualities which inherently create resilience. Better yet, as individuals do so, they experience themselves not as passive recipients of “services,” but as contributors, as co-creators, as valued members of the community. As the Dalai Lama famously said, “People need to be needed.”
This is what we’ve learned in our work at Open Source Wellness. Our work must be generative (both socially and financially – more on this below) for it to thrive. By utilizing health coaches, peer leaders, and patients’ own experiences and wisdom to generate a culture of care and support, we liberate providers to focus in on the medical needs of their patients. (As a mentor of mine likes, to say, “Do what we do best, and partner for the rest!”) Meanwhile, coaches provide the social scaffolding, the “starter culture” that generates the framework, context, and safety for community care to arise naturally.
For those not familiar with Open Source Wellness, we’re an Oakland-based nonprofit, and we deliver "Community as Medicine.” The program operates both in-person (when not in a pandemic) and virtually, leveraging high-touch small-group relationships and coaching support for the basic practices that keep us healthy, resilient, and well: MOVE (physical activity), NOURISH (healthy meals) CONNECT (social support), and BE (stress reduction). Outcomes include reductions in depression, anxiety, social isolation, and loneliness, increases in physical activity and fruit/vegetable consumption, and a 77% reduction in ED visits and hospitalizations.
OSW partners with health insurers, healthcare provider organizations, FQHC's, low-income housing providers, employers, governments and other entities to support both patients and staff. Importantly, the model generates revenue for FQHC's by producing high-quality Group Medical Visits in partnership with clinical providers. In brief: The OSW team of health coaches and peer leaders deliver a high-vitality, high-touch 16-week program that patients love: 2 hours live virtual time per week plus text and phone support in between sessions. During the 2 hours live, one clinical provider from the clinic conducts short, focused individual visits with each participant, then charts and bills for every patient seen. More info on the financial structures here, but in sum, the OSW Virtual Group Medical Visits program generates far more revenue for clinics than it costs to run, and delivers excellent clinical care while improving provider experience.
They key to transforming an exhaustive and extractive clinical system is not more clinical care, or more “self-care.” It’s intentionally-designed social structures that are generative, that call forth and uplift the social resources within and between our patients. AND - it is clinic-community integration 2.0: Leveraging the synergistic abundance found in partnerships to deliver excellent care, generate revenue, and create a happy, healthy, resilient workforce.
Let’s create that, together!
Dr. Elizabeth Markle
For more info on our work:
Elizabeth Markle, Ph.D., is a licensed psychologist, speaker, writer, researcher, and Chair of Community Mental Health at California Institute of Integral Studies. Dedicated to multi-theoretical and multi-level approaches to individual and community health and healing, Elizabeth's current area of study and innovation is around combining clinical expertise with social entrepreneurship to create sustainable, thriving cultures of health and wellbeing. She is the co-founder of Open Source Wellness (www.OpenSourceWellness.org), a nonprofit initiative offering experiential behavioral health and wellness via a "behavioral pharmacy" approach in collaboration with healthcare providers and insurers.