Key Components for Systemic Change

Through its experience in implementing the behavioral healthcare integrated model, HFP has identified five key components for systemic change:

• Organize a collective voice and pooled learning: The scale of the program was one of its success factors; the resources needed to create the change were too extensive for any single clinic or organization to take on alone, such as working with insurers to change the reimbursement structure. Having a centralized way of organizing a network of sites and providers made the investment to implement the integrated model more feasible.
• Cultivate champions: Each stakeholder has daily operations that consume most of its resources. Without a champion, development of this model would not have taken consistent priority. Provider champions or “early adopters” are also needed on the ground to promote and demonstrate the implementation of the model.
• Create a sense of community: A community eases some of the challenges in implementing the model by providing support to those stakeholders who are breaking away from the status quo, sharing lessons learned to make the process smoother for the next person, and creating accountability for participants to stay invested in the program.
• Start where they are: The behavioral healthcare integrated model is so successful because it worked within the existing system to identify what could and could not be changed and at what pace. It did not seek to fit the existing system into a preconceived model.
• Organize a multi-pronged strategy: Many changes needed to come together at the same time in order for the behavioral healthcare integrated model to work (i.e., skills, structure, policies). Approaching the problem from several angles also creates a critical mass to speed up acceptance of the solution (HFP 2009: 17).