Healthcare reform and changes in Medicare and Medicaid reimbursements are quickly moving healthcare organizations to focus on healthcare outcomes rather than activities, including influencing the family, community, and environmental factors that impact good health. Experiences with affiliation with a healthcare system will be shared by two of Milwaukee's oldest and largest human services agencies to inform and to illustrate the findings of a national study on such affiliations.

Workshop objectives/takeaways:

• define key challenges in affiliating with a healthcare entity;
• determine what potential gains organizations can find in such an affiliation;
• receive input as to questions, fears, fantasies regarding affiliation;
• receive partner “readiness” checklist for affiliation assessment; and
• gain knowledge regarding the results of a national survey on hospital affiliations.

Presenters: Jane Pirsig, executive director, and F. Michael Arnow, board chair, Aurora Family Service

Workshop synopsis:

In 1995, Family Service of Milwaukee, a 115-year-old institution, joined Aurora Healthcare, a relatively new, growing hospital system at the time. Three years later, Children’s Service Society of Wisconsin joined Milwaukee-based Children’s Hospital of Wisconsin.

What followed for both was the navigating of uncharted waters, as agency boards, management teams, and staff began to translate their vision into realty. Through these affiliations, both agencies have been able to provide a more comprehensive and integrated approach to their services and overall business plan. However, it is critical to acknowledge that at times it also challenged both the strength of the vision as well as the participants.

Since that time, a number of agencies have “taken the leap,” providing the opportunity to garner best lessons learned from a cross section of this innovative, and some would say foolhardy, group. Aurora Family Service is spearheading the completion of a national survey to bring these lessons to the field, as the interest and inevitability of such affiliations becomes apparent. The study will include feedback from 15 organizations that have affiliated with a healthcare provider over the past 15 years, as well as 45 external stakeholders.

For a social service agency, affiliation with a healthcare provider is the equivalent of moving to a new country with only a paper pocket translation dictionary, and no comparable tool on the receiving side. A highly sophisticated process then ensues as the organization moves through ever deepening cultural shifts, striving to attain “a culture within a culture,” a state absolutely necessary to support the ability to operate within and impact the healthcare system, while maintaining self-identity and competency. Value and practices in thinking (linear vs. system), language (medical vs. social service), finance (margin vs. fundraising), time horizon (three months vs. annual), can create intense occasions of clash or breakthrough … or both.

The results and analysis of this national survey will identify both process and outcome measures, from the view of internal and external partners regarding the validity and importance of each. Issues to be considered include:

• loss of identity, gained capacity, shared board roles;
• loss of control, gained access, shared strategic planning;
• loss of donors, gained services, shared decision-making; and
• gained scope, shared accountability.

A framework for decision-making will be presented to assist in the proactive consideration as well as management of such innovation, as well as a call for a mechanism for continued shared learning and collegial support—a critical element of successful implementation.