The model for Morris-Singer’s approach to advocating for primary care originated with his experience as an organizer in communities facing anti-LGBTQ ballot measures. As an LGBTQ community organizer, he says, he learned the power of mobilizing diverse groups of people around shared interests and “the importance of someone understanding their own ecosystem.” Although the goal of community organizing is to effect change, he came to realize that cultivating “mind-set shifts and new narratives among stakeholders and decision makers” was a necessary precondition to establishing significant change.
The working group drew the attention of students at other U.S. medical schools, and Morris-Singer began to think more broadly about what it would take for health care providers to see themselves as agents of change. This thinking led to his founding, and now leading, Primary Care Progress.
Drawing on social movement strategies and social psychology research, PCP’s programs teach leadership and teamwork skills to medical students, physicians, and allied health care providers that will help them navigate a health care system that expects increased productivity and patient satisfaction while also expecting providers to grapple with declining reimbursement and large-scale adoption of electronic health records—all workplace factors that contribute to what many describe as an epidemic of burnout in the profession.
The new guard
Some of the skills vital to navigating this change, says Morris-Singer, fall within a concept known as “relational leadership.”
“A relational leader is someone who doesn’t just focus on the what and how of their work, they focus on who,” he explains. Relational leadership isn’t a fixed position, instead it’s a “mind-set and interpersonal orientation” available to all health care providers depending on context.
Think of it as a series of concentric circles with a medical student, physician, or other primary health care provider at the center. When providers apply growing self-knowledge to improve how they work in groups, their ability to communicate and collaborate is strengthened, they are less susceptible to burnout, and their positive influence frequently brings out the best in colleagues.
The potential of relational leadership doesn’t stop there, according to Morris-Singer. When health care providers gain greater insights into how they learn and work in teams, they also become more collaborative, innovative, and strategic contributors to those teams. They become better prepared to advocate for change and spur innovation from inside the systems in which they work. The same tools that allow medical students to pilot primary care programs during residency, he says, can be used by established physicians to initiate change in their practice groups.
PCP’s academic programs run on two tracks adjacent to formal medical school curricula and are founded upon the leadership development strategy that underpins the organization’s Relational Leadership Institute. Its Student Action Network serves as an umbrella for a variety of interprofessional student programs, including collaborations with the American Academy of Family Physicians, which focuses on family medicine through the Primary Care Leadership Collaborative, and with the Interprofessional Student Hotspotting Learning Collaborative.
“A relational leader is someone who doesn’t just focus on the what and how of their work, they focus on who.”
According to the Camden Coalition of Healthcare Providers, the student hotspotting collaborative is an annual program that aims to train interdisciplinary teams of professional students to use a patient-centric approach when working with individuals with complex medical and social needs. PCP co-hosts the collaborative; other co-hosts include the Camden Coalition, the AAMC, the National Academies of Practice, the Council on Social Work Education, and the American Association of Colleges of Nursing.
PCP also sponsors and coaches seventeen U.S. university-based student cohorts. At HMS, for example, the Center for Primary Care Student Leadership Committee (SLC) has been part of PCP since the nonprofit committee was founded.
According to Russell Phillips, the director of the School’s Center for Primary Care and the William Applebaum Professor of Medicine at Beth Israel Deaconess, the SLC grew out of the student group that advocated for the creation of the HMS center.
“That spirit of advocacy continues within the SLC,” says Phillips. “Today we work to empower students to become leaders and innovators in primary care. The committee provides a platform for interprofessional dialogue and collaboration, crucial for establishing team-based problem-solving skills the students will enhance throughout their careers.”
The SLC’s current community-based project is advised by Sara Selig, an associate director for the Community Outreach and Patient Empowerment Program, the domestic affiliate of Partners In Health, and based at Brigham and Women’s Hospital. Selig is an HMS instructor in medicine in the hospital’s Division of Global Health Equity. The project focuses on working with community stakeholders to create resources that encourage providers to practice cultural humility with the aim of delivering culturally competent mental health care.
To innovate, by definition, is to make a change and do something new. It’s become an axiom that what our health care system needs from every quarter is change. One sector calling for change is society as a whole.
Another is academia. The curricular innovations of the past decade—inside and outside medical schools—are a bellwether. When pedagogies change, it’s a sign that educational institutions recognize a need to evolve to better serve their mission.
As educators, Schwartzstein and Morris-Singer are answering both calls.
Andrea Volpe is a Massachusetts-based writer.
Images: Cici Arness-Wamuzky (top); Gretchen Ertl (Schwartzstein); Bill Purcell (Morris-Singer).