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Lori Knutson: Duke Leadership Faculty and Integrative Pioneer on Working with Health System Culture PDF Print E-mail
Written by John Weeks   

Lori Knutson: Duke Leadership Faculty Member and Integrative Pioneer on Working with Health System Culture

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Lori Knutson, RN, BSN, HNB-BC
If one measures a professional's integrative health wisdom based on the total number of integrative visits engaged under one's watch, Lori Knutson, RN, BSN, HNB-BC stands head and shoulders above the rest of the field.

The former director of the Penny George Institute
guided the development of the nation's most significant inpatient and outpatient initiative in integrative care in the massive Allina Health. The initiative's processes and outcomes have served as the foundation for start-up pitches and plans for scores of programs in other systems around the country.

Knutson's present work is as
the founder/president of Integrative Healthcare Solutions LLC. She is also a core faculty member of the Duke Leadership Program in Integrative Healthcare. This column from Knutson features some of the measured wisdom from her experience - a sample of what participants in the Duke program will learn.      
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Integrative Healthcare, Health System Values and Organizational Readiness
Lori Knutson, RN, BSN, HNB-BC

Our healthcare system is shifting focus-first, to reward delivery of care across a wider continuum of settings and providers and, second, to place more emphasis on engaging individuals in becoming and staying healthy. These trends align well with the goals of Integrative Healthcare-which in population health, can reduce costs of care and achieve strong outcomes for common and costly problems, such as chronic pain and depression.

But is your organization's culture ready for Integrative Healthcare?

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IHPC's cost document
Much discussion has centered on ways in which Integrative Healthcare supports the Triple Aim of healthcare: improving the patient experience of care, improving the health of populations, and reducing the per capita cost of healthcare. 
Evidence is growing to support this connection. A 2015 report from the Integrative Healthcare Policy Consortium, Integrative Health and Medicine: Today's Answer to Affordable Healthcare, cites a number of studies that show that patients who work with Integrative Health and Medicine practitioners are achieving the Triple Aim more effectively than those who work only with conventional practitioners. Such evidence is also available in the studies assembled on cost and patient experience at the Project for Integrative Health and the Triple Aim.

However, if a healthcare organization's culture is not ready, efforts to introduce Integrative Healthcare will not succeed. Organizational readiness is fundamental to implementing Integrative Healthcare, yet few have acknowledged it.

Instead of rushing directly into tactics, the successful leader will take steps to assess the organization's culture, identify obstacles and key players, and then develop a plan specifically tailored to that cultural landscape, to introduce Integrative Healthcare.

The first step is to assess the organization's beliefs, values and attitudes. A very useful tool is the Organizational Culture Assessment Instrument, which guides the user in outlining the organization's dominant characteristics, leadership attributes, management style, organizational "glue" (what holds the organization together), the organization's strategic emphases, and its key criteria for success.

Move forward to develop an action plan only after completing this cultural assessment. In the action plan, be sure to address the following:

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    More evidence for the cost case
    Who will be involved in the implementation, from grassroots to leadership levels? The impetus must come from the top, with the inclusion of those on the frontline, in order for the effort to succeed. Middle management alone, even with much passion and determination, cannot drive an Integrative Healthcare initiative. It will never be sustainable without leadership support. Develop strategies, tailored to your culture assessment, to engage leadership and secure their support. At the same time, begin building a group of allies so you are not an isolated voice pushing your initiative forward. You alone cannot change the system.
  • What barriers will you face-lack of time, poor trust levels, under-investment in human resources, low employee alignment with the organization's mission? All of these can interfere with success in implementing an Integrative Healthcare program.
  • What are the solutions to overcome these barriers? The right solutions will be specific to each organization, but you must create a business case, which is where Integrative Healthcare's alignment with the triple aim comes in. Both in your written business case and in meetings to present it, keep in mind your culture assessment and use language that will resonate with your leadership in order to persuade them. You must have a crucial, courageous conversation that links Integrative Healthcare to who your organization is, why it does what it does, and what it hopes to achieve.

Those considering this process will need the right leadership skills to succeed. The Leadership Program in Integrative Healthcare at Duke University is a unique program that helps current and future leaders develop the skills and the business plans needed to successfully introduce or build an Integrative Healthcare program at their organization.

As we all know, Integrative Healthcare is not only about how we approach patient care. It is a philosophy that applies to organizational culture as well. To introduce an Integrative Healthcare program, certainly keep patients' well-being in mind, but, if you also address the cultural aspects, your chances of success will be much stronger.
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Comment: The approach Knutson lays down here has the of course feel that only comes via the crucible of deep experience. I find myself wanting to sit in on her class for the anecdotes and experiences through which Knutson will certainly spice the content. Her leadership is all the more remarkable in that she has done so as a nurse - an almost taboo authority position for a nurse in the MD-centric health system integrative medicine world. This speaks to the remarkable leadership traits in Knutson.

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Site of leadership program
If you have interest in leadership in this field and haven't checked out the Duke program, do so now. You will find a terrific team of deeply experienced players. These include, besides Knutson, program director Adam Perlman, MD, MPH from New Jersey's St. Barnabas Health Center and now Duke Integrative Medicine; Ben Kligler, MD, MPH who is vice chair of the integrative medicine department at Mount Sinai Beth Israel; and acupuncture and Oriental medicine and interprofessional academic leader Elizabeth Goldblatt, PhD, MPA/HA, among others. The first two,each clinicians as well as program leaders, have served as chair of the Academic Consortium for Integrative Medicine and Health, the 61 medical school group. Goldblatt is the former chair and now co-executive director of the Academic Consortium for Complementary and Alternative Health Care with its 58 national organization and individual institution members. Proven integrative leaders teaching integrative healthcare leadership. Bingo.



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