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Collaborative Health Policy

A study by the William D. Ruckelshaus Center identified strong interest in using university-based third party neutral services to build consensus among diverse and often competing healthcare interests. The Center acts as a impartial resource for collaborative problem solving in the State of Washington and Pacific Northwest and assists leaders in efforts to build consensus and resolve conflicts around difficult public policy issues.

Health Policy Projects:

Intellectual and Developmental Disabilities (I/DD) Redesign Progress

A Ruckelshaus workgroup reached consensus in 2018/2019 to re-design I/DD adult supports and services, after more than 30 years of stakeholder conflict. Twenty significant recommendations were presented to the legislature; most are now in various stages of funding and implementation. COVID-19 and organizational turnover have affected progress, among other potential factors.

During the 2023 session, the legislature asked the Center to evaluate stakeholders’ varying perceptions of recommendation progress. In addition, the Center was asked to research and identify other promising related I/DD innovations in other states and to suggest possible process recommendations for future collaborative efforts and implementations.

The Center is conducting a broad series of assessment interviews with individuals and organizations. A report that synthesizes the commonalities and differences of stakeholder perceptions will be completed by the end of February 2024. The report will also summarize innovations and trends, as well as possible process recommendations.

For more information, please contact Kevin Harris.

WA Behavioral Health Communication Framework

Washington state has worked in recent years to transform the way that Medicaid services are delivered and reimbursed, including integration between physical health, mental health, and substance use disorder services. The significant scope of this transformation has resulted in implementation challenges around collaboration goals, policy effectiveness, and partner communication. The Washington State Association of Counties and the Washington Health Care Authority asked the Center to facilitate a process to help the parties build, test, and implement a consensus-based communication framework to help foster integration success moving forward.

The Center facilitated county commissioners and staff, Health Care Authority officials and BH-ASOs to develop their own communication framework that addresses their individual and shared perspectives, concerns, strengths and barriers, and creates a structure to build trust, collaboratively solve county-specific/regional and state systemic problems, and make positive progress towards behavioral health systems change.

Read the WA Behavioral Health Communication Framework December 2021 Project Summary & Recommendations Report here.

For more information, contact Project Manager and Senior Facilitator Kevin Harris.

Everett CHART

The City of Everett asked the WSU Metropolitan Center for Applied Research and Extension (Metro Center), WSU School of Economic Sciences, and the Ruckelshaus Center to evaluate Chronic Utilizer Alternative Response Team (CHART), a piloted criminal justice, healthcare and housing diversion program that may be scalable to many areas within Snohomish County.

Throughout Everett, many vulnerable and marginalized people use services that span multiple systems, including law enforcement, the jail, first responder services, healthcare and social service agencies and homeless shelters.  Many individuals have overlapping legal, physical health, mental health and substance use issues that result in repeated, expensive and avoidable contact between these systems. CHART is a team of criminal justice, healthcare, emergency response, and research partners who collaborate in an effort to improve care outcomes and reduce the impact of chronic utilizers on these strained systems.

By taking a systemic approach, CHART’s goals were to:

  • create an individualized plan that will have a positive and measurable impact on the use of those resources without simply shifting costs from one partner organization to another;
  • decrease the system impacts associated with the disproportionate overlapping service utilization by these individuals, and
  • positively impact the lives of those identified for participation in CHART.

The Center completed a Situation Assessment of more than 25 key CHART partner organizations in Snohomish County –  to understand the strengths and barriers of the pilot program experience, as well as individual and collective organizational needs to evaluate specific metrics and outcome measures. A group convening workshop was held in early October 2019, to explore consensus around organizational strengths, barriers and expected evaluation outcomes measures. The results of the assessment and workshop provided guidance to the WSU School of Economic Sciences and helped connect to the necessary data to conduct the economic evaluation of the CHART pilot.

The project released an Assessment Summary Brief. View the Summary Brief  here.

For more information, contact Project Manager and Senior Facilitator Kevin Harris.

Redesigning Intellectual & Developmental Disabilities Policy

Intellectual and developmental disabilities (I/DD) are a diverse group of chronic conditions that are due to developmental, neurological and physical impairments. These conditions include Down and Fragile X Syndromes, Cerebral Palsy, autism, fetal alcohol spectrum disorders, pervasive developmental disorders and intellectual deficits.

Washington state provides different residential and support models for people with I/DD, ranging from four state-run ‘Residential Habilitation Centers’ (RHCs) to varying degrees of home and community-based services, including residential, habilitative, therapeutic and vocational services.

The legislature, DSHS, unions, providers, advocates and families have debated for decades the merits and challenges of quality of care, access to services and costs of delivery between the different models. The federal Centers for Medicare and Medicaid Services has threatened loss of federal funding to portions of several RHCs, based on surveyed violations. DSHS and the legislature asked the Ruckelshaus Center to provide process design and neutral facilitation to help parties reach consensus-based solutions around the mix of service venues, other potential uses of facilities and related policy recommendations to the legislature. After two years, the ‘Ruckelshaus Workgroup’ reached consensus around a long-term vision and legislative recommendations to re-design the way that I/DD supports and services are delivered in the State of Washington.

Read the DD-RHC Workgroup’s 2019 Report with Ruckelshaus Center Addendum, Rethinking Intellectual and Developmental Disability Policy to Empower Clients, Develop Providers, and Improve Services (PDF)

Read the DD-RHC Workgroup’s 2018 Report with Ruckelshaus Center Addendum (PDF)

For more information, contact Project Manager and Senior Facilitator Kevin Harris.

Southwest Washington Accountable Community of Health

The Center worked with the SW Washington ACH to assess the collaborative potential of community leaders, healthcare providers and payers to reach consensus around regional implementation (Clark, Skamania and Klickitat counties) of statewide Medicaid transformation goals. Each region must determine how to collaborate at community levels to decrease health disparities, improve access to care and health outcomes, and increase delivery of care efficiencies. This ACH region can earn up to $55 Million of the State’s $1.5 Billion federal Medicaid transformation demonstration, if collaborative progress and outcomes targets are met involving:

  • Physical and behavioral health (mental health and substance use disorders) care delivery integration
  • Care coordination to address the ‘whole person’
  • Opioid prevention and treatment
  • Focused efforts around series of optional initiatives, including oral health service access; chronic disease prevention and control, and maternal & child health

Read the SW WA ACH Initial Brief (pdf)

For more information, contact Project Manager and Senior Facilitator Kevin Harris.

Yakima Health Provider Capacity

The Center worked with Pacific Northwest University- Health Sciences to provide neutral facilitation services to a key set of healthcare providers, including hospitals and rural health centers in the Yakima Valley. Yakima has historically had a disproportionately high uninsured/Medicaid population- Medicaid transformation has swamped local healthcare provider’s ability to provide appropriate primary and specialty care services to their community. The Center facilitated a process to help executive and operational leadership collaborate to identify short-term interventions and longer-term strategic innovations that will help with emergency room diversion, physician and other practitioner recruiting, and other access to quality care improvements.

For more information, contact Project Manager Kevin Harris.

Snohomish County Health Leadership Coalition

The Ruckelshaus Center provided process design and facilitation services to the Snohomish County Health Leadership Coalition’s LiveHealthy2020 initiative. The Coalition is a convener of over 130 public, private and civic-based organizations, with the vision of improving the health and economic vitality of Snohomish County by improving nutrition, increasing physical activity, enhancing mental and emotional health, and fostering civic health & connectivity. The Center helped the Coalition design and implement collaborative processes to help their diverse set of signatory organizations and others scale their ‘accelerator’ efforts to create larger impact around Snohomish County population health outcomes.

For more information, contact Project Manager Kevin Harris.

Snohomish Health District

In 2016, the Snohomish Health District asked the Center to assist in navigating a potential transformation of its governance and delivery of care. The Health District provides public health services to Snohomish County’s 755,000+ residents, from maternal and child health programs to safe drinking water. A 15-member Board of Health, including county and city elected officials, oversees policy and budget development.  Supporting residents of the fastest-growing county in Washington, the Health District has struggled with its role within statewide healthcare transformation, sustainable local and state funding, and board member turnover. The Center conducted a situation assessment — a series of interviews with a broad range of leaders and organizations throughout the community to discern issues, opportunities and dynamics among key parties, as well as prospects for collaborative dialogue, to identify and agree on long-term solutions. The District implemented many of the Center’s recommendations, to improve engagement and streamline the Board’s decision-making process.

Read the Snohomish Health District Situation Assessment (pdf)

For more information, contact Project Managers Kevin Harris or Amanda Murphy.

Eldercare Workforce

The Center partnered with the University of Washington’s Center for Health Innovation & Policy Science (UW CHIPS) on a project that examined eldercare workforce capacity in Washington state. In December 2012, the Center and UW HPC received a grant to begin the first phase of this project. The Center also participated in a University Network for Collaborative Governance (UNCG) initiative to launch similar efforts in states across the country that will engage health care and workforce stakeholders in developing eldercare workforce strategies. The UNCG initiative will focus on: 1) Hosting a national colloquium on Eldercare Workforce Collaboration, resulting in a report to serve as the basis for a multi-state pilot; 2) A pilot to evaluate and report on results and lessons learned of the assessments; and 3) Convening assessments in several states through UNCG centers, including the Ruckelshaus Center. For more information, contact Senior Facilitator for Health Policy Kevin Harris.

Additional Resources: Eldercare Workforce

Nurse Staffing

Between 2007 and 2012, the Center assisted in resolving long-standing disagreements concerning hospital staffing decisions. Concerns by the parties included the effects of nurse staffing levels in hospitals, patient safety, costs and working conditions for nurses. Numerous studies have been conducted for this national issue, yet no accepted resolution has been developed. In 2007, the Center held an initial forum between the Northwest Organization of Nurse Executives; SEIU Healthcare 1199NW, United Staff Nurses, UFCW 141, the Washington State Hospital Association, and the Washington State Nurses Association, in which they reached an agreement to work together. In 2008, these parties signed an agreement at a ceremony with Governor Gregoire to begin discussions facilitated by the Center. The goal of all parties in the discussion was to develop a model solution for this pressing problem in health policy.

Additional Resources: Nurse Staffing

Updated on August 23, 2023

Policy Issue and Project Assistance

Are you wondering if your policy issue or project might benefit from the Ruckelshaus Center’s assessment- process design- neutral facilitation- consensus building expertise?
A diagram of the health policy design and implementation

Please check out this graphic (pdf) and contact Kevin Harris.

Healthcare Webinar

Kevin Harris (pdf), Senior Facilitator – Health Policy, recently conducted a national webinar for the Association for Conflict Resolution entitled Collaborative Governance in Health: the Link Between Collaborative Process and Implementation. In case you missed it, watch here.