Twenty Four Properties of Bedlam that Imbue the Alliance with Distinctiveness  

Property

Conceptual Elaboration

Property #1:  Institutional Collaboration.

 Key collaborative relationships at community/city level make the Alliance work at the service delivery level.  

Bedlam thrives because of key relationships the project has formed with major institutions within the greater Tulsa area including health care providers, higher education, foundations, public schools, local organizations, and human service providers.

Property #2:  Broad Concept of Health.  

The Bedlam Alliance for Community Health embraces a broad concept of health.  

Health is not merely the absence of disease but involves the promotion of health and effective functioning within a given context that equips people with the resources to meet effectively the challenges they face in daily life.

Property #3:  Multiple Models of Health Care.  

To make a broad concept of health tangible, Bedlam uses and mixes multiple models of health care.  

The scope of health care is broad and involves the following models acute care, management of serious illness, oversight of serious disease states, community health promotion, and public health.

Property #4:  Agile Program and Service Development  

Bedlam is quick to respond to community initiated requests for site development.

 

 

The project has considerable experience with site development and has deep knowledge about starting up and sustaining clinic sites.  This knowledge, garnered through the crucible of action and experience, means that Bedlam can (1) template sites at the same time it responds to locally defined needs, (2) replicate sites with ease, (3) engage in quick start up, and (4) prototype innovative responses to fill in gaps in service delivery.

Property #5:  Community Initiated Sites.  

Bedlam looks to communities to initiate a project.

 

(1) Bedlam does not impose itself on particular communities but encourages communities to act on their own behalf to define what they seek in a health care response; (2) Bedlam site development is triggered by community leaders who want health components; (3) Bedlam follows the lead of community members and honors their conception of health needs.  

Property #6:  Informal Marketing.  

Informal marketing characterizes Bedlam’s approach to site development.

 

Bedlam does not target communities nor does it advertise or engage in direct marketing. Community leaders learn of Bedlam through interact in rich social networks.  Community leaders engage Bedlam and initiate dialogue about collaboration.  The work of Bedlam spreads by word of mouth.

Property #7: Local Collaboration and Shared Responsibility.  

Creation of Bedlam sites is a product of collaboration with community institutions and involves shared responsibility among the institutions seeking to create an effective health care response.  

Bedlam does not act on behalf of a community but with a community in efforts to create a site that meets self-identified needs. The “us” factor is central to implementation of a clinic that is relevant and meaningful to the local scene.  Without the “us” factor a Bedlam clinic will not be “rooted” in the local community. Shared responsibility means that collaborators bring resources to create and sustain the clinic.

Property #8:  Street Level, Neighborhood Based Sites  

Most Bedlam sites are street level and neighborhood based and their siting make them part of the community.  

A Bedlam site is close to the populations who need health services and who experience serious health issues as well as unmet needs.  Neighborhood-based means close to the action and close to the potential users.  Neighborhoods are contexts in which poverty influences both the formation of health issues and the strategy of delivery.

Property #9:  Integrated Facilities/Programs  

Bedlam sites are typically nested into host cultures making health care a part of another entity.  

 

“Bedlam adapts to each site, but commonality is the provision of primary care in a form that is useful to a site.”  Bedlam sites can be found in schools, community schools, public housing, and community centers and they shape their provision of health care mindful of what a host entity seeks to achieve on behalf of the people it serves. 

Property #10: Proximity to Populations at Risk  

Bedlam sites are immersed in communities the members of which can be characterized as populations at risk.  

 

 

The immersion of the sites means that Bedlam clinics are close to populations that experience the negative health consequences of poverty. Risk factors play an important role in shaping the health care delivery strategies and practices of clinics.  Bedlam providers are mindful of the health consequences of poverty.  Health disparities and their manifestation across the lifespan influence the provision of care and the management of disease states like asthma, diabetes, and obesity.

Property #11:  Availability and Access  

Bedlam sites encourage utilization on part of high risk patients and achieve this by being available, accessible, and approachable.

 

The local availability of sites make them readily available often times within walking distance of people who have limited transportation.  Friendly and welcoming sites reduce access barriers and mindfulness of insurance coverage (and the lack of it) means that financial barriers are minimal.  Staff members of a host entity actually make use of a facility imbuing it with value and worth. Considerable triage, immediate resolution of difficulties, and urgent care imbue a facility further increase value to user.

Property #12:  Outreach and Mobility  

When potential users cannot access a site Bedlam will reach out and move out into the community through a mobile response.

A newly added mobile capacity means that Bedlam can achieve a presence in contexts in which there is a high need but limited availability for health care, such as parks and local events. 

Property #13:  Comprehensive Service Provision

Given Bedlam’s emphasis on mixing models of service, and its broad definition of health, service provision addresses multiple aspects of health.  

The scope of health care service is comprehensive and includes physical, behavioral, social, and educational aspects.  This comprehensiveness means that users are encouraged to view their health broadly and to use the site to address aspects of their functioning that other health care entities may eliminate given narrow definitions of medical necessity.

Property #14:  Broad Health Outcome Set  

Given Bedlam’s emphasis on comprehensiveness, potential health outcomes are broad and intersect other outcomes that reflect functioning within a given context.

Comprehensive health care provision within a given context, such as schools, creates opportunities to promote health outcomes linked to other outcomes like school attendance, continuity of the educational experience, academic growth, housing retention, and averting expensive forms of care such as emergency room service.

Property #15: Continuity of Care

Bedlam is much more than a free clinic offering episodic care.  It values the achievement of longitudinal continuity of care for people struggling with serious health conditions.

Bedlam offers users a medical home, with the storage of health information needed to ensure quality and continuous care.  Uniform and consistent health histories, up to date medical information, sound information management, follow along of persons coping with serious health conditions, and innovations such as e-mail contact with providers and telemedicine foster continuity of care.

Property #16:  Responsiveness   

Bedlam seeks responsiveness to broad community needs as well as needs brought to clinics by users and sponsors (such as schools).

 

 

Responsiveness is broad in scope and involves (1) responsiveness to community needs, (2) addressing milestone health needs among children, (3) meeting medical needs that have gone unaddressed, (4) sponsoring health promotion activities (after school camps), (5) response to crises and urgent care requests, (6) readiness for disaster response, (7) filling gaps created by the absence of appropriate providers within a given community, and (8) responding to absence or lack of appropriate health coverage.

Property #17:  Lean Sites  

Actual sites are not extravagant and a no thrills approach add to the projects aim to achieve cost effectiveness.  

Photographs of sites communicate that staff operate with bare bones physical facilities often times accommodating their practices to the space and locations the host entities can offer.  This does not mean that the sites are impoverished but more like they are Spartan and minimal.  

Property #18:  Centrally Located Sites within the Host Entities  

Locations are well thought out with clinics likely centrally located within the buildings or physical areas of the hosts.  

Within community schools, clinics are often times adjacent to the administrative offices and in the front of a school to support physical access, surveillance, and safety of students. Within Sandy Park, a public housing entity, a centrally located converted two bedroom apartment serves as the health facility.

Property #19:  Transdisciplinary Practice Model

 The project blends functions, knowledge bases and practice leadership to facilitate flexible, responsive, and efficient health care provision.

“Connecting the pieces together.”  Transdisciplinary model and staffing—blending of functions, knowledge bases and practice leadership.  Overlapping understanding and knowledge of health care provision among different types of providers including physicians, physician assistants, and nurse practitioners. Health care interacts with other domains such as primary school education.  Providers interact with teachers, social service personnel, behavioral health and child welfare. “Spider web” metaphor. 

Property #20:  Integration of Bedlam Physicians with OU Medical School

 Physicians are part of Bedlam and Family Medicine in OU Medical School, Tulsa .  

The health care model is well integrated in to the School of Medicine with several physicians holding appointments within OU Family Medicine and whose appointment is split between clinical teaching, service, and Bedlam responsibilities. There is an effort to integrate residents into the clinic sites.

Property #21:  Bedlam is Strengthening Ties with OU Health Science Disciplines  

The project is broadening its scope of engagement of academic disciplines relevant to its aim of providing comprehensive care within a broad concept of health.   

Bedlam is promoting engagement of the following OU academic disciplines:  (1) Medicine, (2) Public Health, (3) Nursing, (4) Pharmacy, and (5) Social Work.

Property #22:  Promotion of Volunteerism among Health Science Disciplines  

Some Bedlam sites promote involvement of practicing physicians in the direct delivery of managed health care and in the supervision of medical students.    

Volunteerism among physicians is distinctive given the number of physicians involved in several clinic sites and the scope of their involvement and the sheer numbers of service they contribute to make these clinics work.

Property #23:  Realism in Medical Education and Interprofessional Education.

The project supplements medical education of students and expands clinical service opportunities.

 

For interested medical students the project offers enhanced experiential learning through exposure to serious cases of postponed medical care and underserved populations under the supervision of practicing physicians. Students experience diversity not present in standard clinical education settings and work with physicians who do not grade them in the traditional sense.  Bedlam serves as a context for co-curricular education and service learning.

Property #24:  System Oversight of Quality of Care  

Quality oversight is managed through administrative and practice linkages with OU Medical School.  

Academic medical director oversees the quality of medical care.  Quality management is centralized through project home within OU Medical School.