Theory


Bedlam Alliance for Community Health [BACH]

            BACH espouses numerous values it organizes and operationalizes through the deployment and development of its multiple clinic sites and, through these values, the alliance has created a distinctive form of community health service delivery.  The theory BACH employs can be described as a community-based approach to primary and acute medical care in which the university-based alliance works closely with community partners to identify the need and to test early in the process community commitment to the development of a primary health care clinic. The formation of partnerships and collaborations are essential in the early stage of clinic development realized through (1) meetings between the BACH executive and relevant staff with community representatives, (2) examination of the need for health care within the community, (3) some form of action to gauge the need (typically undertaken through surveys, forums, focus groups, or canvassing), and (4) some early testing of the potential of clinic utilization within the community.  According to informants it is these steps that strengthen the relationship between BACH and a given community.  The idea of collaboration runs through every clinic site within the BACH portfolio and in the few instances where clinics have failed informants point to the inadequacy of the community partnership.

            The partnership and collaborative dimensions of BACH demonstrate the principal approach the alliance takes to academic civic engagement: BACH is not an entity that simply uses a particular community as a laboratory, training site, or service delivery site for faculty members and students.  Collaborative features of all clinics testify to the strong adherence the alliance makes to mutuality and the common good. While the university staffs the clinic sites, ensures quality, and adequate supplies, the sites of clinics are community-based and integrated into neighborhoods or contexts in which the need for quality, flexible, and accessible health care is apparent to anyone inspecting both the locations and contexts of the sites. For a community member to access a particular clinic site is not difficult and, in many instances, a clinic is in close proximity to a patient’s home.  Such propinquity, a defining quality of how BACH works, is visible especially in the public housing sites:  people living in town homes and apartments can access a clinic located on the grounds of the complex.   And, community members located in the immediate area can also access such a site by walking and/or a short car ride.  This is one of the principal qualities in which BACH takes pride:  clinics are accessible.  BACH also broadens accessible in the following dimensions:  (1) temporal availability, (2) ease of access to immediate care, (3) informality among the health care staff, and (4) the development of strong clinical care relationships between staff and recipients.  That each clinic is a street level structure, inviting to recipients, and warm and welcoming is a fundamental element of the BACH theory.

            The idea of partnership and collaboration is also growing within BACH through the orchestration of relationships among academic health science disciplines.  Increasingly collaborative care is taking a team approach through partnerships formed among multiple disciplines including physicians, nurses, physician assistants, pharmacists, and social workers who are working together with the aim of integrating their care and creating a unified form of knowledge and practice.  These disciplines are now involved in extending transdisciplinarity into the delivery of care to high risk communities and recipients.  Treatment plans that unify service strategies indicate how BACH clinics subscribe to a broad conception of health as involving physical, psychological, social, and cultural domains.  Broadening the meaning of health and, as a consequence, engaging in holistic provision of health within communities at risk is yet another important aspect of the BACH theory. As a result of this commitment to transdisciplinarity and holistic focus, the staffing complements of clinics are increasing in scope as nurses, social workers, and pharmacists expand service delivery options, extend protocols of care, and bring to the care of particular patients diverse knowledge sets.

            Still partnership is operating at a broader systems level as BACH has formed collaborative relationships with specialized providers of care and health resources. Through a network of service providers, BACH can refer and steer recipients to appropriate in patient care, specialized medical assistance, social and human services, laboratory resources, and specialized testing facilities. Such capacities make the BACH clinics and providers a true network of care. And, such capacities make BACH comprehensive.       

            Transdisciplinarity within BACH requires melding and blending of diverse approaches and the shaping of these approaches into unified care plans and health care procedures.  BACH is moving away from a silo approach to health care in which each discipline uses its particular expertise to treat a particular element or aspect of ill health or disease. This silo approach remains prevalent in many health care settings and forms a cultural barrier to unification of action within the health care partnership. Transdisciplinarity extinguishes silos and seeks unification and integration within clinic sites, another distinctive feature of Bedlam’s approach to community health care.

            Within the context of partnership (operating at three levels:  community partnerships, partnerships among providers, and partnerships between providers and recipients) BACH seeks the realization of continuity of care.  Strong access and availability sets the stage for continuity of care since it is easy for recipients and providers to interact and, as a consequence, the enactment of a health care episode is easier than in health settings that are more institutionally based than community-based. Facilitating the retention of recipients in care, for the purposes of health promotion, the management of disease, and the resolution of acute episodes, is achieved by the fact that BACH offers recipients a stable medical home.  Each recipient can enroll in BACH, secure a medical home at a specific clinic, use other clinics as needed, interact with a range of providers, and maintain contact through multiple means (such as e-mail) are assets that contribute to continuity of care. Such longitudinal continuity is a central focus of BACH.  The aim of cross sectional continuity is realized through a team of collaborative providers who work closely in unifying their practice knowledge and expertise.