Dr Patti Robinson Of SpeaktoYourDoctor.com On 5 Things We Must Do To Improve the US Healthcare System
An Interview With Jake Frankel
Train all health care providers to address all aspects of health — biological, psychological, and social — in all health visits. This doesn’t need to take a great deal of time, and supports patient engagement and allows for more individualization of assessment and treatment plans.
As a part of our interview series called “5 Things We Must Do To Improve the US Healthcare System”, I had the pleasure to interview Dr. Patti Robinson.
Dr. Patricia Robinson, Ph.D., is a psychologist, scientist practitioner and a pioneer in the field of integrated care. She is co-author of “Behavioral Consultation and Primary Care: A Guide to Integrating Services.” Dr. Robinson also co-founder Focused Acceptance and Commitment Therapy, or “FACT.” This innovative approach prepared behavioral health providers to succeed in delivering brief services in primary care. She started as a member of a research team three decades ago and then partnered with many providers in defining new strategies for primary care. The result is the Primary Care Behavioral Health (PCBH) model. This approaches how people experience mental health services. Dr. Robinson has shared her work with health care professionals internationally, shaping best practices in behavioral health integration around the world. Learn more at speaktoyourdoctor.com.
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you share the most interesting story that happened to you since you began your career?
In 1994, I made a scientific presentation about integrating behavioral health services into primary care at a national health care conference. After the talk, someone from the United States Air Force approached me and said they wanted to “follow the science” and experiment with integration in some of their primary care clinics. At the time, I didn’t really understand what a consultant was, but quickly I learned that I could be helpful beyond being a member of a research team and beyond being a clinician helping someone who was depressed or anxious or …. I could use my experience in these roles to help others explore deployment of health care innovations that improved the overall system. And that’s what I’ve been doing for the past 18 years.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
When I left my research team in Seattle and began exploring delivery of behavioral health services in a rural primary care clinic, I thought it would take a while for primary care providers and nurses to notice me and to begin to use my services. On my first day in clinic, they referred over 10 people for same-day visits. The last person I saw was considering taking their life. I was surprised that I didn’t have to work to have people come to see me . . . all that I needed to do was show up with a sincere desire to be helpful and to say “yes” when called upon.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
My favorite “Life Lesson Quote” is “Let experience be your teacher.” This was my father’s way of saying get out of your head and into your life. He wanted me and my sisters to try anything we wanted to try, to succeed or fail, to get up by ourselves, to sit at tables we never imagined, and to pay attention all the while.
How would you define an “excellent health care provider”?
An excellent health care provider is a person that makes you feel cared about, whether you are a patient, a patient’s family member or a colleague at the clinic. An excellent health care provider also makes every effort to stay up-to-date with scientific findings and works mindfully and playfully with patients and colleagues.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
Podcasts: The Inspired Health Care Leader, Hear From Her: The Women in Health Care Leadership .
I also like Atul Gawande’s books.
Are you working on any exciting new projects now? How do you think that will help people?
I have worked with people in New Zealand over the course of the past seven years to assist with the integration of behavioral health services into their primary care or general practice settings. We began with a proof-of-concept study in five clinics in Auckland in 2017. Results suggested improved access to behavioral health services and higher levels of satisfaction among patients and primary care providers. Additionally, results included demonstration of equity in access, engagement, and clinical outcomes. A national study followed that involved 12 clinics located in different areas of the country. Ten months into the study, results suggested that the proof-of-concept findings were being replicated. The government decided to fund integrated care for all New Zealanders; scale-up of services began and continued through the pandemic to the present day. Many new health care providers have been recruited, hired and trained over the past 6 years. People moving into the new job of Health Improvement Practitioner (HIPs) participate in a structured 6+ month training that includes 4–5 days of classroom instruction and 4+ days of on-the-job training in their assigned clinic. Prior to being endorsed for independent HIP work, all HIPs learn Focused Acceptance and Commitment Therapy. I am a co-founder of both the Primary Care Behavioral Health (PCBH) model of integration and Focused ACT, a brief therapy that helps people learn new skills when confronted by problems of living.
Ok, thank you for that. Let’s now jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high-income nations. This seems shocking. Can you share with us a few reasons why you think the US is ranked so poorly?
First and foremost, I think that the US health care system is ranked lower than most high-income nations because it invests less in primary care health services. Primary care is critical for population health, health equity, and the overall efficiency of health care systems.1 Primary care is the first point of contact with health care for most people, and ensuring access to high-quality, comprehensive primary care is of fundamental importance to good health and positive experiences with the health system at large.
The US spends less money on primary care than most other high income countries, and this translates into a less robust primary care system, and a less healthy population. The U.S. spent 4.7 percent of its total health care spending on primary care in 2021, compared to an average of 14 percent in other high-income countries.30.
The lack of funding results in significantly different experiences for patients and providers in receiving and delivering primary care services. A 2024 review of primary care in the US and nine other high-income countries found that 43% of adults in the US reported having long-standing relationships with a primary care provider in comparison with 76% in the Netherlands (see commonwealthfund.org/publications/issue-briefs/2024/mar/finger-on-pulse-primary-care-us-nine-countries). In New Zealand, 72% of primary care providers reported adequate levels of coordination with specialists and hospitals about changes to their patient’s care plan, while only 41% of primary care providers in the US reported adequate coordination of care.
As a “health care insider”, if you had the power to make a change, can you share 5 changes that need to be made to improve the overall US health care system?
1. Invest in primary care. Greater investment in primary care providers and their care teams would allow for expansion of access, increased use of telehealth, and expanded hours for appointments. It would also allow for more comprehensive primary care services that routinely address behavioral health and social needs.
2. Train all health care providers to address all aspects of health — biological, psychological, and social — in all health visits. This doesn’t need to take a great deal of time, and supports patient engagement and allows for more individualization of assessment and treatment plans.
3. Include behavioral health providers routinely in all health care clinics, including primary care and secondary care clinics. While these providers add a small amount to the cost of providing care, they create tremendous savings by reducing the amount of time required from the most expensive care providers and they can prevent unnecessary care by addressing behavioral factors (e.g., adherence).
4. Invest in prevention, starting with birth and continuing throughout human development.
5. Make health care a family and community endeavor. Encourage people to see health care as a valuable service in their community, one that they can influence. When everyday people begin to ask for what they want in healthcare, profound improvements are possible and can quickly become the new standard of care.
What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
These changes can be promoted by individuals. For example, see SpeaktoYourDoctor.com for an information sheet that everyday people can take to their doctors to start a conversation about improving health care. These changes can also be supported by communities, and increasingly communities are coming together to support primary care for all (for example, see primarycareforallamericans.org/about-us). Leaders at all levels want better outcomes, and they are wise to look to patients and to the front line for inspiration, innovation, and continued evaluation to inform change efforts. Corporations are of course helpful to evolving health care, and their challenge is to loosen their attachment to traditional mechanisms of funding health care and move toward value-based strategies for funding health care.
The COVID-19 pandemic has put intense pressure on the American healthcare system, leaving some hospital systems at a complete loss as to how to handle this crisis. Can you share with us examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these issues moving forward?
We need to encourage team-based care and expand the team to include both licensed and non-licensed health care providers. We can realize significant improvements by using the strategies of “task sharing.” Additionally, we can encourage the practice of a reasonable workweek and the practice of strong self-care strategies to create a resilient workforce.
How do you think we can address the problem of physician shortages?
Pay physicians more in specialties that are most significantly understaffed. These would include primary care providers in rural areas. Make multi-disciplinary teams routine in primary care in all regions, and particularly in rural areas. Support physicians by providing trained behavioral health providers to work closely with them and to see assist patients with mental, emotional, and social needs, so that physicians can address medical issues with a greater understanding of the person’s needs.
How do you think we can address the issue of physician and nurse burnout?
Teach them the skills to cultivate “psychological flexibility,” beginning in medical school and continuing throughout the careers. Psychological flexibility is a group of skills that empowers a person to be open to themselves and others, focus their attention on the present moment, and engage in actions that are consistent with their values. Higher levels of psychological flexibility are associated with higher levels of job control and job satisfaction.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
I want to teach people how to be more psychologically flexible in addressing problems of living. I want to do this by offering same-day brief visits to people with medical and/or psychological problems in primary care settings. These brief visits would help the person identify new skills that they could learn to better address current concerns. People would then go out and try new things in their lives, returning for further coaching or assistance as needed.
How can our readers further follow your work online?
You can go to SpeaktoYourDoctor.com. At that website, you will find a tab (speak to your doctor) that has an information sheet for everyday people to use to start a conversation with a healthcare provider. The website also provides about a book I’ve written with Jeffrey T. Reiter, PhD. The book, Behavioral Consultation and Primary Care: A Guide to Integrating Services, was just published in its 3rd edition.
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.
Dr Patti Robinson Of SpeaktoYourDoctor On 5 Things We Must Do To Improve the US Healthcare Syste was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.