A hospital with several outpatient clinics decides to directly implement a vastly proven evidence-based intervention of co-locating mental health (MH) providers with primary care providers (PCP), their nurses, and administrative support personnel to boost collaboration and make it easier for patients to receive timely mental healthcare. Currently, MH providers, PCPs and nurses are located on two different floors of the hospital. The administrative support personnel are located in a different part of the hospital. The hospital leadership believes co-locating these personnel would make it more competitive with other hospitals and more patients would use the hospital’s services. The anticipated improvement in patient care experience might also result in increased revenue. Although PCP and MH teams have worked together for a long time, they are accustomed to the old referral system in the electronic medical records, which is creating resistance. Both PCP and MH providers feel they will have their workdays constantly interrupted because the new process requires the PCP to do a warm handoff, that is, taking the patient to where the MH provider is. They believe there should be more staff hired to help with this change. The providers are all committed to providing quality healthcare but believe this change is only motivated by leadership’s concern with increasing revenue.

1.

Describe possible barriers and facilitators of the inner settings that might be impacted by the co-location.

2.

What are the elements of the outer setting?

3.

What processes are already used in the existing system of healthcare that could be used to facilitate implementation of warm handoffs?