NLM Director’s Comments Transcript
Nuka System of Health Care: 07/22/2013

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I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
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The Alaska-based Nuka system of health care is an alternative approach to clinical practice that is drawing attention as a possible model for other states, and perhaps other nations. I was fortunate to participate in a recent meeting in Anchorage that discussed the Southcentral Foundation’s health care transformation efforts – and introduced Nuka to persons from hospitals and clinics across the U.S. and some other countries.
Nuka is an Alaska Native word that means a strong, living, and large structure. Anchorage’s Southcentral Foundation applies the term Nuka to describe a system of caring for patients (and the community of Alaska Natives Southcentral serves) that prioritizes achieving physical, mental, emotional, and spiritual wellness.
While other health care systems espouse similar wellness goals, Donald Berwick M.D., the recently departed director of the Centers for Medicare and Medicaid Services (CMS) [who attended the meeting], described the Nuka approach as unique and a role model.
What strikes you immediately are Nuka’s and Southcentral’s emphases on a team approach to health care, helping patients improve their quality of life, and a sincere effort to build personal relationships among providers, staff, patients, and the surrounding community.
Incidentally, the Southcentral Foundation calls patients ‘customer owners’ because Southcentral works exclusively for Alaska Natives, who provide extensive advisory roles in the hospital and clinic’s management and policies. The Southcentral Foundation assumed the clinical responsibilities of the Indian Health Service under the Indian Self-determination Act about three decades ago.
Since that time, Southcentral has revitalized what it means to be in a medical clinic for a checkup or routine care. For example, the first Nuka-related surprise occurs when a patient (or visitor) expects to enter a physician’s office for a routine clinic appointment -- and instead meets a team of four persons who sit together in an open area.
That’s right – there are no physician’s offices, no nurse’s stations in the clinic. The team who helps you (and whom you are encouraged to know) includes a primary care physician, a doctor’s assistant (who administers some clinical tests during your visit), a nurse (who arranges further care and provides medical instructions), and a person who helps you coordinate future appointments and navigate your way through the medical center. The team’s four members take pride in their ability to work together. Physicians can use a private examination room to treat patients.
If you need to see a specialist, such as a nutritionist, psychologist, or pharmacist, these providers rotate throughout the clinic teams. Other medical specialists, such as cardiologists, are available on referral the same day — within another area of the medical center. Incidentally, the clinical options include Native Alaskan traditional healing, which is available at a person’s request and encouraged as a compliment to western medical treatment.
Have I got your attention? How many clinics linked to a hospital do you know that have a similar approach and level of staff coordination?
Moreover, Nuka’s teams are encouraged to screen patients to enhance their quality of life — in addition to responding to their physical condition. So, Nuka’s screening may include physical fitness, nutrition habits, family and personal relationships, and what is often perceived as social work issues (such as housing quality and access to transportation). In other words, the team is encouraged to react to someone’s needs and boost his or her quality of life parallel to traditional clinical interventions.
Nuka and Southcentral also perceive wellness as individual, family, and community-based. So, the clinics and medical center encourage exercise programs for persons of all ages, and provide community-based counseling to counter ongoing health challenges such as: obesity, alcoholism, drug abuse, abusive family interactions, and learning how to buy and cook nutritious foods.
All of this is based on extensive efforts to train every Southcentral employee how to communicate well with others and how to share stories about one’s personal character and life journey. One of Nuka’s core discoveries is staff members who know each other well function optimally — and understand the importance (and will take the time) to try to know their patients. Southcentral’s employee and patient satisfaction are well above national averages. Southcentral won the prestigious Malcolm Baldridge National Quality Award in 2011.
In a talk during the meeting Dr. Berwick said (and I quote): ‘this is the cutting edge health care system in the U.S.’ (end of quote). Berwick added Southcentral and Nuka were a source of inspiration that influenced CMS’ recent investment in Oregon to encourage a statewide approach to wellness and health care that may serve as a future, national model. Since the Oregon health care experiment has yet to be fully implemented, it is premature to report how well the Southcentral/Nuka model works if adopted within a more diverse patient population in another state.
However, more than 100 participants interested in applying the principles and some specific aspects of Nuka care attended the meeting, including several administrators and physicians from U.S. Veterans Administration medical centers, a multisite federally qualified health clinic in New York City, officers from state departments of health, and a delegation from one of the largest hospitals in Singapore. I was told recent attendees included medical officials from several other nations.
Overall, it was inspiring to watch as medical professionals learned about and tried to embrace a fresh approach to providing care and rethink their primary responsibilities to patients and surrounding communities.
I should add Katherine Gottlieb, the Southcentral Foundation’s chief executive officer, is a member of NLM’s Board of Regents. I thank her for helping me begin to understand the extent of Southcentral’s transformative efforts – and I hope you enjoyed hearing about it. You can read more about Nuka at: southcentralfoundation.com/nuka/
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MedlinePlus.gov’s health facilities health topic page contains links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to related clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. From the health facilities health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.
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