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Organizational Change: Improved Pain Management and Better Rural Healthcare

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Cabin Creek Health Systems (CCHS) provides primary care at four community health centers in Kanawha County in rural West Virginia. The 14,000 annual users are served by 120 employees and 20 physicians and nurse practitioners.


As a federally designated Area Health Education Center and regional lead agency, CCHS offers continuing education for rural medical providers. To address the difficult issue of chronic pain, CCHS asked Plexus Institute to help design a May 2008 workshop that would tap the knowledge and experience of attendees.

A Liberating Structures (LS) Approach

Expert presentations were followed by reflection and discussion sessions. Attendees engaged in one to one and small group conversations to share experiences and pose questions.

  • Open Space and Celebrity Interviews were among the complexity-informed processes that generated participatory learning.
  • Attendees concluded chronic pain needs a systematic organization-wide approach rather than leaving clinicians to struggle individually.
  • Specific guidance on evidence based approaches was discussed with focus on implementation.


The workshop had immediate and long-range results. People from different centers left with action plans to improve their chronic pain care. Follow-ups produced a chronic pain group as a resource for all. Plexus helped with another workshop on data use, and CCHS began new ways to engage staff and build relationships. LS were adapted to other challenges.

  • Physicians concerned about overuse of narcotic pain medications found 400 patients with narcotic prescriptions at one clinic alone. After 18 months of work with patients and staff only 30 patients there had such prescriptions. 
  • An interdisciplinary "huddle,” instituted to discuss medically complex patients, generated new information—such as need for a home visit or awareness of a local service or resource—that individuals alone often don’t have. 
  • Broadened use of LS for strategic planning led to new services. These included obesity group visits, substance abuse support for patients, and support, stress reduction, and burnout prevention for employees, all efforts CCHS employees suggested and volunteered to facilitate.
  • All five West Virginia health systems are creating a managed care organization in which centers will have new levels of responsibility and accountability. CCHS is offering a series of high-energy LS-based workshops to help providers adapt to change. 

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