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Relationship Based Care in Action

Author: Susan Harrison

In June 2015 I visited Alaska’s Southcentral Foundation. I chose to make the journey because I was fascinated by the stories that I had heard and read about their ways of working. During my five-day visit I was profoundly impressed to witness an organisation that lives and walks the talk of relationship based care.

Southcentral Foundation is a primary and community health services provider with 1,750 staff who work alongside the 65,000 people who use their services. The model of care, called Nuka, places relationship at the heart of everything that Southcentral Foundation does.

Nuka is a word used in many different cultures; some common meanings include honour, strength, big living things, dignity, love, generosity and support.

The Nuka approach to health care services is designed and owned by the people who use services. “Customer-owners” is the name that people have chosen to describe their relationship with Southcentral Foundation.

Nuka health practitioners describe their primary function as maintaining and facilitating continuity of relationship with customer-owners. Human relationships sustained over time come first. Practitioners draw on their clinical training and expertise as a secondary activity to support customer-owners find their own ways of sustaining their individual and family wellbeing.

Since the Nuka approach was developed in the late 1990s, Southcentral Foundation report that they have seen 50% drops in emergency room visits, hospital days and visits to specialists.

Customer-owners describe high satisfaction with the services they receive, and staff fulfilment in their jobs is reflected in low turnover figures. Background information about Nuka and the Southcentral Foundation can be found on their website.

There is international interest in the Nuka model and how it can be applied in different settings.

The US Veteran’s Health Administration is implementing Nuka approaches across their services. Harvard Medical School’s Centre for Primary Care has recently published two case studies on the work of Southcentral Foundation.

Don Berwick who worked at the US Institute of Healthcare Improvement, and wrote the 2013 policy document on patient safety: A promise to learn - a commitment to act, has given strong public support for the Nuka model.

In the UK the most interest to date has been in Scotland. Further details can be found at International Futures Forum.

Susan Harrison has over 25 years’ experience of working in operational and strategic roles in health, housing and social care in London and the South-East. Currently she manages an NHS and Local Authority community service for adults with Learning Disabilities. View Susan's Linkedin profile here.


The publisher is the Centre for Welfare Reform.

Relationship Based Care In Action © Susan Harrison 2015.

All Rights Reserved. No part of this paper may be reproduced in any form without permission from the publisher except for the quotation of brief passages in reviews.