Innovating healthcare for all

Medical Staff Seated In Circle At Case Meeting

Working in a downtown Portland, Maine hospital, three nurses became convinced the most effective healing requires a holistic approach: a concern not just for the needs of the body, but for the intertwined needs of mind and spirit.

The nurses – Kathryn Landon-Malone, MSN, CPNP, RN, Kristen Lombard, PhD, RN, PMHCNS-BC, and Crissa Evans, RN – wanted to explore the potential of a new kind of healthcare, blending the science of medicine with the healing arts and creating a container that allowed for both time and relationship between patient and family and practitioner, to help patients to achieve their optimal health.

To test their ideas, they tapped into their adaptive leadership skills and convened a varied group of physicians, nurses, other healthcare practitioners and many others to begin considering ways to introduce a more holistic, relationship centered model into traditional clinical settings.

The group grew quickly to 40 members – including doctors and nurses, nuns and housekeepers, administrators and therapists, and more – and became known as the Holistic Health Council.

As their circle widened and word of their intention to improve healthcare spread, they realized what they were conspiring to create answered a deep need of patient and families, doctors and nurses and all clinicians, healthcare leaders and staff, and communities.

Gradually, they began to focus on the need for a new center for optimal caring (healthCARING), a place where passion for healing would merge with the values of acceptance, professionalism and respect nurtured with a shared community of safety and love.

I was blessed to join this group during its formative stages and lead them as the Executive Director for the next six years.

Innovative Model of Care

The Hygeia Foundation d/b/a True North in Falmouth, Maine, a non-profit research institute, integrated multi-specialty group practice and innovation laboratory, became the realization of this dream. A place where clinicians could practice within a dramatically different and innovative model of healthcare based on compassionate relationship, integration, and mutual respect. Where reliable research was conducted and accessible. Where quality improvement, innovation, complexity science, individualized patient care, and cutting-edge evidence-based medicine were the norm. And where collaboration (Circle Process) held all.

Circle Process

Circle Process is a model of governance based on a combination of the ideas Christina Baldwin presented in her book Calling the Circle, the teachings of Paula Underwood, and the guidelines of Relationship-Centered Care by the Fetzer Institute.

(I was blessed overtime to introduce to circle, additional innovations, quality improvement, performance management, measurement strategies, accountability, finance and business principles and heart-centered leadership.)

NOTE: True North, as the first healthcare system to utilize Circle Process, is featured in the book The Circle Way.

Some features of Circle Process at True North:

  • Rotating Leadership: We level the playing field. While one’s title, experience and gifts are as important as another’s, leadership shifts according to the needs of the circle and deferring to expertise (see HRO (High Reliability) principles). In doing so, we continually find the resources needed to accomplish our goals most efficiently and effectively.
  • Shared Responsibility: Each person asks for what he/she needs and offers what he/she can based on the trust that someone will come forward to provide what the circle needs to honor our mission while living according to our values.
  • Consensus decision-making: Making decisions through consensus building, which does not mean (for our circle) unanimously. Where all voices are listened to, where each lens of those in the circle is seen through, where all feel heard, respected, cared for. Where it is encouraged to agree to disagree. This has led us to far better decisions because all felt safe to share their voice even if initially it might be a lone voice.
  • Covenants, agreements and decisions are revised as goals of the circle (and the circle itself) evolve (see PDSA quality improvement methodology). This allows for continuous improvement for optimal impact.

Value of Circle

At True North we believed that Circle Process helped to heal many of the multidisciplinary wounds we all felt and nurture the caregivers (and all staff) personally and professionally … thus best positioning all of us to optimally engage patients and families and one another. (See Physician and Nurse Burnout and Bullying in Healthcare).

“The experience of circle has enhanced the care I provide for young children and their parens,” Landon-Malone said. “The experience of being loved, honored, and sometimes challenged in circle has deepened my ability as a healthcare provider as it allows me to get to the root of issues, to meet people where they are, to trust there is a larger process at work, and to walk with people in a way that calls out their own intrinsic ability to solve problems, see what’s there, and ultimately, to heal.”

Lombard agrees, saying the simple guidelines of Circle Process provide a structure that allows the caregivers to practice how to be more present with themselves and with others.

“This increases our confidence, courage, trust and connects us more strongly with a sense of meaning in our work. That deepens our practice in many ways,” she said.

Individualized Patient Care

Understanding each patient is unique and the one-size-fits-all approach does not provide for safe, culturally competent care or optimal healing, the circle desired the integration of proven healing modalities which align with the preferences of our patients and meets them where they are.

The model we created, evolved and continuously innovated, was person-centered, culturally competent and relationship-based.

The model allowed for ample time for a true partnership to develop between the patient (and when appropriate the family) and practitioner. Ample time to develop relationship and trust, ample time for the patient to share their whole story (and not be interrupted within 11 seconds) and for the clinician to truly listen to understand. Ample time with this additional information provided (these additional nuggets of wisdom) to leverage trustworthy research and cutting edge medicine to identify and then address the root-cause of the patient’s health challenge.

Recognition & Impact

True North was recognized by …

And we were asked to share our innovative model at MGMA conferences, as part of the Maine Dartmouth Family Residency program, and many other national conferences.

Because of the vision of three nurses and an incredible circle of clinicians and staff, for fifteen years (and well ahead of the curve) True North doctors and nurses and many other practitioners innovated and created their dream practices with love and joy and a renewed passion for healing … and in doing so created an amazing place for staff to work and patients and families to receive individualized, effective and safe care.

I have often been asked if the broken aspects of the healthcare system can be fixed by a small group of people … and each time I reflect on the words of Margaret Mead …

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”


To learn more, please contact me at


Together we will fan the flame of good in the healthcare system and improve that which needs improving.




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