Over the last year, people have often asked me if being a Harkness Fellow was what I expected. It sounds rather a cliché to say it exceeded my expectations, but it genuinely has. The hospitality of the Commonwealth Fund, my mentors and many new American friends this year has left me with incredibly fond memories of the US and many friendships I hope to continue.   

One of my mentors has a favourite quote from Confucius: “If there are three men in the street in front of you, two of them could be your teachers”. I have met many teachers this year and am grateful to each one of them. The focus of my learning has been on the topic of “value in mental health care” but broader lessons arise from my time spent immersed in a different culture and different health care system. Or health care systems – plural - as in the US.

Many health care delivery challenges are shared in both the US and UK. For example, improving the integration of care, redesigning reimbursement systems and improving outcomes for patients. Throughout the year, it has been a privilege to participate in and learn from rich discussions with senior policy leaders from CMS (Centers for Medicare and Medicaid Services), Harvard, Commonwealth Fund and many others on these complex issues. I have been inspired by the passion and intellect of these individuals, as they strive for health care reform.

However, many aspects of both the US culture and the health care system remain an enigma. I cannot claim competence in the intricacies of “ACOs” (accountable care organizations) or “dual eligibles” (people receiving benefits from both Medicare and Medicaid). But I can see such policies are both a step in the right direction improving health care in the US and provide transferable lessons for the NHS, as other Harkness Fellows have discovered. 

On return to London in a few weeks, I apologize in advance for calling my mobile a cell and my flat an apartment. I fear my spelling may have gone awry too. In addition, over the last year, I have observed - but not fully understood - a range of US sporting endeavors, including the Boston Celtics and Red Sox, and participated in some great American traditions including Thanksgiving dinner and the spectacular July 4 Boston fireworks.

I have no hesitation in encouraging mid-career health care professionals and researchers to consider applying for a Harkness Fellowship. The deadline for the 2012-13 Harkness Fellowships is September 12, 2011. The only disappointment is that you can only do it once!  http://www.commonwealthfund.org/Fellowships/Harkness-Fellowships.aspx