Primary Care Practice Redesign Newsletter
Cohort 1 | Issue 11
June 27, 2019
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This newsletter is a biweekly forum to keep practices
connected and informed on the Cohort 1 Redesign efforts.
Be sure to right-click to download pictures.
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Update on Redesign: You Did It!
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Congratulations and thank you to everyone who participated in the pilot cohort of primary care redesign. We hope you found this experience valuable and we are grateful for all of the work you put in to this project.
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Highlights from the Final Learning Collaborative
PDSA in Action: ED Simulation
You participated in a fun team activity at the Collaborative to put some of the skills you learned throughout redesign into action. Teams of 8 received a bag of disassembled Potato Heads and photos of how they should look. With some set rules and roles, and limited time to prep and execute, teams did an outstanding job of working together to implement effective care for their Potato Head patients.
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Key Takeaways
- The PDSA (Plan, Do, Study, Act) system is a critical determinant of performance, more so than skills or effort
- Good communication is essential
- Ideas can come from anyone on the team
- Data is essential for improvement
- Repeating the PDSA cycle is a valuable process
- Reduced waste = enhanced efficiency
- All steps should add value
- Simple changes improve quality and efficiency
- Performance improvement can be fun!
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Redesign Sustainability Goals
- Maintain culture of improvement
- Ensure implemented projects continue
- Keep practices connected
- Provide continued leadership engagement
In order to meet these goals we will host bi-annual collaborative workshops and bi-monthly webinars. Stay tuned for more information!
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Congratulations to our Award Winners!
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Lisa Renaud
, Practice Manager,
MSD 1090
Most Likely to Start a Dance Party
Emily Martinez
, Medical Assistant Supervisor, MSD 1090
Most Likely to Always Have a Big Smile on Her Face
Internal Medicine Associates
Cool Snaps Award
Alexis Louie
, Project Coordinator,
MSD 85th Street
Perfect Attendance Award
MSD Brooklyn Heights
Forward Thinking Rockstars
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Mejreme Demirovic
, MA/RA,
MSD 23rd Street
Most Likely to Be a Constant Contributor
MSD Williamsburg
All For One and One For All
Molly McNeil
, Practice Manager,
MSD Samuel Friedman
Most Likely to Go the Extra Mile
Christine Cate
,
Practice Manager,
MSD Ansonia
Most Likely to Change the World, One Work Flow at a Time
MSD Ansonia
Practice with the Most Resilient Change Agents
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Reflections on Primary Care Redesign
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At the final learning collaborative on June 14,
Dr. Stella Safo
and
Dr. Roy Cohen
reflected on this program, why we need redesign, and some challenges and takeaways
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Dr. Safo
and
Dr. Cohen
began by reflecting on what’s changed in medicine since the start of their careers. Among the negatives: the increased prevalence of burnout among providers. Dr. Safo recalls feeling scared of burnout by the time she finished her residency; she saw her mentors practicing medicine in a way that didn’t uphold their values. This inspired her to design a system that allows practitioners to deliver care to their standards.
Why do we need primary care redesign?
It’s clear something has to change. Daily workloads significantly increased with the advent of the EMR, increasing patient access to providers, and data. Provider and Staff Wellness survey results from the beginning of this program showed significant levels of feelings of burnout.
On the bright side, as a health system, we’ve started to achieve population health goals and are working to address burnout and standardization, and look to be an innovator in the New York market. To deliver on these aspirations and keep people healthy, we need new models of team-based care and system support to distribute workloads among primary care staff. This initiative focused on team-based care as the building block for primary care redesign.
What was our approach to primary care redesign?
We began with practice assessments to understand the history and current state of your practices; any effort to improve practice workflow must start here. From there, we focused on two project series: building blocks (Lean and QI principles, wellness surveys) and workflow-related projects (huddles, transitions of care, same day access).
What were some challenges and successes with redesign?
We realized along the way that one size does not fit all: our practices are different in structure and patient populations. We also learned a lot about the process itself, such as how to best use the practice facilitators. Front line staff mastered change process skills like Plan, Do, Study, Act (PDSA) and Lean principles. We focused on huddles, streamlined system resources, shared new system initiatives, and the survey feedback showed improvements in feelings of burnout and callousness.
Dr. Cohen said, “Success is all about the people. Collaboratives build community and offer a safe space to bring people together to share information, progress, and challenges. Peer to peer is often the best form of learning and primary care is a team-based sport.”
Dr. Safo added, “Even though changes and improvements seem small, I’m most inspired by seeing the system trying to do the right work to empower better patient care…striving to build a system where everyone can get the care they need.”
Lessons Learned
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Ed Lucy, Chief Administrative and Contracting Officer for the Mount Sinai Health System, joins Dr. Fields to share his expertise in negotiating payer contracts. Dr. Fields points out that some people feel that we should treat healthcare as any other commodity where there is a market rate loosely tied to cost. But as their conversation reveals, the delivery side is much more complex in that there are multiple challenges to contend with and greater strategic goals that need to be aligned. They also discuss the move toward value-based care, how this differs from capitation contracts that were popular during the 90s, and what population health models may look like in the near future.
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Dr. Fields sits down with Alicia Gresham, Vice President for Network Operations at Mount Sinai, to explore ways for physicians to move towards a population health model that compensates physicians on the quality of care rather than their patient volume. Ms. Gresham explains that it is essential we show physicians what this population health model looks like and how their compensation will change. Physicians may struggle at first with this process, however, in order for physicians to stay sustainable, they must try to transition to a more holistic model of patient care that has been adjusted to our growing health system, staff, and patient needs.
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Transformation in the News
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Restoring the Lost Practice of House Calls: How CareMore in Connecticut Reduced ED and Hospital Utilization through Home-Based Integrated Care
CareMore implemented comprehensive care teams of PCPs, nurses, case managers, medical assistants, and social workers to provide comprehensive preventive, chronic condition, urgent, and post-discharge care to high-cost, high-need patients within their own homes. Not only does this reduce barriers to access, but it adds a familiarity to doctor-patient relationships and makes some social determinants of health readily visible. In a ten-month period, CareMore found a 12.5% reduction in hospital admissions and 27.2% reduction in ED visits among the 105 patients who had continuously engaged with CareMore and maintained the same health plan throughout.
Click here
to read the full article from
The Harvard Business Review
.
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Charter on Physician Well-Being
Mount Sinai’s own Dr. Jonathan Ripp, Senior Associate Dean for Well-Being and Resilience, is co-founder and co-director of the Collaborative for Healing and Renewal in Medicine (CHARM), which created a Charter on Physician Well-Being. The Charter outlines guiding principles and commitments for physicians to address well-being among providers and health care professionals. Learn more and sign on to the charter
here
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