There is a
growing body of evidence
supporting practice facilitation as an effective strategy to improve primary health care processes and outcomes through the creation of an ongoing, trusting relationship between an external facilitator and primary care practices (Erin Fries Taylor, 2013). Mount Sinai has brought this resource to its primary care practices for a period of six months to help support practices in reaching incremental and transformational improvement goals.
We sat down with
George Lourentzatos
, Senior Manager, Practice Facilitation, and
Chris Scalamandre
, Practice Facilitator, to learn more about their roles and achievements over the past few months. According to George, “It is the norm in primary care for each role to work in silos. Where we come in is to enable team members to take a step back, evaluate their interdependencies, and plan how they can work together to achieve efficiencies in their common goal – providing exceptional patient care.”
Chris explained, “Change is hard. But you cannot improve upon what you do not measure. I see my role as helping the practices realize the importance of incorporating ongoing quality improvement into their workflows. For example, the goal of one PDSA
(Plan Do Study Act)
exercise is to help physicians manage their in-baskets more efficiently, employing the skills of the medical assistants to answer patient messages and leaving the physicians more time to spend with their patients.”
One of Chris’s key goals is ensuring that staff are working to the top of their licenses, and she finds that “people find more satisfaction and gratification in their work if they are leveraging the skills they were trained on to affect patient care.”
Teamwork
“It’s a win-win for everyone when patient care is the focus and the entire staff are working together to the top of their abilities to make an impact on the patient experience and health outcomes,” Chris commented.
In a team-based practice, it is not only the physicians that contribute to patient care. It’s empowering for a medical assistant to review a chart and make recommendations to the physician or for a front-line staff person to suggest changes to more efficiently register and room patients. Both George and Chris empower staff to ask the question “Why?” and engage everyone in the practices in finding solutions to problems. Front-line staff know the problems and they also know the solutions, they commented.
Practice Improvement Skills: PDSA
One key tool that the facilitators have introduced to practices is rapid-improvement PDSAs, exercises that are being employed to improve wait time or phone response rates by problem-solving in a very specific way. If one method doesn’t work, then it’s time to try a new one until you come up with something that makes a measureable difference. Process improvement is continuous.
George commented, “Our goal for this program is to allow practices and staff to really be able to try out different solutions. That means making the time to evaluate, problem solve, and experiment. Since we are only there for a short period of time, the key is sustainability – and we are seeing staff at the practices truly own process improvement. While everyone’s main focus is patient care, it’s also okay to take time to work on process improvement activities that will impact that care.”
He continued, “Primary care is often a patient’s first access point into the Mount Sinai Health System and our primary care practices are the face of Mount Sinai. It is important that practices run well, and that staff are vested in their work in order to care for our VIPs—our patients.”