Primary Care Innovations: Stories from the Field. PCPCC Webinar Christine A Sinsky, MD Thomas A. Sinsky, MD June 29, 2012

Similar documents
In Search of Joy in Practice: Innovations in Patient Centered Care

Joy in Practice: Innovations in Patient Centered Care. Association of Chiefs and Leaders of GIM Christine A Sinsky, MD, FACP Feb 17, :40-4:40

Effective Strategies for Engaging and Retaining Clients in HIV Care and Treatment. Lessons Learned from Teams in Primary Care Settings

Family Physician Well-Being: Update for the North Dakota AFP

Solving the adult primary care crisis: it s time to think differently

MA Medical Society Boston, MA May 6, Christine A. Sinsky, MD, FACP Vice President, Professional Satisfaction American Medical Association

Resilience Strategies for Team Care THOMAS BODENHEIMER MD, MPH CENTER FOR EXCELLENCE IN PRIMARY CARE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO

In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices. Ann Fam Med 2013;11: doi: /afm.1531.

The 10 Building Blocks of Primary Care Building Blocks of Primary Care Assessment (BBPCA)

Making the Medical Home Work/Teamwork in Primary Care. Amy Mullins, MD Trinity Clinic Whitehouse

Bright Spots in primary care

Monthly PCMH/HH Webinar. The Use of Scribes in the Patient Centered Medical Home

Innovative Models for Team-Based Care: A Solution for Burnout Gaines Richardson, MD, Faculty Monroe Clinic / Mark Thompson, MD, SSM Heath, WI

Empowering Medical Assistants Improves Primary Care

Joy At Work - BellinHealth and HealthPartners

Expanded Rooming and Discharge Protocols

Improving Clinical Flow ECHO Collaborative Change Package

VHA Transformation to a Patient Centered Medical Home Model of Care

Mark Linzer MD General Internal Medicine Office of Professional Worklife Hennepin County Medical Center

How will this module help me successfully put team documentation in place?

7/7/17. Value and Quality in Health Care. Kevin Shah, MD MBA. Overview of Quality. Define. Measure. Improve

CREATING A NATIONAL CAMPAIGN TO IMPROVE HYPERTENSION CONTROL. Improving chronic care: It takes a team

Nurse Visits A Tasting Flight of Visit Models

NCQA s Patient-Centered Medical Home Recognition and Beyond. Tricia Marine Barrett, VP Product Development

Why pay attention to burnout. The ACLGIM Worklife and Wellness Survey. Strategies for reducing burnout and promoting wellness in GIM

Presentation Outline

Productivity: New Care Team Model

Disclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws.

Medical Home Summit September 20, 2011

Use of medical scribes in a primary care setting; THE EXPERIENCE OF OUR OFFICE AND POSSIBLY YOURS.

Organized, Evidence-based Care

University of California, Davis Family Practice Center: Update 2014

Team Integration Strategies

The Four Pillars of Ambulatory Care Management - Transforming the Ambulatory Operational Framework

Medical Assistants: Embracing New Roles

Care Redesign and Quality Improvement. Beth Averbeck, MD Senior Medical Director, Primary Care HealthPartners Medical Group

Strategy Guide Specialty Care Practice Assessment

New Models of Care- Looking at PCMH & Telehealth

PCC Resources For PCMH. Tim Proctor Users Conference 2017

Patient Centered Medical Home The next generation in patient care

Deeper Dive on Team Roles: Part 2

Patient Referrals to Self-Management Programs

Organization American College of Physicians, Inc and Kentucky Chapter of the American College of Physicians

Overview of The Joint Commission s Primary Care Medical Home (PCMH) Certification

Sustaining a Patient Centered Medical Home Program

Patient Care: Case Study in EHR Implementation. With Help From Monkeys, Mice, and Penguins. Tom Goodwin, MHA MIT Medical Cambridge, MA March 2007

Program Overview

BUILDING BLOCKS OF PRIMARY CARE ASSESSMENT FOR TRANSFORMING TEACHING PRACTICES (BBPCA-TTP)

Using Data to Increase Capacity in Ambulatory Care. Session #156, February 22, 2017 Dan Hamilton, COO, Nor-Lea Hospital District

Achieving Meaningful Use : 10 Keys to a Successful EHR Install & Adoption

ACHIEVING POPULATION HEALTH: THE POWER OF TEAM BASED CARE

PACT: The VA s Medical Home

Results from Contra Costa Regional Medical Center

The Cleveland Clinic Experience

Table of Contents for CCC Toolkit

econsultation Technical Assistance Webinar #1: Background, Conceptual Framework and Early Successes SEPTEMBER 9, 2015 WEBINAR #1

Approaches to practice transformation to improve outcomes along the HIV Care Continuum Panel Session

gh Group Visits and 03/18/14 that lead 3. Be able delivery model 4. Be able CONTENTS CME Credit Page 2: Description of CHAMPS Page 3:

Care Coordination Overview. Janet Tennison, PhD UPV Standards October 8, 2013

Table of Contents. Bellin Health Lessons from a Successful Medicare Pioneer ACO

COLLABORATIVE PRACTICE SUCCESSES IN PRIMARY CARE

Using a Patient-Centered Care Plan and Teamwork to Support Self-Management

The road to excellence in primary care teaching clinics

Putting PCMH into Practice: A Transformation Series Care Coordination & Care Transitions (CC) September 12, 2018

Team-based Care: Answering the Call in Academic Medicine. Scott Shipman, MD, MPH Director of Primary Care Affairs and Workforce Analysis

From Reactive to Proactive: Creating a Population Management Platform

Optimizing the Workforce: The Intersection of Healthcare Reform, Delivery Innovation, and Training

EHR Enablement for Data Capture

2014 PCMH Standards: How CPCI Can Help with Transformation. CHCANYS Quality Improvement Program November 20, 2014

Value of Safety Improvement Collaboratives for Home Care: Strategies and Outcomes

Pioneer Accountable Care Organization Model: General Fact Sheet May 22, 2012

Comprehensive Medication Management (CMM) for Hypertension Patients: Driving Value and Sustainability

Working at Top of License How do you reallocate work among a team? January 28, 2015

Patient Centered Medical Home: Transforming Primary Care in Massachusetts

Breaking Down Silos of Care: Integration of Social Support Services with Health Care Delivery

A8/B8: Self-Management: Critical to Chronic Care

PCMH: Recognition to Impact

Implementation and Impact of Lean Redesigns in Primary Care

Lahey Health and Cleveland Clinic: Building a Primary Care Strategy out of a Surgical Legacy

Using Data for Proactive Patient Population Management

Part 2: PCMH 2014 Standards

Population Health for Rural Hospitals: 3. Patient Care Coordination and the Intensive Medical Home

Office of Mental Health Continuous Quality Improvement Initiative for Health Promotion and Care Coordination: 2013 Project Activities and

2014 Patient Centered Medical Home (PCMH) Recognition

Rethinking the model of primary care. Tom Bodenheimer MD Center for Excellence in Primary Care UCSF Department of Family and Community Medicine

Instructions for Completing the BHICCI Case Rate Readiness Assessment (CRRA) and Workplan

Building the Universal Roadmap to Population Health Management

Care Fragmentation IOM 09/09/09

DFMCH Team Based Care Taskforce

Community Practice Model. Florence, Oregon

Michigan Primary Care Transformation Project. HEDIS, Quality and the Care Manager s Role in Closing Gaps in Care

9/15/2017 THROUGHPUT. IT S NOT JUST AN EMERGENCY DEPARTMENT ISSUE LEARNING OBJECTIVES

Grove Medical Associates, P.C. A Case Study in Continuous Quality Improvement

UTILIZING LEAN MANAGEMENT PRINCIPLES DURING A MEDITECH 6.1 IMPLEMENTATION

Emergency Department Throughput

Building a Better Home: Transformation to a Patient Centered Health Home. Anna M. Gard, FNP-BC Association of Clinicians for the Underserved

National Committee for Quality Assurance

Transitions of Care: Primary Care Perspective. Patrick Noonan, DO

Oregon Medical Group Team Medicine 3 April 2014

SAMPLE WORKFLOW. DAY OF CONSULT - Patient Site (Pease refer to the flow chart for event timing and site participation requirement)

Transcription:

Primary Care Innovations: Stories from the Field PCPCC Webinar Christine A Sinsky, MD Thomas A. Sinsky, MD June 29, 2012

In Search of Joy in Practice Co-Investigators Christine Sinsky- PI Tom Bodenheimer-PI Rachel Willard Tom Sinsky Andrew Schutzbank David Margolius

Advisory Council

Places Where PC Physicians & Staff are Thriving? Where the work of primary care is do-able Enjoyable as a life s vocation

Group Health Olympia Joy in Practice Martin s Point- Evergreen Woods Multnomah County Health Dept Allina Fairview Rosemont Clinic Mayo Red Cedar ThedaCare Harvard Vanguard Medford Brigham and Women s Hospital Clinic Ole Sebastopol Community Health La Clinica la Raza de Univ of Utah- Redstone Clinica Family Health Services Medical Center Medical Associates Clinic Mercy Clinics Quincy, Office of the Future Cleveland Clinic- Strongsville North Shore Physicians Group Mass. General Hospital Newport News Family Practice West Los Angeles- VA South Central Foundation Site visits to 23 highperforming practices (most PCMHs) Workflow Task distribution Physical space Technology

Challenges Chaotic visits EHR work to MD Inadequate support Teams function poorly Time documentation

Challenges Innovations 1. Chaotic visits with overfull agendas Pre-visit planning Pre-appt labs Systematic Prescriptions

Fairview: Care Model Redesign MA pre-visit call Agenda, Med review Depression screen Advanced directive

Mayo-Red Cedar arranges for pre-visit lab

Same day pre-visit lab (15 min) ThedaCare

Annual Prescription Renewals Physician time 0.5 hour/day Nursing time 1 hour/day per physician 80 million PC visits/year 350,000 PCPs x 220d/yr x1 visit/d

Challenges Action Innovations Steps 1. Chaotic visits with overfull agendas Insurers Single co-pay lab/visit Institutions Hold future orders Staff order entry Pharmacies and Board Prescription 15 mo Resynchronize No automated faxes

Challenges Innovations 2. Inadequate support to meet the patient demand for care Sharing the care among the team 2:1 or 3:1 Rooming protocol Between visit Health coaching Care coordination Panel mgm t

Mayo Red Cedar : New Model of Nursing (2:1) Physician centric to team based model Immunizatio diabetic foot, lifestyle, HTN visits; even though 25% more visits/day, less harried; proud

Genesis: 3 week vacation New Model of Nursing Doctor to nurse: I was behind an hour every day. Thank God you are back! Nurse to doctor I enjoyed my time away from the daily grind that I was tempted not to return. Doctor and nurse Our practice needs to change

Challenges Action Innovations Steps 2. Inadequate support to meet the patient demand for care Educators MA, nurse: MI, SMS Institutions/Regulators Staffing Scope of practice Payers Fund non-md services Technology Team log-in

Challenges Innovations 3. Vast amounts of time spent documenting care More time doc than delivering care Scribing Assistant order entry

I used to be a doctor. Now I am a typist. Personal communication. Beth Kohnen, MD, internist Anchorage AL 8.3.11

The Doctor 1891 Fildes Undivided attention

The Doctor 2012

Challenges Innovations 3. Vast amounts of time spent documenting care Scribing Assistant order entry

Scribing: Newport News Family Practice

Collaborative Care Newport News n What we all hoped for n Team: 3:1 Nurse/physician

Collaborative Care Newport News n Four Components to Visit n Data gathering, organizing and documenting n Data analysis and exam n Decision making, creating a plan n Plan implementation, order entry, pt ed

Collaborative Care Newport News n Four Components to Visit n Data gathering, organizing and documenting n Data analysis and exam n Decision making, creating a plan n Plan implementation, order entry, pt ed

Pre-visit: Nurse with Pt (8-12 min) n Nurse gathers, records n Vitals, Med Rec., n Previous two notes n ER, Consult notes, n New lab or x-ray n Agenda, HPI n ROS guided by templates

Visit: Nurse, Patient and MD n Nurse gives report n M.D. n Hx, PE n M.D. n verbalizes med changes n lab, x-ray orders n diagnosis/billing codes n next followup appt. n Nurse records

Post-visit: Nurse with Patient n Nurse n Reviews plan n Prints and reviews visit summary n Escorts the patient to checkout n US Army

Scribing at Cleveland Clinic Kevin Hopkins M.D.

Collaborative Care Cleveland Clinic: Stonebridge n Turbo practice n 2 MA: 1 MD n 2 pt/d cover cost n 21 28 visits/d n 20-30% revenue n Spread to others n We re having FUN

The MA s are more fully engaged in patient care than they have ever been and they enjoy their work They have increased knowledge about medical care in general and about their individual patients in particular. Kevin Hopkins M.D.

Collaborative Care University of Utah: Redstone n 2.5 MA: 1 MD

I get to look at my patients and talk with them again. We re reconnecting. Our patient satisfaction numbers are up, our quality metrics have improved, our nurses are contributing more, and I am going home an hour earlier to be with my family.. Amy Haupert MD, family physician, Allina-Cambridge 11.29.11 personal communication

Office Practice of the Future Quincy Family Practice Residency n 2 MA: 1 LPN: 1 MD

Collaborative Care Six sites Similar results Access 30% Costs covered Satisfaction Quality metrics Physician home hour earlier no work at home

Challenges Action Innovations Steps 3. Vast amounts of time spent documenting care Institutions Rooms: 2 computers Assistant order entry Institutions/Regulators Team log-in Technology Seamless transitions between users

Challenges Innovations 4. Computerized technology that pushes more work to the clinician Verbal messages In-box management

The task list is unbearable. I spend 1.5 hours clearing out my task list before leaving and another 1.5 hours at home after the kids go to bed. Primary Care Physician, Des Moines, IA; 2011

Challenges Innovations 4. Computerized technology that pushes more work to the clinician Verbal messages Inbox managment

Fairview: Filtering Inbox Reduce backpack 90min/d to few min Line of Sight

Verbal messaging at Fairview rather than getting tangled in a thicket of e- messaging.

Semi-circular desk, APF

Iora Health, Dartmouth-Hitchcock

Printer in every room University of Utah Redstone

APF, Massachusetts General Hospital

Challenges Action Innovations Steps 4. Computerized technology that pushes more work to the clinician Institutions message generation Nurses filter inbox Regulators Security modifications signature requirements Technology Quick log in Save a click

Challenges Innovations 5. Teams that function poorly and complicate rather than simplify the work Co-location Huddles Team meetings Workflow mapping Structuring the physical and personnel environment to support trust and reliance

Flow station at North Shore Physicians Group

Fairview Co-location of scheduler

Co-location at South Central Foundation, Alaska

APF, Massachusetts General Hospital

Pre-clinic Huddle

Team Meetings Do Work + Make Work Better

Health coach running meeting we all own practice, own meeting

ThedaCare: All staff trained in QI, Pulling in same direction, capacity for change

Clinic walls lined with data ThedaCare

Lean Problem solving Harvard Vanguard Medical Associates

Harvard Vanguard Medical Associates

26 Improvement Specialists South Central Foundation, Alaska

Challenges Action Innovations Steps 5. Teams that function poorly and complicate rather than simplify the work Institutions Co-location Line of sight Space for huddles Time for meetings Improvement specialists Aligned reporting (MA/ nursing to clinical lead)

Key Lessons For Burnout and Joy Share the care with team 2:1 or 3:1 staffing in stable Physician-centric to team-based care Clear communication Co-location Team meetings Systematic Planning Workflow mapping Everyone: do the work & to make work better

Next Steps Individual Stories Will be published on line at ABIMF p paper Video project 10 of the 23 sites Toolkits/Learning community Practical advice Campaign for envy and demand BWH

Discussion