Beginning the Quality Journey

1. Beginning the Quality Journey Michael H. Clark MD Lifespan Family Healthcare, LLC Newcastle

2. Why am I here talking with you today? I am a nationally recognized expert in quality improvement? I am so far along on the journey of quality improvement that you will probably never catch up? I am energized by the possibility of leading a high-performance healthcare team and have begun to see benefits of quality improvement already in my own practice.

3. Why Quality Improvement? Because despite my education, my clinical skills, my years in practice, my attention to detail, and my commitment to clinical excellence, a gap often exists between the quality care that I aspire to and the care that is actually achieved.

4. But, I’m too busy to do this… This IS about practice efficiency This IS about getting home earlier This IS about feeling more confident that I am providing the right care to the right patient at the right time. This is a “Both-- And” proposition!

5. The Lifespan Story… Lifespan Family Healthcare Office in Newcastle

6. The Lifespan Story, cont… Start-up solo family medicine practice • Vision for patient-centered, high quality health care with integrated mental health care • Vision for patient empowerment through education and communication • Vision for coordinated and integrated care • Desire to get off the hamster wheel

7. The Lifespan Story, cont… • EMR with Health Maintenance module • Chronic illness and preventative care “flowsheet” • Emphasis on high-quality patient communication • Carefully chosen staff with eye towards building a cohesive team • Well-received by community

8. The Lifespan Story, cont… No registry No population based disease-tracking capacity Motivated and conscientious team, but not achieving team based care as I had envisioned Office visits complicated and time consuming Growing patient panel Financial realities begin to sink in

9. The Lifespan Story, cont… Not able to sustain the attention to detail and thoroughness that I envisioned as the patient volume increased Older, sicker and more complicated patient panel Real concern that I was not achieving the clinical outcomes I envisioned, but no way to be sure Unable to measure or assess my patient population

10. The Lifespan Story, cont… Growing and successful, but… • In-place systems became overwhelmed • Team members frustrated and overworked • Exhaustion and near-burnout Back on the hamster wheel!!

11. New Direction • LEADERSHIP • Self-assessment and self-understanding • Identification of current strengths and needed skills • Humility • MENTORSHIP Seeking out those who have gone ahead of me • Elevates and validates my efforts • Energizes the work

12. New Direction cont… • RELATIONSHIP Seek out those who are struggling alongside you • Mutual encouragement • Exchange ideas • Antidote to professional isolation

13. New Structures & Tools • REGISTRIES Chronic Illness/Clinical Improvement Registry Database that collects disease-specific clinically relevant Information (lab, clinical and medication data) and maintains that data in both population-based and patient specific formats. It is searchable and able to provide patient specific data in a clinically useful way.

14. Population Based Care

15. CIR Self Care Report

16. New Structures & Tools, cont… • Registries, cont… • Incentive money • Quality of care assessment tool • Staff/team education tool • Process development tool • Patient care improvement tool

17. New Structures & Tools, cont… Clinical Microsystems • A patient-centered clinical care improvement tool • Provided a systematic structure for practice evaluation and shed light on the processes that were most in need of improvement • Available online: http://dms.dartmouth.edu/cms/materials/workbook/ • The workbooks provide tools and methods that busy clinical teams can use to improve the quality and value of patient care as well as the work-life of all staff who contribute to patient care.

18. Building the Team Why team based care? To deliver on the promise of high quality care, a practice needs to transform from a machine that processes the patients for the doctors, to a team that proactively manages the care of its patients.

19. Building the Team, cont… • Making the case for CHANGE • “What did we do wrong to deserve this?” • “I am working as hard as I possibly can!” • “What does this have to do with the real work of caring for our patients?”

20. Building the Team, cont… • Engagement • Linking the process of improvement to the larger vision • Communication • Consistent • Effective

21. Building the Team, cont… • Respect and value each member • Foster ideas and creativity • Understand and value the processes that support your own • Equip the team members • Ensure tools and resources are available when needed • “everyone is a surgeon”

22. Building the Team, cont… Quality improvement can’t be simply outsourced to an outside quality expert. To impact care in an ongoing and sustainable manner, it must be a function of the entire team. It must be connected to the Vision It must be incorporated into the culture It must be consistently and effectively communicated

23. Quality is a process not an event

24. Resources • How's your health http://HowsYourHealth.org/ • Clinical Microsystems • http://dms.dartmouth.edu/cms/materials/workbook/ • Chronic Disease Electronic Management System • http://www.cdems.com/