Making
Improvement
Last
Hallmarks of Successful
Sites
Sue Houck
Houck & Associates, Inc.
CSI Best Practice Session
April 15, 2011
Sources
•California HealthCare Foundation’s
Ambulatory Care Redesign
Collaborative
•AAFP’s NDP project
•Houck & Associates’ case studies
and observed experience
Adaptive Reserve
“The more successful practices had an
internal capability for organizational
learning and development. We labeled this
capability the ‘adaptive reserve.’”
Transforming Physician Practices To Patient Centered Medical Homes: Lessons From the National
Demonstration Project. Nutting, P. et al. Health Affairs. March 2011.
Adaptive Reserve
1. Leadership
2. Aligned vision
3. Healthy relationships
Adaptive Reserve
Leadership facilitative vs. authoritarian
Aligned vision for clinical care, operations, and
financial function
Healthy relationships rich communication, shared
trust and regular, protected time to reflect and learn
Transforming Physician Practices To Patient Centered Medical Homes: Lessons From the National
Demonstration Project. Nutting, P. et al. Health Affairs. March 2011.
Aligned Vision
“There will be many competing demands on
time and money. Management must always
keep referring back to the priorities set and
systems agreed upon and keep everyone on
task until the new way becomes completely
ingrained and integrated into everyone’s
thinking and day to day operations.”
Doug Eby, VP Medical Services, Alaska Native Medical Center
Leadership
“Leadership is central...When leadership
hands off improvement, it doesn’t work. It’s
also important that physicians buy into a
philosophy of improvement.”
Dr. Charlie Burger, Nurembega Medical Specialists, Bangor Maine
Leadership
“Sites that achieved the most impressive gains
are led by change agents that are proactively
engaging in activities to institutionalize key
design features and permanently alter
individual and collective work behaviors.”
Evaluation of California HealthCare Foundation’s Ambulatory Care Redesign Collaborative. Lewin
Group Final Report.
Leadership
“…change agents that are proactively engaging in
activities to institutionalize key design features and
permanently alter individual and collective work
behaviors.”
These include:
•Incorporating redesign into structures and activities such
as weekly staff meetings to keep staff engaged in
redesign
•Rotating staff members that are not part of redesign to
work with those have have been involved
Evaluation of California HealthCare Foundation’s Ambulatory Care Redesign Collaborative. Lewin Group
Final Report.
Pitfalls of Incremental Vs. Transformative
Change
“Putting discrete model components in place appears to be far easier than
modifying existing roles and work patterns for using them effectively. For
example, many practices implemented disease registries without reconfiguring
work processes to use them effectively for population management, such as
identifying all patients with asthma and proactively suggesting that they obtain
influenza vaccination.”
Transforming Physician Practices To Patient Centered Medical Homes: Lessons From the National Demonstration Project. Nutting, P. et al. Health Affairs.
March 2011.
Healthy Relationships
“All of our informants spoke to the advantages of
creating care teams in order to increase the
efficiency of the patient visit. Care teams create a
sense of shared accountability for redesign and
demonstrate that improved productivity stems from
the efforts of a team, not a single provider or staff
member.”
Evaluation of California HealthCare Foundation’s Ambulatory Care Redesign
Collaborative. Lewin Group Final Report.
Healthy Relationships
Sharing of best practices of other clinics that
have adopted redesign was strongly
recommended by virtually all sites. This
information sharing would allow the groups to
collectively solve problems such as resource
issues and identify additional improvements.
Evaluation of California HealthCare Foundation’s Ambulatory Care Redesign
Collaborative. Lewin Group Final Report.
Reality Check
How would you rate your practice’s adaptive reserve?
Quality
1-5 Description
Leadership
Facilitative vs. authoritarian
Vision
For clinical care, operations, and financial function
Healthy
Relationships
Rich communication, shared trust and regular protected time
to reflect and learn
1=feature is missing or a low priority, 5=feature is present and a high priority in the practice
Possibility
What 1-3 actions would you take in the next
week to improve adaptive reserve at your
practice if you know you could not fail?
Remember
“The good-to-great companies understood a simple
truth: Tremendous power exists in the fact
of continued improvement and the
delivery of results. Point to tangible
accomplishments-however incremental at first-and
show how these steps fit into the context of an overall
concept that will work. When you do this in such a way
that people wee and feel the buildup of momentum,
they will line up with enthusiasm.”
Good-to-Great. Jim Collins.