Health Care Home Study Tour 2015: Mary Carthew
Sleepless in Seattle…
Philladelphia
…and Chilly in Philly
Exploring Medical Home - USA
Group of Health Leaders from across NZ
Activities included
- Group Health in Seattle site visits
- Microsoft - overview of emerging technologies
- Dinner with Seattle based Physician Assistants
- Medical Home Summit in Philadelphia
And…a small amount of time to sight see…
Bubble Gum wall in Seattle
Reaching for the Glass Ceiling
Patient Centred Medical Home, Seattle
Medical Home Design Principles
✔
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The relationship between the clinician & patient is at our core.
The primary care clinician will be a leader of the clinical team, responsible
for coordination of services, and together with patients will create
collaborative care plans.
Care will be proactive and comprehensive. Patients will be actively
informed and encouraged to participate.
✔
Access will be centered on patients needs, be available by various
✔ modes,
Clinical and business systems are aligned to achieve the most efficient,
✔ satisfying and effective experiences.
Patient flow…one way flow of information
to the right person in general practice – minimising
noise
Patient Centred Medical Home
 Reduced ‘panel’ size (1:1800 from 1:2400)
 Reconfigured team (GP; dedicated Medical Assistant
and Physician Assistant; team RNs; Clinical Pharmacist).
 30-minute booked appointments with doctors
 ‘Team huddles’ at the start of each day
 Doctors attending the clinic phones for 30 minutes
each morning
 Nurse consulting (co payment same for seeing a
doctor as a nurse)
 Team member role clarification for patients
 Weekly whole practice meeting
 Structured induction programmes for new staff
 Leadership skills training for all staff.
Continually ask ourselves “What’s next for
our patient’s health?”
Health literacy – ‘closing the loop of
communication’ ASK, BUILD, CHECK
No stories without
data… No data
without stories
Volume vs value - do the right thing
Patients vary, treatment shouldn’t
Being technically right is of no use if
you are emotionally disconnected
We visited Microsoft
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The cloud, the cloud, the cloud
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Health productivity and collaboration
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Health Analytics
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New mobile technology enabling health
care to become more connected
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New systems will start to challenge traditional
roles in health eg: diagnostics
Devices and mobility
We saw planes being made at Boeing
Lean thinking in action
Reduced production time from 29 days to 9 days for a 737
3.5 million parts, 2 planes produced a day
7 year waiting list for aeroplanes
Complex design, complex logistics – standard work, increased
quality
• Boeing employ 125,000 staff
• Strong links with local health providers sharing lean principles
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Toilet hygiene US style
Nursing work…
The sky is the limit: Chihuly Garden & glass, Seattle
Risk Stratification- the way
of the future
Nurses know their patients!
Defining roles
Patient Centred Medical
Home U.S.
General Practice, N.Z.
Physician Led
GP
Physician Assistant
Not yet, but coming
Nurse Practitioner
NP
RN
RN
Licensed Practical Nurse
EN
Medical Assistant
Primary Care Assistant
Clinical Pharmacist
Not yet
Administrative assistant
Receptionist
Nursing work – using PDCA cycle
Plan-Do-Check-Adjust
Data Drives!
Some key insights for Nursing, NZ
 NZ is blessed with the nursing workforce we havelet us value it!
 Outreach in NZ is more than a phone call…yes!
 Be careful with what we give away – new roles
are on the way!
 Be brave about learning from change and
mistakes along the way
 Data data data! – make better use of the data
we have
 Shared decision making between nursing
services and patients pays huge dividends
And more …
 Approximately one half of patients leaving a health
consultation do not comprehend what was
recommended
 Telephone calls following acute episodes make a
difference to health outcomes
 RNs need to focus on the population at highest risk of
major morbidity – we do it well!
 Nurses cannot do everything! Role definition
 Nurses make a difference by leading small quality
projects - Plan-do-check-adjust
Re-engineering primary care is like
rebuilding the plane while flying it
Aotearoa – home is where the heart is!
Kia Ora – thank you!