Fifteen years ago, PRHI presented a bold premise that has now been proven repeatedly. It posited that the same quality improvement techniques that had produced near-perfect performance in high risk, complex industries like aviation and nuclear power, could be applied successfully in health care to reduce errors, improve reliability and create efficiencies. We now know that techniques like Lean and PRHI’s own Perfecting Patient CareSM (PPC) method can reduce infections, improve patient flow, reduce laboratory errors, and enhance the management of chronic diseases.
But all these small, targeted efforts have not produced widespread and sustained quality and efficiency improvements. PRHI’s new book, Moving Beyond Repair: Perfecting Health Care demonstrates that such “spot repair” is not a substitute for enterprise-wide adoption of quality improvement methods applied to daily work in all its facets. They won’t produce the broad transformational improvements in quality and efficiency that patients seek and deserve.
Moving Beyond Repair highlights success stories of using PPC methodology to repair broken processes and to drive the larger transformation of entire organizations. Providing added momentum are new reimbursement methods, widespread adoption of information technology and increased data availability, public reporting on comparative performance, substantial incentive payments and penalties tied to achieving certain quality and safety targets. The tools and training to achieve transformation are available through PRHI.
Our aim in the book is to challenge healthcare leaders to aspire to the highest performance that system-wide adoption of Lean thinking and Perfecting Patient CareSM methodology can produce. We welcome partners who want to engage in this transformation process.
PIC – HAMILTON HEALTH CENTER
The patient arrived at Hamilton Health Center, a Federally Qualified Health Center (FQHC) in Harrisburg, for a routine physical. A native New Yorker, she moved to central Pennsylvania to be closer to her family. But she felt isolated in her new environment. She couldn’t find work, and she stopped crafting the custom pieces of art that once proudly decorated her home.
The woman suffered from depression, which remains undiagnosed in about half of primary care patients with the condition. Through the Pittsburgh Regional Health Initiative’s Partners in Integrated Care (PIC) program, a collaborative care team at Hamilton Health Center was able to treat the patient’s physical and behavioral health needs right in the doctor’s office.
The evidence-based PIC model screens primary care patients for depression and/or unhealthy substance or alcohol use and supports them with a care team that includes behavioral health specialists. Behavioral health concerns are rarely addressed in primary care settings, despite one in five patients screening positive for depression or risky substance use when physicians use such assessments.
After screening positive for depression, the patient agreed to meet with Joyce McCadney, a licensed social worker at Hamilton Health Center. They discussed the patient’s troubles since leaving New York, and her ongoing struggles with depression that she rarely sought treatment for in years past. She beamed, however, when the topic turned to art.
“She loved to work with her hands,” McCadney says. I asked her to bring in some of her work the next week and she came in with all kinds of things. I was amazed at her skill and passion. We tapped into that creativity as a means of motivating her to take action to improve her situation.”
McCadney used Motivational Interviewing (MI) techniques, eliciting the patient’s own reasons for making positive changes and working with her to set goals. One major goal: rekindling the patient’s love of art. Each week, she showcased her latest creation while meeting with McCadney and the care team at Hamilton Health Center, which serves 20,000-plus patients.
“She never missed an appointment,” McCadney says. “She took the anti-depression medication prescribed by her doctor, and it worked really well. Recently, she called me to say that she found a job. Identifying her depression was the first step, then the relationship we established through PIC helped her to make huge changes.”
Many of Hamilton Health Center’s patients – 87 percent of whom live below 200 percent of the poverty line – struggled to access mental health services prior to PIC, says President and CEO Jeannine Peterson.
“Traditionally, medical providers want to refer out anyone who has a mental health problem,” Peterson says. “A lot of times, our patients weren’t getting to those appointments or they had to wait up to six months. Participating in PIC allowed us to train our staff for mental health services and create an integrated mental and physical health model in a way we’ve never done before. This truly works in our environment.”
Dr. Harsha Rao, a Physician Champion and endocrinologist at the VA Pittsburgh Healthcare System, changed his clinic's approach to treating diabetes to a team model. The team model aims to improve efficiency by allowing multiple practitioners to perform all necessary tasks for each patient in a single, hour-long session. Each patient's encounter became a comprehensive care experience.
Setting up a system in which different clinicians each do different tasks associated with a patient's care was somewhat akin to setting up a production line, Dr. Rao said. He said PRHI's coaching in industry-based Perfecting Patient CareSM (PPC) principles helped with the implementation of his model. Dr. Rao said the principles were directly responsible for the fact that the team was able to increase the flow of patients during its four-hour afternoon sessions from 8 to 12 on the just the third attempt. Read entire text.
At the East Liberty Family Health Center, a federally qualified health center, Dr. Eileen Boyle believed that all medical practices would need new approaches to chronic care as private insurers and Medicare begin to pay for performance, emphasizing outcomes over the number of episodes of care a patient receives. Through the Physician Champion Program, Dr. Boyle and her team used the PPC system and it has resulted in work redesign and improvements.
"Implementing PPC has helped us design and standardize the work," said Dr. Boyle. "The successful changeover of our appointment system has generated a lot of excitement on the staff. There's no more ‘dead time' followed by ‘crush time.' Staff feels like they have more control over their environment, and more freedom to do a better job." Read entire text.