ClinicRedesignVI

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Published on January 28, 2008

Author: Renato

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Clinic Redesign in Indian Country :  Clinic Redesign in Indian Country Linda Aranaydo MD Crossing the Quality Chasm:  Crossing the Quality Chasm Between the health care we have and the care we should have lies not just a gap but a chasm Institute of Medicine report March 2001 Crossing the Quality Chasm:  Crossing the Quality Chasm There are serious problems in quality The problems come from poor systems…not bad people We can fix it but it will require significant change The American healthcare systems in their current forms cannot adequately serve patients’ needs. Trying harder will not work Changing systems of care will Crossing the Quality Chasm:  Crossing the Quality Chasm There are only two things wrong with the American Healthcare system How it is financed How it is delivered (Dr. Chuck Kilo) Financing greatly determines the extent of services we can offer and funding sources are threatened Given the finances we have now can we deliver healthcare in a better way? Crossing the Quality Chasm: AIMS:  Crossing the Quality Chasm: AIMS Health care should be Safe Effective Patient-Centered Timely Efficient Equitable Crossing the Quality Chasm: Why?:  Crossing the Quality Chasm: Why? Improve health outcomes Increase patient satisfaction Increase staff satisfaction and retention Eliminate waste, rework, inefficiencies Improve the bottom line Cross the Quality Chasm: How?:  Cross the Quality Chasm: How? Redesign care using best practices Use information technologies Manage knowledge, skills & relationship Build effective teams Coordinate patient care Use performance and outcome measurements Every process is perfectly designed to produce the results it produces:  Every process is perfectly designed to produce the results it produces Results of current systems and processes: We have survived the Indian wars, we are not extinct, but we are not as healthy as we could be and there is much preventable suffering. If we want different results we have to change the processes redesign the systems of healthcare delivery according to what we value Processes and Systems:  Processes and Systems Total Quality Management (TQM) Customer focused improvement of processes Change is gradual, step by step Reengineering system redesign dramatic transformational change, for a rapidly changing environment Indian Healthcare System Origins Our Journey to Wellness:  Indian Healthcare System Origins Our Journey to Wellness War Dept—Indians as enemies Dept of Interior—Indians as trees Dept Health/Human Services-Indians as people Self-determination—Indians as members of sovereign nations with the legal rights to govern and provide for their continued existence--638 Indian Healthcare Historic System & Processes:  Indian Healthcare Historic System & Processes Federal Government Political processes to allocate resources Bureaucracy Rule-making to allocate resources and maintain the status quo Tribal/Intertribal Government/Politics Advocacy to increase services Healthcare Industry Customer driven business model The New Indian Healthcare System:  The New Indian Healthcare System You are creating it every day Funding from the IHS, other federal agencies, state, local governments, foundation grants, third party revenues, tribal enterprises 638 healthcare delivery systems designed for the continued existence and wellness of tribal families, individuals and communities Managed by tribal leaders and professionals in partnership focused on common goals You decide on your goals, processes and tools Your most important resources are people: your patients, staff, board and community. How do we help Indian health care systems become more:  How do we help Indian health care systems become more Safe Effective Patient-Centered Timely Efficient Equitable ? Stop assigning blame and start assessing the best way to improve:  Stop assigning blame and start assessing the best way to improve “If we have any chance for improvement, it has to be in a climate where we--all of us who are in healthcare--are working together..We are working to accomplish a goal that’s free of animosity, finger pointing and blame. Once you start putting blame in different parts of the system, then what happens is people will logically retreat. They will not be cooperating in common solutions.” Read Tuckson MD, United Healthcare Clinic System Redesign Requires:  Clinic System Redesign Requires A reason to change A willingness to commit time, resources Shared values and goals stated clearly Strong committed leadership from the board and administration willing to form teams Staff willing to learn how to be team members within departments and interdepartmentally A continual source of best practices, training and encouragement My Favorite Resources and Tools:  My Favorite Resources and Tools Best practices in healthcare delivery in the world Institute of Healthcare Improvement, Dr. Don Berwick Best practices in healthcare delivery in the world in American Indian/Alaskan Native Country Alaskan Native Medical Center, Dr. Doug Eby Best practices in life & healing our own tribal traditions of healing, promoting wellness and maintaining balance Motivation and Change in Indian clinics:  Motivation and Change in Indian clinics The great majority of people who work in Indian clinics are motivated by a genuine concern for the health of Indian people have family members and friends who depend on this service for primary care services want to do a good job have not had extensive training in management or organizational development lack adequate support staff and fear that change will make more work, not be more efficient Motivation and Change in Indian Clinics:  Motivation and Change in Indian Clinics You can’t make anyone do anything they don’t want to do Especially Indians Especially Doctors Basic personalities are not likely to change, but adults can learn new skills and information if it satisfies a core value, a need to know & act Organizational Motivations to Change:  Organizational Motivations to Change Push Financial shortfall, redesign by cutbacks Poor health outcomes Painful status quo Pull Satisfy a core value or shared vision (dedication to a healthier Indian community, to excellence, to fun at work, to learning new information, skills, to healthy workplaces) Good health outcomes Financial stability Changing in Wellness:  Changing in Wellness Are we at war with change? Are we at peace with the cycle of life and the inevitability of change? Do we just survive change, fighting it at each step? Do we thrive with the opportunity to create new solutions to old problems? Changing in Wellness:  Changing in Wellness Stress response vs Relaxation response? What works for you individually What works for you and your team Are all the team members taking good care of themselves? When was the last time your had a good laugh together? ANMC World Class Quality: Journey to Wellness:  ANMC World Class Quality: Journey to Wellness Same day primary care access for 2 years Whole primary care system redesign and integration Huge improvement in chronic illness care-improved health outcomes Decrease urgent care use by 50% Patient/provider match 75% (see your own doctor) Patient Satisfaction through the roof Spreading Best Practices in California:  Spreading Best Practices in California CRIHB Training for Medical Dept Teams June 2002 Collaboratives for Change: IHI, BPHC Sue Houck, expert on clinic operations & redesign Dr. Dale Benson, expert on TQM Some Great Ideas: open access, system redesign, population based chronic disease management, measure capacity & demand Choosing Change:  Choosing Change These executive directors and medical directors agreed to form a medical department improvement team: Sonoma Indian Health Project United Indian Health Services Potawat Health Village - Arcata Howonquet -Smith River Toiyabe Indian Health Project Sue Houck Consulting / Coaching funded by CRIHB Kellogg Foundation Grant:  Sue Houck Consulting / Coaching funded by CRIHB Kellogg Foundation Grant From Sept 2002-July 2003 three clinics worked with Sue Houck Clinic Site Visit Assessment Individual & Team Coaching Conference calls Training in Redesign Best Practices funded by CRIHB Kellogg Foundation Grant:  Training in Redesign Best Practices funded by CRIHB Kellogg Foundation Grant International Summit on Redesigning the Clinical Office Practice— April 14-15, 2003 Multiple Presenters including Dr. Chuck Kilo, Dr. Doug Eby New ideas, skills, deeper understanding of processes Attendees UIHS—6 staff including physicians SCIHP—4 staff including physicians, exec director Shingle Springs—one physician MACT Health Board—finance officer We met other Indian attendees from Chinle, ANMC, Barrow AK Sustainable Improvement That Works:  Sustainable Improvement That Works CRIHB Training June 20-21, 2003 Sharing Project Achievements as Teams Presentations Sue Houck FNP MBA Chuck Kilo MD MPH Doug Eby MD MPH Sustainable Improvement That Works:  Sustainable Improvement That Works Know what you value (true aims) Start where you are, realistic assessment Form a team Determine your priorities Determine your commitment in time and resources Choose a project, level of importance and difficulty determined by the group Determine your methods, outcome measures, timelines Team self-evaluation, learn from other teams Remember These Resources:  Remember These Resources Institute for Healthcare Improvement www.ihi.org www.qualityhealthcare.org Annual IHI International Forum Second week in December 2005 International Summit on Clinical Office Practice Redesign Spring 2005 Sue Houck FNP MBA suehouck@ix.net.com

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