From Zero To Doctor In Nothing Flat

My mother in-law, who had suffered for about three years with frontal lobe dementia, passed away this week. Our family was blessed to have caring and thoughtful doctors, nurses, and technicians who helped us negotiate the final hours of her life with dignity and compassion. Throughout her illness I got to vicariously experience what it’s like to care for a loved one and negotiate the medical system under these circumstances.

My summary of the experience; a collection of dedicated and caring healthcare providers, each trying to deal with one part of complex problem, in a system that is disconnected and offers little in terms of coordinated relationships.

The problem cannot be blamed on any one person or organization fault. It’s about how interrelated systems of care work together. The good news is that progress is being made, right here in my community. I want to share an article from our archives originally posted on May 2, 2013. At the end, I’ve added a new piece, the national recognition that Via Christi received for their pioneering work in patient-centered care.

“We’re transforming a system that was fairly jumbled and chaotic into a system that is streamlined and simplified, with teams of caregivers synchronizing their work together for one purpose — improved patient-centered care. Next Element’s expertise has been an essential component in our efforts.” — Terry L. Mills, MD

Terry L. Mills, MD, and 15 other Via Christi Clinic physicians are redesigning their primary care practices to run like a finely tuned race car.

To better serve their patients, seven primary care teams at Via Christi Clinic are participating in an 18-month pilot project to transform themselves into “patient-centered medical homes.” This new approach is designed to provide patients with more coordinated medical care, increased access to preventive services to keep them healthy and better management of chronic diseases. Via Christi Clinic is one of Kansas’ largest multi-specialty group practices.

“I think this country has under-emphasized primary care and we’re seeing the results of that now with the epidemic of obesity, chronic diseases and other medical problems,” says Mills, who works in Newton and is leading the medical home project with Newton branch manager Pam Copper. “Our challenge is to re-engineer primary care to make it more patient-centered.”

Using an automobile analogy to illustrate the transformation taking place, Mills explains, “Our current practice is like a street car. But what our patients need and what society needs is a primary care formula 1 race car. Both types of cars are built from the same materials but it’s how you assemble and use those pieces that matters.”  In a patient-centered medical home, physicians serve as leaders of teams of physician assistants, nurse practitioners, and other clinicians focused on providing patients with the best possible treatment quickly and efficiently.

“To take the car analogy further, the care team is like the pit crew on a racing team,” Copper explains. “Bringing in communication and team-building experts was a critical part of building an effective pit crew.” Mills adds, “As we researched similar initiatives across the country, the common theme among successful programs was that they front-loaded with communication training and team-building.”

The primary care project is an example of how Via Christi is transforming under its Vision 2020 strategic plan to provide higher-quality, patient-centered care, delivered by physician-led clinician teams.   “We’ve been practicing in silos,” Mills says.

“If we are truly going to harvest the power of integrated care, we really need to move to team-based practice. The need for cross-team collaboration and stress of change and innovation is simply too high not to focus on a resilient and aligned teams.”

Building world-class pit crews

Great patient care starts with healthy patient care teams. Via Christi engaged Next Element to help them build world-class pit crews.

• Step one involved personality-based communication skills training for all providers. This 16-hour curriculum called “Quality Teams” was delivered in four-hour blocks with focus on how to rapidly assess patient communication preferences and adjust treatment approach to increase engagement and participation in care.

• Step two brought the rest of the patient care team members up to speed with an abbreviated 8-hour communication skills training called “Quality Patient Relations.” Both trainings were based on the internationally acclaimed Process Communication Model® (PCM) developed by award-winning psychologist Dr. Taibi Kahler. Why PCM? Copper explains, “It is so different from any other personality training because you can continue to build on the foundational principles, and find so many ways to apply it in professional and personal life.”

• Step three involves regular on-site visits where Next Element’s communication experts participate in team-meetings, coaching teams on accountable decision-making, dealing with conflict, applying personality-based communication to many aspects of patient-care, avoiding negative drama and negotiating rapid-cycle change. “Next Element is part of our team and we want their communication tools to become part of our cultural mindset. Regular accountability and reinforcement of new skills has been essential for the long-term success of this initiative,” Mills explained.

So what does all this mean for patients?

Newly re-aligned teams have been able to implement significant improvements in how patients flow through the system. Just a few of these include:

• Simplified and streamlined scheduling so that patients can get appointments more quickly.
• Improved speed with which patients get their questions answered over the phone.
• Email communication with patients about non-urgent medical care issues with the goal of reducing the number of voicemails, paper messages and faxes at by 80 percent.
• Creating the new position of “patient care coordinator” in each of the three clinics. This nurse works with patients to help them better manage their conditions, make sure they access needed preventive care, such as diagnostic tests, and help them develop personal health improvement plans.
• Setting up patient advisory councils to make sure patients’ needs always come first, and to suggest ongoing improvements.

Success!

Three Via Christi Clinic patient-centered medical home pilot sites achieved Level 3 recognition from the National Committee for Quality Assurance. NCQA’s PCMH recognition assessment is one of the most widely used national quality evaluation and recognition programs. Level 3 is the highest recognition that it awards. Read more here. Congratulations to Dr. Mills and the entire group of people who believed in a better way and made it happen.

Where have you experienced great patient-centered care? Will you share your success stories here?

Copyright 2016, Next Element Consulting, LLC

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