BY DENNIS CONNAUGHTON
It's becoming painfully clear: The old practice model just doesn't work anymore. Family physicians are under increasing pressure to improve the quality and efficiency of care by adopting such new practice models as open-access scheduling, group visits and care teams. Still, nobody said it would be easy.
Make the task a little less daunting by realizing that a key element is your ability to change the culture of your practice, said Charles Kilo, M.D., M.P.H., president of GreenField Health in Portland, Ore.; an internist; and a fellow at the Institute for Healthcare Improvement in Boston. Kilo led the Oct. 1 Assembly practice redesign course "System Wide Improvement: Where to Aim."
Defining the culture
When Kilo talks about culture, he doesn't mean spending a night at the opera. The culture of an organization or practice is "the way we think and believe about our behavior," he said.
Most physician practices were created to maintain the individual rights of the physician, such as autonomy in making decisions. But new practice models require teamwork to improve quality and service and to reduce costs, Kilo said. And therein lies the rub. Any physician in a group practice who wants to make his or her own decisions about the design of the practice and ignore the majority opinion needs a cultural turnabout.
"Understand your practice as a whole system, not as individual parts," Kilo said. "The quality of the care you deliver depends on the interaction among the parts of the system."
An ideal clinical office practice design requires some key changes to improve performance, including care teams, open-access scheduling, electronic medical records, patient self-management and performance measures, he said. All the parts of that design need to function as an effective whole system -- and that requires altering the culture of the organization to support the changes.
Altering the culture
Changing the culture involves leadership and thinking in terms of the macro health system -- that is, the health care environment in which you practice, Kilo said.
"There are only two problems in health care -- the way it is delivered and the way it is financed," he quipped. "The failure we are experiencing in health care is largely a failure of primary care and a failure to organize health care resources around primary care."
Because primary care physicians develop long-term relationships with their patients, they are in a prime position to improve health care. "Primary care is the only natural locus for the overall control of cost and quality in health care," Kilo said.
Hospitals and other specialists need to be reorganized around the needs of primary care physicians, Kilo stated. "The financing of primary care, in particular, must change. Primary care physicians need twice as much money or half as many patients" to reduce health care costs and improve the quality of care.
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Copyright © 2003 by
American Academy of Family Physicians.