 Sept. 30 - Oct. 2, 2003 |
| ASSEMBLY EDITION • NEW ORLEANS |
Family practice is not your father's old practice model 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. However, effecting change in your practice is a formidable task.
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 a practice redesign course yesterday titled "System Wide Improvement: Where to Aim."
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Charles Kilo, M.D.: |
When he said culture, Kilo didn'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.
Culture plays a critical role in every organization. "Most health care organizations spend more than 90 percent of their time and energy trying to convince people to change or trying to coerce people into change, and less than 10 percent of their time actually working on change," Kilo explained.
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 reduce costs, Kilo said. And therein lies the rub. If one physician in a group practice wants to make his or her own decisions about the design of the practice and ignore the majority opinion, that physician 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.
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.
He maintained that hospitals and other specialists need to be reorganized around the needs of primary care physicians. "The financing of primary care, in particular, must change," he said. "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.