"Think about what you'd like your office to become, because if you don't have a clear idea of where you're going, it's very difficult to get there." With that statement, Bruce Bagley, M.D., engaged the participants at AAFP's Practice Enhancement Program May 20 - 21 in Spokane, Wash., launching the innovative program on its maiden voyage.
Practice Enhancement Pilot Provides Tools for Change
By Sheri Porter
• Spokane, Wash
5/26/2005
The Practice Enhancement Program features brainstorming with quality experts, role-playing with peers and lots of interaction.
Bagley, the Academy's medical director for quality improvement and an AAFP past president, listened as FPs blurted out their wish lists, including open-access scheduling, electronic health records, patient triage and a good chronic care model. This comment summed up the sentiment erupting around the room: "I want to do the right thing for the patient at the right time. And I want it to be easy to do the right thing."
Physicians from eight family medicine practices and three family medicine residencies, each accompanied by one clinical staff person and one nonclinical staff person, came to the meeting eager to learn how to rejuvenate their practices through office redesign.
Physicians from eight family medicine practices and three family medicine residencies, each accompanied by one clinical staff person and one nonclinical staff person, came to the meeting eager to learn how to rejuvenate their practices through office redesign.
Survival of Family Medicine at Stake
The PEP pilot was designed to teach small and medium-sized practices how to implement changes outlined in the Future of Family Medicine report published in 2004.
"I'm here because I'm afraid family physicians are going to be dinosaurs in two to three years," said FP Lucien Megna, M.D., of Richland, Wash. "How do we differentiate ourselves from the other practitioners? Giving our patients a medical home is a start."
The FFM model has many components, said Bertha Safford, M.D., of Ferndale, a PEP faculty member and a past member of AAFP's Commission on Quality and Scope of Practice. Ultimately, FPs need to implement all of the components of FFM, said Safford, but not all at once. "There's no right answer when it comes to which piece of FFM you put into place first," she added.
For FP Mark Larson, M.D., of Ellensburg, Wash., that first "gotta have it" piece is open-access scheduling. "My next open slot for patients is the end of June," he said, adding that "open access is the foot in the door" toward total office redesign.
"I love what I do, but I don't want to keep doing things the same way for the next 20 years," said Larson, the father of two young children. Larsen called his medium-sized practice with six FPs and two midlevel providers "a rat race" and is looking to improve both patient care and his quality of life.
"I'm here because I'm afraid family physicians are going to be dinosaurs in two to three years," said FP Lucien Megna, M.D., of Richland, Wash. "How do we differentiate ourselves from the other practitioners? Giving our patients a medical home is a start."
The FFM model has many components, said Bertha Safford, M.D., of Ferndale, a PEP faculty member and a past member of AAFP's Commission on Quality and Scope of Practice. Ultimately, FPs need to implement all of the components of FFM, said Safford, but not all at once. "There's no right answer when it comes to which piece of FFM you put into place first," she added.
For FP Mark Larson, M.D., of Ellensburg, Wash., that first "gotta have it" piece is open-access scheduling. "My next open slot for patients is the end of June," he said, adding that "open access is the foot in the door" toward total office redesign.
"I love what I do, but I don't want to keep doing things the same way for the next 20 years," said Larson, the father of two young children. Larsen called his medium-sized practice with six FPs and two midlevel providers "a rat race" and is looking to improve both patient care and his quality of life.
Making Change Happen
Take it slow and steady. "You can't go home and shock your staff with six or eight changes, " said Safford. "Pick one or two to begin."
There's also the reality check when returning home to staff who may not share your enthusiasm. "You go away, you get excited, you go home, you get slammed," said Safford. "All those good intentions slowly drift away." You sink like a water skier behind a slowing boat, she said.
"We want to send you home with crystal clear first steps so you can translate your goals to others," said Safford.
To that end, the teams -- each of which came to the meeting with specific practice improvement projects in mind -- narrowed their goals down to one very small and measurable aim.
Safford gave this example of an aim statement she used in her practice: Every patient 18 or older will have his or her blood pressure measured accurately and appropriate action will be taken if the BP is elevated. The measurement of the aim was to have a questionnaire given to every patient for one week. The questions, to be completed in the office, were simple: Was your blood pressure taken? Were you sitting in a chair with your feet on the floor? Were you told if your blood pressure was elevated? Did someone talk to you about it?
"It worked," said Safford. "The patients were engaged -- they loved it and the process got them to pay attention to their blood pressure." The experience was one step on the road to better management of Safford's hypertensive patients.
There's also the reality check when returning home to staff who may not share your enthusiasm. "You go away, you get excited, you go home, you get slammed," said Safford. "All those good intentions slowly drift away." You sink like a water skier behind a slowing boat, she said.
"We want to send you home with crystal clear first steps so you can translate your goals to others," said Safford.
To that end, the teams -- each of which came to the meeting with specific practice improvement projects in mind -- narrowed their goals down to one very small and measurable aim.
Safford gave this example of an aim statement she used in her practice: Every patient 18 or older will have his or her blood pressure measured accurately and appropriate action will be taken if the BP is elevated. The measurement of the aim was to have a questionnaire given to every patient for one week. The questions, to be completed in the office, were simple: Was your blood pressure taken? Were you sitting in a chair with your feet on the floor? Were you told if your blood pressure was elevated? Did someone talk to you about it?
"It worked," said Safford. "The patients were engaged -- they loved it and the process got them to pay attention to their blood pressure." The experience was one step on the road to better management of Safford's hypertensive patients.
A Look Ahead
The Spokane teams are just beginning their journeys. They will continue to work on their areas of quality or practice improvement for the next few months, aided by local quality initiative experts who served as team mentors throughout the meeting in Spokane.
A second PEP pilot is scheduled for Sept. 9 - 10 in Iselin, N.J. According to Bagley, after tweaking the program to best serve member needs, the Academy will roll out this program to a limited number of chapters in 2006. In addition, he said the Academy is also exploring other ways to deliver the same material in other formats.
A second PEP pilot is scheduled for Sept. 9 - 10 in Iselin, N.J. According to Bagley, after tweaking the program to best serve member needs, the Academy will roll out this program to a limited number of chapters in 2006. In addition, he said the Academy is also exploring other ways to deliver the same material in other formats.
