Building for Tomorrow: The Idealized Design of Clinical Office Practices


Fam Pract Manag. 2000 May;7(5):13.

Are you frustrated by the current chaos of your office systems? Are your patients complaining about the telephone service, about having to wait days and weeks for an appointment and then having to wait more after they arrive at the office?

Do you provide lab results to all patients on a timely basis? Do you interact with your patients between visits, providing disease-specific information, guidance and monitoring?

Is your bottom line suffering because of office inefficiencies and staff turnover? Are your dedicated and well-intentioned staff members frustrated by obstacles to providing good service?

If you cannot answer these questions in a way that makes you feel proud, it may be time for office system redesign. We have already proved that just working harder is not helping. We must begin the transformation to a new level of office service, function and quality. The article by Charles M. Kilo, MD, MPH, and Scott Endsley, MD, MSc, in this issue describes the office practice of the future [see “As Good As It Could Get: Remaking the Medical Practice”]. They have left behind some of our usual ideas about the way it should be done and have asked instead, “How good could it get?”

The IDCOP initiative

The answers Kilo and Endsley are exploring are not just theory; rather they are the result of more than two years of work done by the Institute for Healthcare Improvement and 42 practice sites around the country in what is called the Idealized Design of Clinical Office Practices (IDCOP). Each of the principles of practice design has been tested in real-life office practices just like yours and mine. In fact, our practice, Latham Medical Group, has been a prototype site for the IDCOP initiative since the beginning. Although we are finding it difficult to change everything, we now know where we have to go, and we are making small steps toward the ultimate redesign. For sweeping redesign to work, the entire office staff needs to begin to understand the language of quality improvement and office redesign.

I understand that Family Practice Management plans to continue publishing articles on topics related to the IDCOP initiative — topics such as open-access scheduling, electronic communications with patients, master scheduling and reducing waiting times and delays. It is important to disseminate what we learn through this project to as many family physicians as possible. I hope you can use this information in a way that fits with your office culture and purpose to provide better care and better service.

We need to start now

Changing times and changing expectations will compel family physicians to respond to their patients' needs in a way that is not possible with our current systems. Visit-based care is only one aspect of the complete and lasting relationship between family physicians and their patients. Patients will increasingly have information and questions about their symptoms, diagnoses or medications (usually gleaned from the Internet). They will expect to be partners with us in their care and treatment decisions. We must be able to respond to this unprecedented availability of medical information by continuing to provide personalized health advice to our patients.

Care teams, e-mail, electronic medical records and the Internet will all be commonplace in patient care by 2005. If we are to remain current and competitive in this rapidly changing health care market, we must begin the work of office redesign now. It is a slow process, so don't be impatient, but begin now so you'll be ready for the future when it becomes the present. The practice of the future may not be so far away after all.

Dr. Bagley is president of the American Academy of Family Physicians and managing partner of Latham Medical Group, an eight-physician family practice group in Albany, N.Y.


Copyright © 2000 by the American Academy of Family Physicians.
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