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Start training by rebuilding a piece of your practice; eventually you'll be able to rebuild the whole.

Fam Pract Manag. 2010;17(1):7

I know I've sounded this theme before, but it's both important enough to bear repeating and too appropriate to this issue not to reiterate here: Practice redesign is a huge, daunting task that becomes more manageable if you take it one step at a time – and not just because you're tackling it piecemeal. There's some synergy at work.

This is a point embraced fully by Ronald Adler, MD, FAAFP, and Jeanne McBride, RN, BSN, MM, the authors of “Tools and Strategies for Improving Asthma Management”: “Regardless of practice setting, an iterative process of sequential small changes informed by plan-do-study-act cycles can produce substantial change over time. Simply asking the question ‘What can we do by next Tuesday?’ will likely result in measurable improvement.” And this is not just big talk about small improvements; the authors explain how they were able to make substantial improvements in asthma care in their setting, a residency clinic, and they outline the principles of their project – principles that could apply in your practice.

I don't, of course, mean to suggest that practice redesign is easy. And I'm not even suggesting that you can redesign your whole practice one small piece at a time. At some point you're likely to find yourself faced with a redesign project big enough to dwarf the ones you have already accomplished.

Redesign is not a walk in the park; it's more like a hike in the mountains. You need to be in shape to climb. If you can't imagine getting to the peak, don't feel daunted. Remember that you need first to make it through the foothills and that when you do, you will have realized double benefits. Small practice improvement projects both reshape parts of your practice and give you training for bigger projects, just as hiking in the foothills helps get you into shape for climbing the higher reaches.

You do need to keep your eye on the summit as you climb, and it helps to refer to maps like the one laid out by the AAFP ( or TransforMed ( But you can get there. Just put one foot in front of the other, look for progressively steeper hills to climb, and keep going.

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