Okay, today I felt success.  I mean I really felt success.

I was at a clinic and one of the staff members pulled me aside.  She showed some real excitement about what she was about to show me.  "You'll like this," she said.  "It was really fun and you'll like this."  She searched high and low for a sheet of paper.  When she finally found it, a post-it note with major scribbles all over it, she relayed what she had done.  She had been requested by one of the physicians in the office to make a call to a patient and to change the dose on a medication.  She had kept track of all of the steps that took place and all of the events that occured as a result of that one request.  Several hours later, 8 people involved, request complete.  She looked at that information with a co-worker and they determined how they might remove a few of the steps the next time.  They decided on an issue to bring to one of the teams to have them look at for possible improvement.  "I just knew that we were spending more time and energy on some of these requests than we thought, look at this, can you believe it?"  You bet I can.  But I couldn't hardly believe the excitement that came from that 3 inch yellow post-it note.  I had feelings not unlike the times my first grade daughter brings home some of those "first time accomplishments".

They have the bug!  They can't leave things the way they are!  They notice inefficiency and they want to track it and figure out what they can do to change it now.  This was an effort taken completely outside of one of the improvement teams in Ferndale, by one of the staff members that was seemlying the slowest on board with this "process flow improvement stuff".  We win - 'cause now, she's got the bug!

The hard thing to change is the culture and now the signs to show that the culture is changing are starting to surface.  And now I'm starting to feel successful.  Successful because they have the bug and now they won't be able to get rid of it, and that means sustainability.  And it goes to show - when the foundation is set, the building will follow :-)

5:54:33 PM     comment []   Google It!  

I have a few ideas that I want to make sure I capture.  Mostly because if I don't - I'll forget.  I don't have any conclusions as of yet, but I am aware of the need to dig deeper.  My tendency is to crunch numbers.  I like to see things as black and white.  Do or don't.  You know, based on these guidelines that if a patient is in this range we need to make this intervention (medically).  Simple, right?

I've got a few stories about the changes we are making and how they are affecting outcomes and I think I may be noticing a trend.  I'm wondering what others may think.  Here it is....

1. Much of the work being done by the clinical care specialists seems to be of a social nature.  They are providing great care, but the needs are high on the social end.
2. When I "followed a physican for a day", I noticed that many of the issues people had hinged on social issues - depression, counselling was a big part of those visits
3. The group visits at Ferndale are seeing very good outcomes.  I don't think there is anyone that has attended that doesn't have improved outcomes - they are all encouraging others and giving each other tips on how to manage their disease - that's the benefit to the physician.  Patients can get them to do things that the physician would not have been able to otherwise.  They are also getting recognition for improvement from peers, a celebration of success.
4. When we first started looking for patients for our Chronic Care Team in Ferndale, patients were referred by a CCS if they were thought to be interested.  Of the three I took, one of the patients was thought not to be appropriate because of 'the way she was'.  Once contacted, she indicated she was interested and so, we got her on the team.  The physician couldn't believe the turn around in how she was.  Her numbers had improved as well.  Her social situation had completely changed and the outcomes were drastically improved seemlying as a result of that social intervention.
5. It has been noted many times in re-design conversations over the past few months that there are people that either do not take what is prescribed because they can't afford it, or they might for example decide to alternate the weeks they take their heart meds and their diabetic meds in order to stretch them out. A very large amount of time is spent on searching for programs to help patients with the cost of meds.  This is clinical staff time that is deemed ''necessary" to support the patient but is not reimbursed.
6. I have picked up that it appears many people with one of our two chronic diseases in this project scope also have 'depression' and that is consistent.
7. I've heard stories of clinics that have instituted regular phone calls out to patients that have been "frequent flyers" and that has proven quite often to be enough to keep the patient out of the office quite a bit of the time.  They just need to talk to someone.  Again, not reimbursed but done because it makes room for those patients that need "medical attention''.

I'm wondering whether evidenced based  is 'medical outcomes based on clinical intervention' only, or if there is some indicator of the effects of social interventions on these same outcomes and if that aspect of the changes we are bringing is having the largest affect.

If we are looking at changing what we pay physicians for and what services we supply when, we might want to think about having MSWs accessible at each clinic to take some of the load from physicians.

10:16:26 AM     comment []   Google It!