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We have success in our system by including our physicians in the decision-making process. We identify our early adapters/ physician champions (by our readiness assessment or improvement assessment surveys from AHRQ) and present the new leadership role of a service line/ process/ project as a career opportunity for them. We support and train the identified physician leaders on the expectations before they become active in the position. We engage the intellect of our physician leaders & teams in planning, building and prioritizing QI efforts. This participation in the dialogue together allows our physician leaders and the teams to go through the applicable data and validate themselves which in turn helps us in the sustainability of our projects. We also encourage dyad roles – Teaming physician leaders with the administrative leader. In our Dyad model, doctors work side by side with business trained colleagues in making the QI changes needed to ensure that the environment MDs practice in is always focused on the doctor-patient relationship, the most critical relationship in healthcare.

None of us would advocate a return to paper charts given the notable successes in areas like reduction of medication errors with EMR use. It will be a win-win for patients and providers if EMR system tools are used efficiently with pre-built templates, shortcuts, messaging systems in real time, reminders for high priority tasks, triggers, portals, smart pens, speech recognition software…etc. I find it more useful in our practices to encourage approaching the work flow from the team perspective and consistently train, train and train.

On May 5, 2017, CVNR commented on On line scheduling :

We started online scheduling both in our specialty practices and primary care practices as a pilot first with few of our early adapters/ physician champions. We did it as a PDSA project for three months. As expected, we were able to show improved productivity for these providers, decreased no-shows, increased patient and staff satisfaction, and we were able to see a profitable ROI on our online booking investment. We presented our findings at our staff and provider meetings. The findings encouraged most of our physicians, and they have currently opened up their on-line schedules with applicable and appropriate filters. It is this shared decision making between the leadership and the doctors that ensured success in our online appointment process implementation.

On May 5, 2017, CVNR commented on Physician Handovers :

Along with the repeat backs and the read backs, we train all our staff to use the standardized tool SBAR (Situation – Background- Assessment – Recommendation) to maintain clarity in the handoff communications consistently. This tool is built into our EMR and used in all our settings. It focuses on patient, plan, purpose, problems and precautions. We find this tool to be easily adaptable in all our unit settings, meets our staff expectations, value added advancing quality & safety of care, and most importantly minimizes inefficiency by removing redundancies and uncertainties. Safety is our number one core value, and we encourage our staff to have a questioning attitude – Validate and verify to ensure safety.

This question brings to my mind Beef and Chicken analogy. If one form of meat is more accessible or convenient to obtain, people are more likely to buy more of it for consumption. In contrast, beef and potatoes might be viewed as complementary if having more beef encourages people to buy more potatoes.
As leaders of the organizations, I believe we should first plan our strategy based on our community needs – are we going to provide substitute services similar to these free standing facilities (redesign organizational care processes) or complementary services (integrate with urgent care/ free standing facilities). Next step would be to strategize around these selected services/ collaborations in alignment with our value based care, population health initiatives to better meet needs of our patient population.