Primary Care's Profile

I don’t think that patient experience and operational efficiency or staff acceptance have to be a trade off. Certainly you need to be efficient to run the business side of things, but that doesn’t have to be at the expense of patient satisfaction. Access and friendliness are going to be your biggest returns. If you business processes are making it difficult to deliver, they need to be changed- else you may not have much business to worry about. As for staff acceptance, they are in the business of taking care of people, so they should want to make patient experience a good one. If they are luke warm, you need to find a way to get them excited about it or cut them loose. Nothing will kill your business or reputation faster than grumpy staff interaction with patients. Conversely, you won’t need to advertise if your staff is really kind and friendly to the patients because word of mouth will spread that your business is the place to go for …
Ask your staff what they think would make for a better patient experience. They will be able to tell you what the barriers are. Maybe have a patient survey asking what is there three most important aspects of the visit. We’ve done these things and it has been quite helpful. We revisit this issue all the time.

We have incorporated behavioral health into our primary care sites over this past year. It has been recieved quite well from both sides. The psychologist I have embedded in my office is available for integrated visits, meaning I can often walk down the hall and get her for a 15 min quick visit for someone that is really struggling- freeing me up to move on to the next patient. The psychologist is able to triage and start a treatement plan to complement what I do. Work flows are easy to develop.
financially it’s a win because insurance tends to cover this service in our area. We are also exploring how chronic disease can benefit from behavioral health involvement. Things like pain and addiction are easy to see the connection, but things like poorly controlled diabetes are also benefitting. We’ve had behavioral health in our system for a long time, but access was poor and they seemed very silod and distant. Having them in my office is great. They participate in our office meetings like they are one of the group. I would hate to think of practicing in an office now without integrated behavioral health.

Dashboards are only as good as the data that gets put in. It is critical that the data is accurate, validated, and up to date. Physicians will be quick to dismiss data if they feel it is inaccurate. Having metrics that are actionable (ie- can be acted upon to make improvements) are also key. We have seen inconsistent data in some of our dashboards previously and it was a disaster. We’ve spent a lot of time and money now getting new dashboards up and running. I know feel we have to “sell” them to the providers so that they will use them- which is ultimately to their advantage.

I don’t think this problem is unique to your setting. statistics typically show that folks in our system are not in hospice on average more than a couple of weeks before they die. We as physicians are taught how to keep people alive, and really need to shift to also helping people die with dignity. In our system we have a palliative care team in the hospital and that is good, but we still struggle outpatient wise in getting folks referred in a timely fashion. I think one key is a strong physician advocate/leader to go around and give some talks on the benefits of palliative care and hospice. Education on a regular basis is starting to move the bar a little for us.

Our organization has taken the tactic of pairing a physician with an administrator to create dyad relationship, I assume similar to Rob’s mention of Mayo. the two work closely together to really bridge the gap that is often found between administration and providers/staff. I think this model, when choosing the right provider/faculty/clinical leader can be very successful in engaging those in the stands that want to throw the fruit. Providers/faculty are more likely to respect one of their own and if that person can really explain the ‘why’ of what the mission is we have found that to be moderately successful in moving forward. I have been in a dyad model for years and am currently shadowing the physician leader that I will be replacing at the next level and seeing how he works with his dyad partner.

We have ability for patients to schedule online and it was a slow roll out due to provider pushback. We only have a couple of options for patients to schedule the type and it really is based on time- an acute visit or physical. We started this with my office and would only allow a couple of those spots on the schedule each day. As we gained experience that patients were picking the right type of visit (not wasting our time with too long of visit for the problem) and showing up (no show rate is lower we have found) we’ve opened all visits up to schedule this way, though most are still done by phoning in. As you mentioned patients love it. You need to make it manageable by limiting the types of visits and get some small pilot groups to champion it. As they seen that its a win that will spread. We started it in Primary Care.

This one hits home, as we are more rural and it is difficult to attract and retain skilled staff. Lower paying medical assistant jobs don’t typically attract folks from out of area to move. We do have a local Junior College that we have developed a close relationship with that produces nurses and medical assistants. We allow them to do their clinical work with us and essentially are able to hire them before they finish training. We are finding that locally grown is the answer. We have considered going to local high schools to develop programs that would have them ready for medical assitant certification when they graduate high school. As for providers, we have national search firms looking, but find that our colleagues are great at getting people they’ve known from training to move our way. Of course, there is a finders fee for them.

Our system has prioritized communication and coordination with each patient’s Primary Care Provider to leverage that relationship to the patient. It has cut down on readmission rates quite a bit. We have case managers in the hospital that know the local resources for post acute care well. We have cultivated relationships with facilities that provide good quality care and steered clear of those with lesser quality. Lack of IT infrastructure may be problematic, but may not be if there are multiple platforms being used in the area, as they often don’t speak well to each other anyway. A fax machine is probably more reliable.