Healthcare Organization Spread of Innovations

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Healthcare Organization Spread of Innovations
Thomas K. Hei, MD, FAAFP
Washington State Collaborative Outcomes
Congress March 26-27, 2007
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UW Medicine Neighborhood Clinics

• 66 FPs, IMs, PAs, ARNP
• 8 Clinics around King County
• Primary care only
• Auburn Pilot Clinic
• Pilot Population 259 patients

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February 2007
April 2007
July 2006
TBD
December 2006
November 2006
Pilot March 2006
February 2007
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Aim Statement

• UW Medicine Neighborhood Clinics will implement
  the Planned Care Model in order to provide
  measurable improved care for our diabetes
  patients.

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Measures

• A1c
• LDL
• BP
• Self Management Support
• Tobacco Cessation Counseling
• (Foot Checks, Eye Checks, MABU)

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The Planned Care Model
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Key Changes in Healthcare Organization

• Focus attention.
• Regular updates on progress
• IT Capacity

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Informed, Activated Patient
Prepared Practice Team
Productive Interactions

• Examples
• Assessment of selected clinical priorities
• Evidence-based interventions
• Built-in decision support tools
• Collaborative plan formulated with each patient,
  based on PCP input and patients readiness for
  intervention/change
• Self-Management support was emphasized
• Proactive follow-up every 3-6 months

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Examples of PDSA Cycles

• Standardized data mining procedure from Epic Care
  EMR system
• Standardized diabetic patient definition,
  attribution, and procedures for scrubbing the
  patient list.

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Run Charts as tools to analyze and manage change
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Major Barrier Time

• Our Diabetes QI effort occurred at the same time
  when the organization was undergoing significant
  challenges in provider staffing and the need to
  develop a new 5-year business plan.
• Lesson learned need to develop lean processes
  that are more durable.

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Keys to Success

• Organizational and leadership commitment.
• Creating a sense of urgency.
• Create and celebrate short-term wins.
• Consolidate improvements to fuel further change.