1. The Problem

2. The Problem The Problem Excerpts from New York Times article June 17, 2008* Excerpts from New York Times article June 17, 2008* I love being a doctor but I hate practicing medicine I love being a doctor but I hate practicing medicine Primary care physicians voice a level of dissatisfaction with medical practice that is alarming Primary care physicians voice a level of dissatisfaction with medical practice that is alarming In summary, from the physician’s perspective, the clinical practice of medicine has been significantly challenged over the last several decades largely because of the evolution of the insurance industry to managed care In summary, from the physician’s perspective, the clinical practice of medicine has been significantly challenged over the last several decades largely because of the evolution of the insurance industry to managed care *http://www.nytimes.com/2008/06/17/health/views/17essa.html?_r=1&scp=1&sq=june%2017,%202008%20doctors& st=cse&oref=slogin

3. The Opportunity The Opportunity It’s a wonderful time to be a family doctor It’s a wonderful time to be a family doctor There is an avalanche of need out there There is an avalanche of need out there It’s important to capture this window of opportunity It’s important to capture this window of opportunity

4. The Solution These altered dynamics in the primary care practice environment are demanding clinical practice change The Solution These altered dynamics in the primary care practice environment are demanding clinical practice change The “Family Team Care” Solution The “Family Team Care” Solution South Troy Health Center’s A&E IHI Project South Troy Health Center’s A&E IHI Project Family Team care is a powerful and leading primary care practice model innovation whereby a physician and two well-trained clinical assistants (RN / LPN) work closely together along with a rooming nurse (LPN) to provide high quality patient encounters Family Team care is a powerful and leading primary care practice model innovation whereby a physician and two well-trained clinical assistants (RN / LPN) work closely together along with a rooming nurse (LPN) to provide high quality patient encounters

5. Family Team Care Family Team Care The Core of the Change The Core of the Change The core of team care is having assistants who are capable and trained to solicit and document a competent and complete medical history The core of team care is having assistants who are capable and trained to solicit and document a competent and complete medical history

6. Family Team Care Family Team Care The Principal of Employing the Highest and Best use of Staffing The Principal of Employing the Highest and Best use of Staffing Work processes are structured such that the component resources of physician, nurse and administrative staff do only what they are uniquely trained and qualified to do with appropriate delegation of all lesser tasks Work processes are structured such that the component resources of physician, nurse and administrative staff do only what they are uniquely trained and qualified to do with appropriate delegation of all lesser tasks

7. Family Team Care The Patient History The Patient History When the physician enters the exam room the assistant communicates the clinical data gathered to the physician who further reviews and supplements the historical information which ensures compliance with standard documentation guidelines When the physician enters the exam room the assistant communicates the clinical data gathered to the physician who further reviews and supplements the historical information which ensures compliance with standard documentation guidelines

8. Family Team Care An Improved Patient Care Experience With appropriate task delegation and an adequate period of training the doctor- nurse team is capable of delivering an improved patient care experience resulting in an enhanced quality of care and satisfaction

9. Family Team Care Family Team Care The Four Components of a Team Care Patient Visit The Four Components of a Team Care Patient Visit Part 1: Assistant only - Data gathering and history taking Part 1: Assistant only - Data gathering and history taking Part 2: Physician with assistant documenting – Review and analysis of the data and conduct of a pertinent physical examination Part 2: Physician with assistant documenting – Review and analysis of the data and conduct of a pertinent physical examination Part 3: Physician with assistant documenting - Medical decision making and the development of the treatment plan Part 3: Physician with assistant documenting - Medical decision making and the development of the treatment plan Part 4: Assistant only - Implementation of the treatment plan and patient education Part 4: Assistant only - Implementation of the treatment plan and patient education

10. Family Team Care Family Team Care Comparing Practice Models Comparing Practice Models Traditional Care Traditional Care The physician essentially conducts the patient visit in its entirety The physician essentially conducts the patient visit in its entirety Team Care Team Care The nurse collects and records the details of the history which enables the physician to fully focus on the patient, The nurse collects and records the details of the history which enables the physician to fully focus on the patient, analyzing and elaborating on the data collected, analyzing and elaborating on the data collected, conducting the physical examination, performing the medical decision making and conducting the physical examination, performing the medical decision making and developing the treatment plan. developing the treatment plan. The nurse documents the above and then implements the treatment plan and provides appropriate patient education. The nurse documents the above and then implements the treatment plan and provides appropriate patient education.

11. Family Team Care Family Team Care Advantages of Team Care Practice Model Advantages of Team Care Practice Model Improved quality of care – PQRI measures satisfied Improved quality of care – PQRI measures satisfied Improved patient satisfaction Improved patient satisfaction Improved staff satisfaction Improved staff satisfaction Improved access and efficiency Improved access and efficiency Coding substantiation Coding substantiation Enhanced protection from liability Enhanced protection from liability

12. Family Team Care Family Team Care The Team Care model places high value on The Team Care model places high value on Quality and safety Regulatory compliance Risk management Quality and safety Regulatory compliance Risk management Evidence based best practices Evidence based best practices Patient centered care Patient centered care Being a medical home for our patients Being a medical home for our patients Open access for urgent and chronic conditions Open access for urgent and chronic conditions Chronic disease management and disease registries Chronic disease management and disease registries Utilizing “Lean” principles Utilizing “Lean” principles Patient and staff satisfaction Patient and staff satisfaction Preventative services and Wellness Preventative services and Wellness IHI office practice redesign change implementation IHI office practice redesign change implementation Robust Electronic health record Robust Electronic health record

13. Family Team Care Family Team Care The South Troy Health Center experience The South Troy Health Center experience Our Journey over the past year Our Journey over the past year IHI office redesign project meetings regarding improving access and efficiency - Nashville June 2007 and St. Louis October 2007 IHI office redesign project meetings regarding improving access and efficiency - Nashville June 2007 and St. Louis October 2007 Our FTC project started August 2007 with the viewing of the training Family Team Care DVD’s and reviewing templates in the manual at Krause Center Our FTC project started August 2007 with the viewing of the training Family Team Care DVD’s and reviewing templates in the manual at Krause Center On site visit in Newport News, Virginia November 2007 On site visit in Newport News, Virginia November 2007 Electronic Team care templates of diseases and symptoms started December 2007 and completed March 2008 Electronic Team care templates of diseases and symptoms started December 2007 and completed March 2008 One assistant team care began December 2007 with weekly meetings One assistant team care began December 2007 with weekly meetings Two assistant FTC began June 2008 with continued weekly meetings Two assistant FTC began June 2008 with continued weekly meetings

14. Family Team Care Family Team Care Summary Summary Team Care has demonstrated competence in improving: Team Care has demonstrated competence in improving: Quality of patient care Quality of patient care Documentation of the visit Documentation of the visit Patient, nurse and physician satisfaction Patient, nurse and physician satisfaction Financial performance Financial performance

15. Family Team Care Family Team Care It is an honor and privilege to serve in this IHI office redesign project. It is an honor and privilege to serve in this IHI office redesign project. Thank you very much for your help and support with this very important project Thank you very much for your help and support with this very important project We at South Troy Health Center are excited and look forward to continuing to fully implement this project over the next year We at South Troy Health Center are excited and look forward to continuing to fully implement this project over the next year

16. Family Team Care Family Team Care Questions? Questions?