1. Creating and Fostering a Culture of Change Gregory A. Elkins M.D. Medical Director Lincoln Primary Care Center Rural Quality Program Conference September 2, 2009 Washington D.C.

2. Lincoln Primary Care Center 1975 Established in Former Grocery Store 2 National Health Service Corps Providers

3. LPCC 2009 33,000 Encounters 11 Providers 4 Sites

4. Well Center Meals Exercise Sessions Other Services

5. Population Served Rural Appalachia Town of Hamlin- population 1,000 Lincoln County- 24,000 Additional Surrounding Counties Nearest Hospital 40 minutes away

6. Change Not a 4 letter word!

7. Why Change? “Things are fine like they are.” “We have always done it this way.”

8. Health Care Delivery System Based on 1900 Needs Physician Centric Acute Care Does Not Meet Needs of 2009! Based on 2009 Needs Chronic Disease and Its Consequences

11. Why Change? To Improve!

12. Quality Improvement What We’ve Done Where We’re Going

13. Fall 2002 First Step Manual Chart by Chart Review Individual Patient Information (Very Limited) Chronic Disease Manager

14. Obstacle: $

15. Team Approach Patient Centered Standardized Goals Clinical Information SystemNHDC

16. NHDC Biggest Accomplishment – Learned How to Change

17. What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement ActPlan StudyDo

18. Spread Obstacles: – Fear of Change – $$$

19. Overcoming Obstacles Show the Data: – Starting A1C- 9.5 – Current A1C- 7.4

20. Allow Staff to Work to Their Potential

21. EHR Implementation

23. Growth Recent Retreat with Management Team and Board of Directors

24. 3 Key Questions Where are you? Where are you going? How are you going to get there?

28. Questions ? Gelkins@LincolnPrimaryCare.com