For many of us change is a difficult process. In organizations like healthcare it seems to advance at a snail’s pace sometimes. There is a need for change in healthcare, most agree, though we would be hard pressed to agree upon the changes needed. One incentive for change is pay-for-performance programs now beginning in several areas. I would like to describe a couple that affect primary care physicians and then give a few suggestions as to how to adopt changes to take advantage of these programs. Even if you are not in a primary care physician program, the methods suggested for change will be helpful, I believe.

In 2006 Medicare plans to institute a pay-for-performance program at the primary
care physician level. Right now a model is being tested and seems to be doing quite
well. In several states Blue Cross Blue Shield organizations are testing pay-for-
performance programs. Here in West Michigan, Priority Health, a healthcare insurer,
has promoted such a program for over five years. How does this work, you may
ask? Priority Health, for example, funds the program for each of its patients a set
amount. Doctors who meet a requirement of the program for a patient are rewarded
with extra money for that patient. Hence, with many patients the income for the
practice can be boosted considerably. The fact is that many are not rising to the
opportunity. With planned cuts in Medicare reimbursements over the next few years,
this source of income cannot be ignored! Healthcare programs need to change, no
matter how difficult.

The impetus for change should rest with the leadership of an organization, although
the change should not be the sole responsibility of the leaders. Representatives
from all parts of the organization should be involved. Once the need for change in a
process is agreed upon, either because of extra revenue from pay-for-performance
programs or other agents or data that positively affect the bottom line, leaders
should convene a task force to plan the change. With input from all, leaders should
map the process as it currently exits and then should make a new map of how they
would like it to be to incorporate the positive changes. The new procedure should
be standardized for all to adopt.

How do you go about adopting these changes on a daily basis? This is probably the
hardest part. Because humans learn in a variety of ways, it will take a variety of ways
to implement the changes. The implementation of the changes should be based
upon the learning styles of the individuals involved. Let me provide an example
using the Medicare program. A patient who enters the Medicare program is entitled
to a paid initial physical. A primary care physician should take advantage of
this. Many don’t. If I were the manager of such an office, I would remind my staff
who set up appointments to be aware of this fact. I would remind them at regular
staff meetings. I would post visible reminders in the office. I might even have a
message flashed on the computer screen once in a while. Then I would review the
appointments of patients who have become Medicare qualified and see how many
had their initial physical or were booked for it. I would adjust my methods to remind
staff of the need for such examinations and continue to improve on this until the
office achieves 100% compliance with the goal.

Booking the exam is not the only needed change. Doctors who perform the physical
must accomplish examination details and actions laid out by Medicare. Hence, to be
paid for the exam, each doctor must adhere to the exam details. I would help the
doctors accomplish this in a variety of ways, depending on the doctor’s learning
style. For example, a checklist of the exam details might be included in the patient
history folder when the exam is performed. That way the doctor will not miss any
steps. As the leader of the change, I would check with billing to see that all the
steps were performed and adapt new approaches or reinforce existing ones to see
that the changes are accomplished 100% of the time.

Changes such as these should be a part of a continuous quality improvement
program at every healthcare provider organization. Let me quickly review the most
important steps. First leaders should identify the changes needed. Then, the leaders
should convene a committee of all affected staff to develop how to accomplish the
change. Once the staff agrees upon the approach, the leaders should develop ways
to implement the change on a daily basis adopting methods that incorporate
learning styles of affected individuals. Then, they should continually analyze the
progress of the changes and make necessary adjustments until the goals are
accomplished. They should then audit the changes occasionally to be sure that the
organization doesn’t fall back into old habits.

I believe that adopting such a change process will dramatically help at your site. You
will see savings in time, increased patient or client health and satisfaction, as well as
an improved bottom line!

Donald Bryant, certified quality engineer, writes “Making Good Healthcare Better” a
free monthly ezine for healthcare providers who want to dramatically improve
patient health, improve the bottom line, and make work more rewarding,
guaranteed. To find out more, visit http://www.bryantsstatisticalconsulting.com

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I think this is a good time for a checkup, or physical as it is termed in the healthcare industry. I mean this is a good time to check the health of your site or setting. As healthcare providers, we are dedicated to curing our patients of their ills and keeping them healthy. My question is, “Do you have the same attitude about the place you work?” Is your site meeting its highest goals? If not, then it is time for a change.

I think that as a group healthcare sites are a lot like our patients. Some patients
don’t work hard at keeping healthy. In fact, many engage in behavior that is very
detrimental to their well-being. You probably can easily image such a person.
Maybe they are very overweight. Well, there are many healthcare facilities that are
like that. They have many processes in which there are steps which add no value,
that are a complete waste of time and effort. Then, there are patients who do a lot
of the right things. They eat correctly, get a good amount of exercise, and generally
have a positive outlook. There are a few healthcare facilities that are fit too.

What does a healthcare site in not so good shape look like? These sites, I believe,
have as their goals just to meet their compliance standards, those set by the state,
JHACO, or the FDA or some other body. As long as they are being accredited, they
are satisfied. Their attitude may be, “If it isn’t broken, don’t change it.” They are
like patients who are content to just sit on the couch, watch TV, and eat whatever
they like as long as they don’t feel poorly.

What does a healthcare site in good shape look like? I believe that such sites are
continually looking for ways to better themselves. They engage in “continuous
quality improvement” activities. They are really concerned about the health and
attitudes of their patients and clients. They use surveys and they question and
listen. Some even use a tool called quality function deployment when designing
new facilities or programs.

Besides listening to patients, they pay close attention to their employees. They
actively seek ideas from the employees on how things could be done better. They
want to have their employees enjoy working at their site and support its mission.
The leaders of such sites actively reflect this attitude.

Further, such sites seek ways to improve the processes at their site. They cut waste
and save time and improve the bottom line. Many tools for doing this can be found
in quality disciplines such as Lean Healthcare and Six Sigma. You can find a very
good white paper on Lean Healthcare at the www.IHI.org website.

What are the results of these positive and active approaches? Our patients are
happier, fitter, and find time to do the things they want. They generally live longer
with fewer health problems. Healthcare sites which are actively engaged in
continuous quality improvement programs generally find that they have the time to
accomplish their objectives and don’t feel rushed, they have an improved bottom
line, and they rarely experience adverse events. The doctors don’t have to work
impossible hours to accomplish all they want. They work as a team.

Let me encourage you at this time to sit down with your colleagues and leaders and
assess the health of your site. If you find that you fall short of what you should be, I
hope that you put in the effort to reach the best goals. After all, we expect the
same from our patients, don’t we?

Donald Bryant helps healthcare providers meet their challenges and writes
“Making Good Healthcare Better” a free monthly ezine for healthcare
providers who want to dramatically improve patient health, improve the
bottom line, and make work more rewarding, guaranteed. More free articles
are at his web site. Be sure to visit.

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