Organizations that want to transform the way they deliver care must have their physicians engaged in the effort – from the planning stages through implementation and beyond. Physicians are among the most influential stakeholders in a healthcare organization, and without their buy-in, organizations will struggle to meet the requirements of any new care model.
In a previous blog post, we watched an integrated health system pilot a patient-centered medical home (PCMH) model to great success, only to lose momentum when the model was scaled up across the broader system. Because physicians weren’t engaged in the process, the system failed to achieve true transformation.
In today’s blog post, we’ll see what happens when physicians are empowered to drive care model transformation.
CASE STUDY #2: IMPLEMENTING A NEW OPERATING MODEL IN A RETINA SUBSPECIALTY PRACTICE
Low productivity. Disjointed work flows and bottlenecks. Physician and staff burnout. At Cooperstown Eye Clinic in New York, an employed, integrated ophthalmology/optometry practice that is part of Bassett Healthcare Network, a general sense of hopelessness had begun to take hold.
The practice was initially composed of six ophthalmologists, one of whom was a medical retina subspecialist, and five optometrists. Over the course of 3 months, the practice lost three of its ophthalmologists – including the medical retina specialist, who was responsible for the practice’s many Wet Age-Related Macular Degeneration (WAMD) patients. The loss hampered the practice’s efforts to accommodate existing patients, let alone provide services to new patients across its five locations.
But rather than give up in the face of adversity, the entire practice banded together. The providers and staff benefited from a culture of collaboration, a product of having worked together for many years. The providers were determined to improve the operations of the practice to ensure that they could continue caring for their patients. To make up for the lost physician productivity, the optometrists took on a significant portion of the general ophthalmology patients across the network, and the remaining cataract surgeons willingly increased their capacity.
Despite these efforts, the group still faced a dilemma – how could they accommodate the loss of the medical retina provider? The diagnosis and treatment of WAMD involves a comprehensive exam and a host of specialized imaging procedures. Given the work flows in place and lack of physician capacity, the process of caring for these patients needed to be fundamentally revised.
The clinicians and administration agreed to implement a new care model that would dramatically alter work flows and provider responsibilities. Soliciting input from clinicians, technicians, administration, and consultants, the group developed the concept of an “injection clinic.” The practice piloted this new approach to accommodate the WAMD patients, with revised staffing models, changes to imaging processes and clinic flow, and adjustments to scheduling practices for WAMD patients.
- The practice arranged for imaging to be conducted prior to the patient seeing the provider. Previously, patients would be screened by frontline staff, see the physician, proceed to imaging, and then return to the physician. Having patients go directly from check-in to imaging eliminated unnecessary steps and frequent bottlenecks.
- Providers performed visual screening and history taking once the patient was in the appropriate treatment room. In the previous model, patients were often called into other rooms so staff could take their history, and often would be sent back to the lobby if the physician room was unavailable. The new work flow eliminated unneeded shifting of patients and wasted time.
- Based on the provider’s exam and treatment plan, some patients were determined not to require dilation, saving significant time normally spent waiting for dilation drops to take effect.
More Efficient Staff Utilization and Patient Scheduling
- The practice assigned two dedicated injection clinic staff members to the providers – one responsible for history taking and dilation, and the other for procedural and documentation assistance. In the past, staff floated between providers and were often assigned on a 1:1 basis.
- Historically, the retina physicians scheduled WAMD patients throughout the day, mixed with other types of visits. Under the new model, WAMD patients were scheduled only on certain days. This allowed the injection team to get into a rhythm, significantly improving the experience for patients and the staff.
As a result of this transformation, the practice was able to accommodate the nearly the entire WAMD patient volume gap left by the departure of the retina subspecialist, with a single general ophthalmologist seeing these patients 2 days per week. Initial throughput analysis showed a nearly 30% reduction in time spent on WAMD visits as a result of these efforts.
A Culture of Collaboration
Had the practice not transformed its model of care, it’s fair to say it wouldn’t have survived the staff departures and other difficulties. But it’s also fair to say that the practice couldn’t have implemented such sweeping changes without physicians and staff being engaged in the process. Building on their already collaborative culture, the transformation was fueled by dedicated physician leadership and a spirit of inclusiveness.
Identifying a physician champion. A physician champion is able to achieve significantly more physician engagement and buy-in as opposed to an administrator leading the effort alone. In the case of the eye clinic, one of the ophthalmologists agreed to lead the effort. He was responsible for obtaining approval from the chief surgeon to pilot the injection clinic model, suggesting the optimal work flow for patient visits, ensuring that any changes in work flows or treatment processes were consistent with clinical best practices, and engaging the frontline staff in the effort.
Working with the entire practice – including support staff. The ophthalmologists, optometrists, nurses, and technicians all participated in the transformation and were thus committed to its success. The providers encouraged and welcomed staff feedback, and many of the most effective work flow changes were suggested by technicians and nursing staff, who were able to highlight inefficiencies they faced on a daily basis.
The challenge now for Cooperstown Eye Clinic is the same that any practice faces when it transforms its model of care – sustaining success. But with its emphasis on physician engagement and collaboration with staff, the practice appears poised to thrive in the long term.