East Cluster Meeting Notes, 2/25/2009

East cluster met today and spent some time reviewing what we've done in this first six months of dedicated cluster work.

To focus our attention on some goals (and hopes), we talked about what makes for a good day at work. Here are some of those ideas:

• Manageable schedules (enough time to do our work)
• Doing something specific, tangible, for a patient that helps them to feel better
• Having a well-stocked cluster
• Having time for providers and nursing staff to plan and reflect
• Attention to detail
• Appropriate appointing
• Running on time
• Helping colleagues to keep things running smoothly
• Great teamwork
• Providing good emotional support for our patients as well as good technical care
• Hearing back from our patients that they're happy with their care
• Seeing our colleagues smile
• Creating a safe, trusting environment for patients
• Giving our patients the care we would like for our families
• Feeling relaxed, ready, and confident
• We wouldn't need to see the quality numbers, because we would know our work exceeds expectations

We also discussed some barriers to having a good day, every day.

• Appointing challenges: some preventive exams should really be problem-oriented, for example, as there is a lot to do in a preventive exam
• There are very different practice styles among our providers. The providers agreed six months ago to standardize some of our practices, but our actions haven't matched our words.
• Some processes are difficult to standardize and create consistent flow breakdowns in our busy days. Immunization reconciliation, ordering, and delivery is one of these areas. A protocol would help everyone feel more confident that we'll get the right immunizations to our patients.
• Medication reconciliation is a huge job for our nursing staff, and a great benefit to our patients and the providers who advise them. Again, there is not an accepted standard for reconciling medications, and we sometimes create work for our pharmacy in the way we do it. A protocol would simplify things.

The solutions we think of have to work for all of us. Some of the things we've tried have worked well (the new blood pressure protocol), and other's haven't (flowstaff workflow charts, Epic tools and dot phrases, and to an extent, this blog).

We deliberately deferred solving specific problems today. I thank everyone for their patience with "the process" today. Ultimately, as the cluster facilitator, I am responsible for delivering results. The best I could hope to do is deliver your wish list for a good day, every day.

I have my marching orders: a good day, every day, and solutions that work for all of us.