Owning the Medical Home, Burien Style

I shared Burien's work on a couple of projects this week at the South Mini-Forum, and thought I would write a bit about it as well.

Through this process of launching the Medical Home at Group Health, Burienites (BRNites?) have sought effective ways to implement the creative piloting work our sister clinics and Primary Care Leadership Team. Excellent processes create solid standard work. Because of this, we enjoy the work, and we have excelled.

I think one of the reasons we've been able to sustain our enthusiasm is that we've explored ways to own the work and make the individual campaigns our own. Simply "receiving" the campaigns as orders in notebooks risks creating a culture of apathy (BRNouts!), staff who ace the checklists but don't feel energized by the effort.

So, how do we take very good ideas and faithfully put them to work at Burien while maintaining our sense of uniqueness, our sense that Burien is unique? It isn't easy! Or fast. Or linear. But owning the work is powerful, and worth the effort.

An example.

We're in the midst of launching the Prepared Visit effort. Goals: capitalize on opportunities to close care gaps, improve outcomes, and unburden our patients and ourselves.

When I look at the work from the perspective of various stakeholders, it's a winner all around: it looks pulls us out of the "tyrrany of the urgent," and helps us plan thoughtful care for our patients. But it is more work for our flowstaff, who are already heavily burdened with the daily demands of rooming patients, eliciting their concerns, reconciling their medications, making endless calls, handling provider requests, and moving information though our system. This doesn't begin to describe the amazing load of work our nursing staff accomplishes, and it is done with such efficiency and grace that it is largely invisible to me.

The idea of loading another task, and no small task, onto our flowstaff seemed like a guaranteed loser if handled poorly. More work? With what time? It seemed sure to feel bad all around if the work was introduced to flowstaff by boss-types who don't do the job and can't relate--really--to what another task means.

So we floated the Prepared Visit idea to a few of our excellent flowstaff, medical assistants with experience, smarts, and credibility among their peers. We asked these opinion leaders for their help: try out the work of preparing for visits before we launched clinic-wide, and share their experience. My medical assistant, Cheryl Rogers, took on the project with enthusiasm. I showed her a checklist five minutes before the end of a workday, and by the time she left she had already prepped one patient for the following day. Her response to the concept was enthusiastic: it was work, but it was worth it. She could see the payoff: preparation would improve patient care and lessen the burden of low-yield outreach letters and calls, work that consumes hours of her precious time every week.

The result. Cheryl and I have done more unscheduled pap smears in the last week than we scheduled in the last six months. And well-child checks. And colon cancer screens. Tetanus shots. Mammograms. Blood tests. Unbelievable, and very satisfying. And our patients like it--surprise. I've started running the checklist on my own with patients who send email.

By the time we had our launch event last week, everybody already knew about the project. They had watched their respected peers dive into the work and talk about it. And though we don't officially launch the project until next week, all of our flowstaff are already doing pre-visit checklists for our patients.

If you ask me, that's a successful launch. We're doing standard work (that we didn't have to create de novo), and we own the work because we presented it in a respectful way, engaging opinion leaders and allowing them to drive the process.

We are very fortunate at Burien to have a engaged, capable, and creative staff who crave meaningful work that matters to patients. Harness that spirit--rather than squash it--and we'll continue to lead the way in creating a model of what Primary Care really should be.

Crossposted at ghmedicalhome.org