Life and work are full of many problems and challenges. What should I eat to be as healthy as I can be and still enjoy eating? How can I find time to exercise? What is the best approach at work to improve sales? How can my worksite be more patient-centered or customer focused?
Seeing that life and work are full of challenges and problems, many requiring well-thought out solutions, it becomes very important how one goes about solving them. Are you the type of problem solver who is reactive, coming up with solutions as problems and challenges occur? Do you anticipate challenges and problems and take a proactive stance? Do you go it alone and find solutions based upon ‘what seems right to you’ and is expedient? Or do you carefully find solutions based upon the best facts available, involving others as needed?
Skills in finding effective solutions to providing quality healthcare is very important now, as pay based upon quality of care and saving costs are beginning to slowly replace fee for service payment patterns. Physicians and staff are being asked to find ways to deliver highly effective care while engaging the patient in his own care. To meet these challenges physicians and staff will need to find effective solutions that evolve over time.
To see how this can occur, let us look at two typical physicians, Dr. A and Dr. S. Both have decided that they would like to provide better care to their type 2 diabetics but they take decidedly different paths to do so. Dr. A decides that the best path is to follow standardized examination and testing of each of his diabetics who come to his office for visits. This includes:
- A1c testing once every three months
- Examination of feet for sores and injuries
- Eye exam
- Checking thyroid
- Checking weight and blood pressure
- Checking reflexes
- Checking heart and lungs and carotid artery
He is careful to record the results for each patient in his EHR and compares the results of previous visits to the current visit. This way, he can see if any significant changes have occurred over a longer period of time.
After six months of focusing on his type 2 diabetics Dr. A. decides to evaluate how well he is doing in helping his patients manage their conditions. He contracts with a consultant who specializes in collecting data from health software in order to see how patients as a group or doing. That is, the consultant collects data at the population level in order to see how the physician is doing overall in treating his patients. After discussing the outcomes with the consultant Dr. A is surprised to find that the outcomes of his efforts are not what he expected. He finds that 25% of his patients have not had a A1c test in at least six months; he does not really know how well these patients are managing their condition. Of the remaining patients one-third have A1c levels that are persistently high and some of these are developing foot problems. Looking over his results, he sees that his sustained efforts are not producing the results that he thought they would.
Dr. S decides to adopt the same examination standards as Dr. A but is also using a patient-centered and team approach. When she first diagnosis a patient as diabetic or pre diabetic she works with the patient to create a treatment plan. The plan includes goals that the patient helps set, such as losing 10 pounds in the next six months and reading material on good dietary habits for diabetics. The treatment plan is signed by both physician and patient and the patient is given a copy.
Along with patient-centered activities Dr. S has hired a nurse educator and coordinator. This nurse works with Dr. S and her diabetic patients in a variety of ways. She makes sure that patients are tested regularly as directed by Dr. S. She contacts patients who are having issues controlling their blood sugar to discuss how to successfully adopt life style changes to better manage their diabetes. The nurse tracks the results of patients’ visits to specialists, such as ophthalmologists. The nurse makes sure that patients schedule appointments to see Dr. S as required. She also takes time to answer questions that patients have about their conditions when they call the office or email the physician.
After six months Dr. S decides to get the help of a consultant who can track population level measures of her diabetics. When viewing the results of the exploration of the data provided by the consultant she and her team members find that the results are quite good. Over 90% of patients are coming in for appointments when required and almost all are getting their lab work done on time. Further, most are keeping their blood sugar levels under control.
The results of Dr. S and her team’s efforts have positive results for both the clinicians and patients. The quality of life is very good for most of her patients. She is receiving a bonus of 2% from private payers for the quality of her outcomes while keeping the costs down. The monetary benefits cover the costs of extra staff and other costs attributable to being more patient-centered.
A recent article in the Medical Group Management Association’s publication Connexion (November/December 2013, ‘Digging for Gold’) provides details of using population health tools to achieve better outcomes for patients. For instance, in this article patients of Northeast Georgia Physician Group made significant advances in controlling their diabetic patients. At 10 of 22 clinics under study patients with uncontrolled A1c levels dropped by more than 48% using population level health management tools.
In closing, let us compare the approaches of Dr. A and Dr. S in solving their problems in managing their diabetic patients. Dr. A worked mostly alone. He did not have extra staff to help in managing his patients. Dr. S used extra staff and teams to help her achieve the results that she desired for her patients. Dr. A was not as patient-centered as was Dr. S. Both used data to help them examine the outcomes of their efforts; the results of this data collection and analysis can be used to produce better outcomes in the future. Teamwork, being patient-center or customer centered, and using data to measure outcomes are all important tools in finding effective solutions to challenges in the healthcare and business setting. Using them and other select tools will lead to effective solutions to difficult problems.
This article is a copy of my January 2014 newsletter. To see the article online click here. To sign up for the newsletter to be delivered to your inbox, click here.