Blog | Wednesday, April 30, 2014

Improving ambulatory care


I recently attended the IHI conference entitled “Improving Patient Care in the Office Practice and the Community“ in Washington, D.C. It attracted about 1,000 people from around the country to share their stories about how to make care better, and I want to share two of them with you.

If you have ever imagined what primary care could look like if you “blew it up” and started over instead of nibbling around the edges of process improvement, then you would enjoy learning more about the Southcentral Foundation. Their president, Katherine Gottlieb, and their medical director, Steve Tierny, gave a detailed account of their journey from a dysfunctional, bureaucratic provider-driven health system providing mediocre care to native Alaskans to a national Baldrige Award winner built around the concept of community wellness.

Don Berwick is quoted on their website as saying that “I think it’s the leading example of health care redesign in the nation, maybe the world,” and I can see why. They have truly put “customers” (not “patients,” which would imply that all of the people they serve are in need of medical care instead of wellness promotion) at the center of what they do, and have wrapped data-driven team-based services around them in what they call the “Nuka” system of care. Really impressive.

Laura Adams of the Rhode Island Quality Institute gave a keynote address in which she told a cautionary anecdote about ill-conceived efforts of providers to become more “patient centered.” She had been involved in the design of a “breast center” at a hospital in a small community, which had included all the things that the providers believed (without asking) that women wanted—pastel colors, soft lighting, soothing music, massage therapy and the like. After it opened, she interviewed patients to see how much they liked it and was horrified when one asked her “what were you thinking when you named this the ‘Breast Center?’” The woman went on to say that she didn’t want her friends and neighbors to know that she had something wrong with her breasts, any more than a man would feel comfortable walking into a building with a big sign that said “testicle center” or “penis pavilion” over the door. Ooops!

Turns out we really don’t know what people want or patients need unless we ask!

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital. He then held a number of senior positions at Mount Sinai Medical Center prior to joining North Shore-LIJ. He is married with two daughters and enjoys cars, reading biographies and histories, and following his favorite baseball team, the New York Yankees, when not practicing medicine. This post originally appeared at his blog, Ausculation.