Institute for Healthcare Improvement: Learning and Innovation Community: Redesigning the Clinical Office Practice

Available through the IMPACT network or on a direct-enroll basis, IHI’s most intensive front-line improvement work happens in Learning and Innovation Communities. These are collaborative change laboratories in which teams from a wide variety of organizations work with each other and IHI faculty to rapidly test and implement meaningful, sustainable change within a specific topic area.

Listen to an informational call on this topic.

Download a brief description of this Community.

Read members' improvement stories:

CareSouth Carolina (Hartsville, South Carolina, USA) set goals and tooks actions to make significant improvements in its six office practices in all six categories identified by the Institute of Medicine.

Powell Valley Healthcare—Mountain View Medical Center (Powell, Wyoming, USA) made changes to achieve its aim to provide same-day service and access to care in the primary care outpatient clinic, with subsequent improvement in patient, staff, and provider satisfaction.

Lehigh Valley Physician Group (Allentown, Pennsylvania, USA) worked on a project demonstrating that total phone call volume can be decreased by simplifying the phone system and combining that effort with a practice redesign, which makes that system efficient and operational.

Redesigning the Clinical Office Practice is available either through membership in IMPACT or through direct enrollment in the Community. Learn more about the IMPACT network.

The Challenge

The Solution

The clinical office practice and outpatient clinics lie at the heart of health care. For most patients, most of the time, these settings are the primary locus of care, trust, and coordination. Many innovative practitioners and local managers have made important breakthroughs in the design and performance of office-based practices over the past several decades.

Despite numerous local innovations in office practices, many promising improvements remain unused; their full potential has not yet been tapped. Practices may not be aware of these innovations, or they may seem too difficult for an average practice to implement. As a result, there is a gap between existing performance levels of clinical offices and outpatient clinics and services and that which is achievable with these new approaches.

Over the past several years, leading organizations have piloted new ways of operating office practices, especially in the areas of improved access and efficiency and the delivery of planned or “proactive” care for their patients. The Redesigning the Clinical Office Practice Learning and Innovation Community will bring together all of these improvements so that participants will be able to say: “Our patients receive exactly the care they want (and need) exactly when they want (and need) it.” The goals will be sustained reduction in pain and suffering, helplessness, unwanted delays, and waste.

Areas of Focus

Organizations seeking to improve their office practices will find support to achieve outstanding results in the following areas:

Access and efficiency in primary and specialty care. The ability of health care systems to meet the growing demand for timely access to care contributes to improved patient health and satisfaction, reduced costs, and the overall success of the organization. Primary care and specialty care providers can rid themselves of unnecessary patient waits by predicting and managing patient demand, using more efficient office practices, and streamlining the flow of patients among provider settings.
Delivering the right care to patients. Whether patients have multiple chronic illnesses or are well but in need of a solid plan for screening and prevention, organizations can deliver the right services to patients and improve outcomes using a proactive care team approach and the Chronic Care Model. Whether your organization is just getting started on chronic illness care, or is ready to manage outcomes for larger populations with many different conditions, you will find resources and expertise in the community to move your efforts forward. Special emphasis on reliable prevention services and greater facility with self-management support will be a special focus in the next year.
New practice designs. A key to achieving better results for patients and for the practice is designing more flexible and continuous interaction with patients. Group visits, email care, phone triage, and post-visit follow-up phone calls are some examples. These methods, while currently being utilized in a small number of organizations, have the potential to revolutionize the clinical office practice.

Aims

Organizations in the Learning and Innovation Community will set ambitious aims consistent with their areas of focus in the community. The following are examples of aims that might be set:

Reduce delays for an appointment with a primary care physician so that the participant organization can offer and deliver an appointment within a day, as measured by the third next available appointment
Reduce the wait time at an appointment by 50%, as measured by cycle time
Access within 7 calendar days (i.e., takes into account a delay that is clinically necessary) to a specialist or for a procedure or treatment within a comprehensive specialty setting (for greater than 20 practices)
Percent of patients receiving evidence-based care for their health or condition is increased by 50%
Percent of patients who are confident that they can fulfill their role in managing their health or condition is increased by 50%