This questionnaire was completed by leaders at CareSouth Carolina, Inc. in Hartsville, South Carolina, USA. It is taken from the chapter on Case Studies from the book What Works: Effective Tools and Case Studies to Improve Clinical Office Practices by Suzanne Houck.
CareSouth Carolina, Inc.
Hartsville, South Carolina, USA
1. What was the impetus for deciding to initiate improvement at your site?
Improvement was initiated at our organization in early 2000 with an invitation by the Bureau of Primary Health Care to participate in the first Learning Session of the Health Disparities Collaborative Diabetes Management. Diabetes is a leading factor of morbidity and mortality in our area, and this invitation presented us with the opportunity to improve care to patients with diabetes.
2. Has leadership been important to your efforts? If so, please describe the role of leadership in improvement.
Leadership has been crucial. In the beginning, leadership paid an obligatory role until the “light went off” and improvement was seen as a key strategy of the organization as a whole, not just by condition or by site.
3. In your opinion, what activities have been especially important to sustaining improvement?
Maintaining continual engagement in a national improvement program: i.e., Institute of Healthcare Improvement IMPACT or the BPHC Health Disparities Collaboratives.
4. How important have core values been to your improvement work?
I read this as how important has our mission been to our improvement work. Answer: it lays the very foundation.
5. How are core values communicated to staff?
Through our mission, vision, and values statements, which are continually readdressed by staff, and by the strategic plan which is annually developed with staff participation.
6. Do you have an ongoing team that leads improvement in your organization? If so, please describe who is on it, how often they meet, and the structure for initiating improvements.
Our improvement team consists of the CEO, CMO, asst. CMO, COO, Director of PI, Director of Administration, and Director of Health. Depending on the improvement project, they may meet weekly or monthly. We use a model of improvement that is a PDSA (Plan, Do, Study, Act) cycle incorporating rapid cycle tests of changes after we ask the following three questions: What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in an improvement?
7. Have there been specific processes or ways of using resources that you have focused on, such as leadership development, access, teams, or chronic care?
We have adopted the chronic care model of planned care and the Advanced Access model for access and flow.
8. Does your site vary the ways that patients can access care, such as group visits, nurse clinics, phone care, and e-mail with patients? If yes, please describe.
Planned care visits, group visits, phone follow-up.
9. How do you track and post results or outcomes? (These include operational, clinical, satisfaction, and financial.) How do you select which metrics to use? Have you found it important to limit the number of metrics used? What metrics do you use?
We use a patient registry to track outcomes. We set goals for these outcomes based on national evidence-based guidelines. Diabetes, cardiovascular, asthma, and depression are the conditions currently being tracked.
We use survey tools from the clinical microsystem action guide (clinicalmicrosystem.org) to track patient and staff satisfaction.
We use practice management software (Medical Manager) to track financial information like productivity, panel size, access, revenues, access.
The list of metrics that we are tracking varies depending on improvement project and team. At a minimum, all of the above are tracked throughout the organization.
At CareSouth, 98 percent of our diabetic patients have had a foot exam within the last year and 92 percent have had a retinal eye exam within the last year. We have reduced HbA1c in patients with diabetes by more than 30 percent. Our average HbAlc measures 7.5 vs. the national average of 9. Over 73 percent of our patients diagnosed with depression have experienced a reduction in depression after six months and at least 92 percent of these patients have remained on treatment after 12 weeks. The national average for continued treatment is less than 50 percent.
10. Does your site do any structured population management such as tracking patients with chronic disease?
Yes, as above.
11. Do you regularly measure patient satisfaction? If so, how often is it measured?
How are satisfaction results shared with staff? Have you tracked patient response to specific improvement efforts such as cycle time or access?
Yes to all.
12. If you were starting your improvement work now, what would you do differently? What would you do the same way?
That’s hard to answer. Probably keep most everything the same.
13. What advice would you give to others embarking on sustainable improvement?
Senior leadership is crucial. Improvement must be embedded in the strategic plan of the whole organization.
14. Please describe your organization:
Community health center
15. Are you part of an integrated delivery network?
No
16. Approximately how many patients are cared for at your site/organization?
26,000
17. On average, approximately how many patient visits occur at your site?
86,000 in the last year
18. How many FTE physicians and mid-levels (nurse practitioners and/or physician assistants) are employed at your site?
16 physicians and 12 mid-levels
19. If you are using formal care teams, what is the makeup of your team(s) (e.g., 1 FTE MD, 1 mid-level, 2 MAs, 1 clerk, etc.)?
1.0 provider (either an MD or NP), 1.0 nurse, 1.0 care manager, 1.0 Front Office Asst, 1.0 Health Information Specialist
20. Do you use an electronic medical record?
No
21. What is your average cycle time for a patient visit?
58 minutes
22. How are physicians compensated?
Production & salary
