Q: What is the need for improvement in Office Practice?

A: The office practice is where almost all Americans have their contact with the health care system. If it isn’t right at the office, a lot of other things go wrong. Failed office visits can result in hospitalizations, serious injuries from medication, and other types of intervention. And most importantly, failed communication at the office visits can result in a lot of unnecessary anxiety and suffering for the population at large.

The evidence that a lot more can be done in office practices is overwhelming. Patients and providers are seldom on the same page when it comes to the issues that really matter to patients. For example, in the typical office practice for adults across the United States, about 15 percent of patients will have significant problems with emotional issues, while only 40 percent of the time will they say that their doctor or nurse is aware of that issue. We find that more than 15 percent of Americans will claim that their medicines are making them ill, and yet the health care system is largely unaware of that.

The office practice is also required to be the front line for important preventative approaches such as mammograms for women, bowel tests for men and women, and so on. Yet when you look at what should be done in prevention of disease—for example, bowel cancer screening—the rates are quite low: in the range of only 50 to 60 percent of what it should be. Similarly, you’ll find that across the United States, only half of the people with diabetes, for example, are keeping their blood sugars within a reasonable range.

The office practice can easily be blamed for all these difficulties, but they are only the reflection of a system that does not have the correct design elements to make the office work right. The important ingredients in that design element are, first of all, a patient who is really informed and activated and ready and able to be a good manager of health issues that come their way. Currently in the United States, only about 30 to 40 percent of Americans claim that they are able to manage important health issues; for some health issues, for example, heart failure, that number drops as low as 20 percent.

A practice team has to understand what really matters to patients so that they’re on the same page. The current opportunity is huge: the number of practices that are rated as excellent by patients, who are themselves good self-managers, is only 20 percent. That means 80 percent are experiencing care that is less than adequate. That’s a huge gap.

IHI.org is not a silver bullet for these issues. Rather, it represents a compilation of well-tested approaches and materials that can facilitate change. When the provider organization is committed to really making change, and leadership is willing to endorse it, it’s invaluable to have this information so that people don’t reinvent the wheel. But, they themselves have to recognize that the change is going to be deep, it’s going to be multidimensional, and that just going to a single website alone is not going to accomplish it. They’re going to have to roll up their sleeves and do some real work.

Q: What are the biggest barriers to improving office practice care?

A: The office practice today is similar in so many ways to the office practice that existed 50 years ago. Because changing care is multidimensional and the environment is complex and stressed, it often seems like a daunting task and people don’t know where to begin.

First and foremost, they need to recognize that the tools are there to help. For example, if an office practice spends just a little bit of time thinking through some of the issues of flow, scheduling, and efficiency, they will harvest resources that they didn’t think were available. And once they begin to harvest resources, staff morale gets better because they see progress, the resources can be deployed more fruitful enterprises, and you begin to get more positive feedback instead of negative feedback for change.