This article first appeared on Wing of Zock (http://wingofzock.org) on December 6, 2012.
By Stacie Pankow and Scott Shipman, MD
A medical center located in the one of the most impoverished sections of the San Francisco Bay area, Kaiser Permanente Richmond Medical Center is making strides not only to improve care quality and patient satisfaction, but the satisfaction of providers as well.
The motivating factor for the significant provider innovations and initiatives implemented at the center over the past few years, according to Jeffery East, MD, chief of Adult and Family Medicine, is the “best care for the patient.”
“To do that, you have to have a group that is productive and happy,” East said.
Richmond Medical Center has reached both goals: Patient satisfaction has increased at double the rate of other Kaiser centers in the region, and its physicians express the highest level of satisfaction. How did they do it? Through clear expectations, shared workload, fairness, transparency, and collaboration.
With 26 physician providers, the clinic is split into five stations. There are four to five physicians at each station, along with MAs and nurses. Half of these physicians work full-time; the other work part-time schedules, which the practice encourages to promote work–life balance. For those physicians electing to work a part-time schedule, administrative duties and patient care are shared proportionally: For example, those who work 80 percent of a full-time equivalent (FTE) cross-cover one another’s patient panels. Those who work 60 percent FTE share patient panels with another part-time provider. According to Dr. East, this change in the physician workload has dramatically reduced physician burnout at the center.
A computer program tracks cross-coverage and workload, as well as provider efficiency. The tracking program generates a monthly report that shows how long it takes for each provider to do certain tasks (office visit, phone visit, medication order, lab report review and clearing, email response). Providers who are highly efficient are identified and help to train their colleagues. This initiative, known as “physicians helping physicians,” helps build relationships among providers and ensures that each provider is working at maximum efficiency. Rather than punishing those who struggle with efficiency, this system rewards the best by acknowledging them as experts and providing them with time to assist their peers.
Despite the success of these innovative practices, Richmond Medical Center is not standing still: Its team is continuously planning for future innovations. The center has a diverse patient population: Almost a quarter of its patients are Latino; many speak Spanish. To improve patient-centered and culturally sensitive care, one of the center’s newer innovations is staffing one of the five team stations entirely with providers, nurses, and MAs who are fluent in Spanish.
These are only a few of Richmond Medical Center’s efforts to provide innovative and team-oriented primary care. The quest for increased satisfaction does not end with patients and physicians. Expanding the roles of MAs and other ancillary staff members enables these other team members to work at the top of their licenses and involves them integrally in care giving. It permits individualized patient outreach, increasing the quality of care as it focuses on patients with chronic illnesses. The center is also working to reduce costs and improve efficiency through a reduction in referrals by having specialist consults occur during the primary care visit, either over the phone or in person, as extended members of the team. Respect for patients’ time and provider productivity is enhanced by the implementation of scheduled phone and email visits.
At Richmond Medical Center, Kaiser Permanente continues to demonstrate its leadership in patient-centered care delivery innovations, as evidenced by high-quality care, enhanced efficiency, and high patient satisfaction. Additionally, the center’s efforts demonstrate that positive patient-centered outcomes can coexist with a culture that prioritizes physician and team satisfaction.
-Stacie Pankow is a Research Analyst in with the Association of American Medical College’s Center for Workforce Studies. She can be reached at email@example.com.
-Scott Shipman, MD is the Director of Primary Care Affairs and Workforce Analysis with the Association of American Medical College’s Center for Workforce Studies. He can be reached at firstname.lastname@example.org.
Special Note: In 2011, the Physician Leadership Forum, in follow-up to an educational session, developed a guide describing many of the core concepts of team-based care. This free guide features case studies on how three different leading-edge health care organizations (AtlantiCare Health System, Brigham and Women’s Hospital, Marquette General Health System) approached fostering team-based care. While each organization approached the issue differently, several common themes emerged – having strong leadership in place to lead the change, using data to drive and sustain the change, and training everyone to work as a team. The three organizations also clearly demonstrated that the best way to motivate a workforce is to find their passion. To download this free guide, click here.