How to Create a Plan for Medical Practice Improvement

Recently I was talking to one of my clients about self-improvement. I asked him, “How many people get up in the morning and think about how they could be better today than they were the day before?”

He answered, “Not enough,” and added the Henry David Thoreau quote: “Most men lead lives of quiet desperation.”

As I considered his answers, I agreed that many do indeed live lives that lack direction and purpose, just getting by day to day, trying to survive their challenges.

I think that these conclusions can also apply to businesses, including health care. Many organizations do not try or do not understand how to improve outcomes, whether a service or product for their clients.

They do not keep a focus on their mission and strategic plan. Rather, they face their challenges in a haphazard fashion, sometimes succeeding but often failing.

For instance, a recent poll by the Medical Group Managers Association found most of their member sites have not checked to see if they are compliant with the new HIPAA standards that begin on January 1, 2012.

However, many organizations do have tools and processes in place, which they consistently employ to help them improve, such as the Toyota Production System (Lean), Total Quality Management and Lean Six Sigma.

At the heart of each of these is the Plan-Do-Check-Act cycle (PDCA), which was developed by Walter Shewhart. The PDCA cycle can be implemented as a problem-solving technique by most organizations with some brief training or study.

I will briefly describe and illustrate the Plan phase of PDCA, which can be used to solve challenges such as the implementation of an EHR, implementing evidence-based practices and designing processes, which improve the outcomes for your patients while helping staff and physicians find more time to spend with patients.

Know Your Goals
The first thing to do is identify is your goals. Do you want to improve the outcomes for patients with chronic diseases? Do you want to find more time to do things you deem important in your practice, such as creating a positive work environment?

For larger organizations, these goals are often found in their strategic plan. Some goals are dictated by challenges forced upon providers by outside organizations, such as using ePrescribing.

Prioritize Your Challenges
Leaders in management and senior physicians should work on challenges that have an impact on more staff, which are more complex and which may require greater funds to solve. For instance, the leadership team would be responsible for the adoption of EHRs.

Other staff can focus on challenges that affect them but are not readily apparent to all staff. For example, the receptionist and office manager at a small ambulatory site can work on organizing supplies and making sure that there are no unexpected disruptions in their availability.

Once staff and physicians have identified the challenges, they should be prioritized. Focus first on those that affect patient safety and outcomes as well as the bottom line.

For example, it is imperative for many organizations to upgrade to the HIPAA 5010 standards, as there will be significant financial problems for those who are not up to date by January 2012.

Form a Team to Design a Solution
Most challenges require more than one person to find a viable solution. In the case of HIPAA 5010, for example, an IT staff person or staff member in charge of the software, office manager, physician, and billing staff should be involved at a medium-sized primary care site.

A manager or physician should identify a leader of this team. This person will be responsible for the work of the team and for the implementation of the plan that it develops. It is very important that one person be in charge and responsible for the outcomes.

Collect Data
How will you know if you are advancing towards your goals? You should collect data! First, decide what you will measure. If you are adopting ePrescribing, you would want to see how much time each day is spent by staff and physicians providing prescription services, including time taken for refills and for faxing back and forth to pharmacies.

Then, as you implement an ePrescribing system, measure how much time these services take at various stages of implementation. As staff members become more fluent with the software and develop new workflows, the time taken should decrease significantly.

Design a Plan
The team working on the challenge should create a document that lists the goals of the PDCA project, who is responsible for the project, the steps to take to reach the end and a timeline for completion.

If the project is large, I would advise breaking it into smaller, sequential projects that are easier to manage and easier to achieve. For instance, in the adoption of an EHR, the first project would involve research into finding ones that meet the needs of the staff. After an EHR is purchased, the second cycle of the PDCA project would be the implementation of some of the features of the EHR into the daily work of the physicians and staff.

Plan-Do-Check-Act is a rational process that businesses can effectively use to solve their challenges. It is based upon the scientific method, which is the basis of much of the work of medicine.

It makes sense, then, to adopt this technique for the improvement of the services and work of all staff at a healthcare site. If you are not using such an approach now, you should plan to do so.

Do you already have a medical practice improvement plan in place? If so, what aspects of your medical practice improvement plan do you need to embolden?

Read part two of the PDCA series, “Do-Check-Act: How to Enact Your Plan for Medical Practice Improvement,” here.

Donald Bryant is a healthcare consultant who helps healthcare providers meet their challenges. Visit Bryant’s Healthcare Solutions website to get a free article: 7 Challenges in Healthcare and How to Solve Them. You may also contact Mr. Bryant directly at 616-826-1699.

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