June 5, 2019
Notes & Updates
It's hard to change. Practice settings, workflows, individual characteristics, and time constraints all affect our will and capacity to try something new even when the status quo is not working for us.
Penobscot Community Health Care (PCHC) is a federally qualified health center located in rural Maine. It serves more than 60,000 patients across 15 practice sites, including nine primary care practices, and it employs 700 people, including 200 providers. In January 2014, we attempted a major change across our primary care sites – implementing a “delegate model,” a team-based approach to care featuring an enhanced medical assistant (MA) role.1
Under this model, MAs are trained to take on additional administrative tasks thereby reducing the burden on primary care providers. The model combines two primary care providers and their MAs to form a team with a shared panel of patients and adds a full-time “care team MA” (CTMA) as a fifth team member. The CTMA, after approximately 30 hours of training, can then take on a range of responsibilities. These include previsit planning, standardized prescription renewals, schedule management, provider in-box management, and identification of patients for routine auxiliary testing and referrals (e.g., mammograms, behavioral health, and care management) using an expanded set of standing orders.
Our change team's initial strategy was to identify teams in five of our larger primary care practices that would champion the new model and share their experience with their peers. As others observed and heard about the success of the model, they too would want to participate. After two or three years, the new model would become the new norm – or so we thought.
In this article, we will share what really happened, as well as the lessons we learned at the three critical stages of change – adoption, implementation, and sustaining change.
Danielle Ofri, MD, attending physician at Bellevue Hospital and Associate Professor of Medicine at New York University School of Medicine, deconstructs the perception of perfection. In a medical culture consumed with perfection, making mistakes is deemed unthinkable and promotes an unrealistic expectation on the part of patients.
Embracing the concept that “sunlight is the best disinfectant,” Ofri makes the case that errors are not an aberration to be swept under the rug, but rather a natural occurrence that we should study and learn from them to foster a culture of understanding, and ultimately better outcomes for patients.