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How to Make Changes in Your Healthcare Organization

For many of us change is a difficult process. In organizations like healthcare it seems to advance at a snail's pace sometimes. There is a need for change in healthcare, most agree, though we would be hard pressed to agree upon the changes needed. One incentive for change is pay-for-performance programs now beginning in several areas. I would like to describe a couple that affect primary care physicians and then give a few suggestions as to how to adopt changes to take advantage of these programs. Even if you are not in a primary care physician program, the methods suggested for change will be helpful, I believe.

In 2006 Medicare plans to institute a pay-for-performance program at the primarycare physician level. Right now a model is being tested and seems to be doing quitewell. In several states Blue Cross Blue Shield organizations are testing pay-for-performance programs. Here in West Michigan, Priority Health, a healthcare insurer,has promoted such a program for over five years. How does this work, you mayask? Priority Health, for example, funds the program for each of its patients a setamount. Doctors who meet a requirement of the program for a patient are rewardedwith extra money for that patient. Hence, with many patients the income for thepractice can be boosted considerably. The fact is that many are not rising to theopportunity. With planned cuts in Medicare reimbursements over the next few years,this source of income cannot be ignored! Healthcare programs need to change, nomatter how difficult.

The impetus for change should rest with the leadership of an organization, althoughthe change should not be the sole responsibility of the leaders. Representativesfrom all parts of the organization should be involved. Once the need for change in aprocess is agreed upon, either because of extra revenue from pay-for-performanceprograms or other agents or data that positively affect the bottom line, leadersshould convene a task force to plan the change. With input from all, leaders shouldmap the process as it currently exits and then should make a new map of how theywould like it to be to incorporate the positive changes. The new procedure shouldbe standardized for all to adopt.

How do you go about adopting these changes on a daily basis? This is probably thehardest part. Because humans learn in a variety of ways, it will take a variety of waysto implement the changes. The implementation of the changes should be basedupon the learning styles of the individuals involved. Let me provide an exampleusing the Medicare program. A patient who enters the Medicare program is entitledto a paid initial physical. A primary care physician should take advantage ofthis. Many don't. If I were the manager of such an office, I would remind my staffwho set up appointments to be aware of this fact. I would remind them at regularstaff meetings. I would post visible reminders in the office. I might even have amessage flashed on the computer screen once in a while. Then I would review theappointments of patients who have become Medicare qualified and see how manyhad their initial physical or were booked for it. I would adjust my methods to remindstaff of the need for such examinations and continue to improve on this until theoffice achieves 100% compliance with the goal.

Booking the exam is not the only needed change. Doctors who perform the physicalmust accomplish examination details and actions laid out by Medicare. Hence, to bepaid for the exam, each doctor must adhere to the exam details. I would help thedoctors accomplish this in a variety of ways, depending on the doctor's learningstyle. For example, a checklist of the exam details might be included in the patienthistory folder when the exam is performed. That way the doctor will not miss anysteps. As the leader of the change, I would check with billing to see that all thesteps were performed and adapt new approaches or reinforce existing ones to seethat the changes are accomplished 100% of the time.

Changes such as these should be a part of a continuous quality improvementprogram at every healthcare provider organization. Let me quickly review the mostimportant steps. First leaders should identify the changes needed. Then, the leadersshould convene a committee of all affected staff to develop how to accomplish thechange. Once the staff agrees upon the approach, the leaders should develop waysto implement the change on a daily basis adopting methods that incorporatelearning styles of affected individuals. Then, they should continually analyze theprogress of the changes and make necessary adjustments until the goals areaccomplished. They should then audit the changes occasionally to be sure that theorganization doesn't fall back into old habits.

I believe that adopting such a change process will dramatically help at your site. Youwill see savings in time, increased patient or client health and satisfaction, as well asan improved bottom line!

Donald Bryant, certified quality engineer, writes "Making Good Healthcare Better" afree monthly ezine for healthcare providers who want to dramatically improvepatient health, improve the bottom line, and make work more rewarding,guaranteed. To find out more, visit http://www.bryantsstatisticalconsulting.com

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