Institute for Healthcare Improvement: Learning and Innovation Community: Redesigning the Clinical Office Practice

Available through the IMPACT network or on a direct-enroll basis, IHI’s most intensive front-line improvement work happens in Learning and Innovation Communities. These are collaborative change laboratories in which teams from a wide variety of organizations work with each other and IHI faculty to rapidly test and implement meaningful, sustainable change within a specific topic area.

Download a brief description of this Community

Read about the office practice improvements made by two Community participants:

Redesigning the Clinical Office Practice is available either through membership in IMPACT or through direct enrollment in the Community. Learn more about the IMPACT network.

The Challenge

The Solution

The clinical office practice is, or should be, the primary point of connection to the health care system for most patients. Yet in spite of a growing focus on improving office-based care, the realities of reimbursement and limited resources can make it a challenge
for many practices to provide well-coordinated care that addresses patients’ needs and wants. The good news? With the right tools and strategies, it can be done, and done well.

Over the past 10 years, many dedicated physicians, nurses, and other care team members have worked to redesign their care systems. One of the most important lessons from that work is the importance of putting the patient experience (what is important to them) at the center of any redesign effort. This patient-centered focus means that every patient:

Receives care in a safe and reliable way that is based on the best clinical evidence, is efficient and free of waste.
Knows their physician and care team. In addition, the physician and care team know the patient as an individual and can provide information and care in a culturally appropriate manner. The patient is supported by a care team that is well trained and works together to best meet their needs.
Has a plan for their care that is based on what is important from their perspective. Is supported in the self-management of their chronic and health conditions.
Can request an appointment or other service without delay. Can easily obtain information when needed.
Knows that someone from their care team will be their guide when they need care from multiple providers and settings, including diagnostic services, specialty care, inpatient, or home care.

Areas of Focus

Knowing what needs to be done is different from knowing how to do it. Whether you have system transformation or a single goal in mind such as achieving same-day access for your patients or providing perfect care for every patient, the Redesigning the Clinical Office Practice Learning and Innovation Community can help you and your organization and/or practice set aims for your work, develop step-by-step plans, and measure progress. Inherent in all our system redesign work is integrating key strategies to assure a patient-centered focus, reliability, and workforce vitality.

We will do this by focusing on the following “tracks” that will bring together teams who are working on common changes in their practice:

Improving access-to appointments, information and specialty care without delays
Reducing waste and improving efficiency
Improving the delivery of patient centered, planned care (care that meets the needs of patients in a proactive way) by focusing on patients with multiple and/or complex chronic conditions such as Heart Failure, Chronic Obstructive Pulmonary Disease (COPD), Depression, Diabetes, etc.

The Community is designed to address the needs of a variety of outpatient and ambulatory practices and clinics, including primary care practices and clinics, multispecialty group practices, large integrated delivery systems, ancillary practices such as physical therapy, occupational therapy and radiology, as well as academic medical center clinics.

Large systems and/or networks will have the option of participating in a special track to assist them in developing and carrying out a plan to leverage changes implemented in an initial pilot practice or clinic across their entire organization or network.

For those practices involved in medical home initiatives, the activities and change strategies used in the Community will be mapped to the National Committee for Quality Assurance (NCQA) Standards and Guidelines for Physician Practice Connections®—Patient-Centered Medical Home (PPC-PCMH™) and can assist organizations in meeting those standards.

Aims

The overall goal of the community is that patients will receive the care they want and need, when and how they want and need it…while at the same time building a joyful work environment and a financially viable organization.

Progress toward aims will be measured using indicators, such as:

Increase by 50% the percent of patients who are confident they can manage their health or condition
Reduce delays for an appointment in primary care to within 1 day, as measured by third next available appointment
Reduce delays for an appointment with specialists to within 7 days, as measured by third next available appointment
Reduce patient cycle time in the office to no more than 1.5 times the actual time spent with clinician
Increase by 50% the percent of patients receiving evidence-based care for their health or condition