This approach, in which clinic staff work together to redesign their systems to become more patient-focused and efficient, is described in a new Commonwealth Fund report, Achieving a New Standard in Primary Care for Low-Income Populations: Case Studies of Redesign and Change Through a Learning Collaborative, by Pamela Gordon and Matthew Chin of PCDC. The report illustrates how four New York clinics improved operations using this process. In addition to the dramatic improvements at Union Health Center, PCDC helped the Jerome Belson Health Center in the Bronx shorten average patient visit times, helped the Brownsville Multi-Service Family Health Center improve its finances, and developed a marketing and customer service program at the Urban Health Plan in the South Bronx to bring in new patients.
"Primary health care clinics are crucial to the health of families and the vitality of the communities they serve," said Anne-Marie Audet, M.D., assistant vice president for quality improvement at The Commonwealth Fund. "These clinics' success stories can provide lessons for other health providers seeking innovative ways to strengthen their performance and improve the quality of the care they provide to their patients."
Once a new system is in place, PCDC works with staff to ensure that changes will be sustained over time. "We have to combat the belief that changes are permanent, or what we call the myth of the self-maintaining innovation," said Ronda Kotelchuck, PCDC's executive director. "PCDC has learned that the improvement process is not a finite project; it is a never-ending commitment that requires continued organizational focus, resources, and course corrections," say the authors of the report.
PCDC is a nonprofit organization whose mission is to help to build a sustainable primary care infrastructure in underserved communities through construction loans and technical assistance. It has worked with dozens of health centers in New York City to streamline and improve their systems since its founding in 1994. PCDC recently received a state grant from Health Care Reform Act funds to expand their services to clinics throughout New York State.
PCDC's learning collaboratives last six- nine months, during which clinic-based teams work with PCDC's experts to examine their systems' operation, develop changes, and then work to implement the changes in the clinic. Efforts to sustain changes are ongoing.
The four case studies detailed in the report include:
The Jerome Belson Health Center, in the Bronx, a center operated by the United Cerebral Palsy Association of New York State that serves a developmentally disabled population. The Belson Center achieved:
- Reduction of total visit time from 68 minutes to 41 minutes;
- Increased productivity by 58%, enabling them to see more patients per hour.
Union Health Center, in Manhattan:
- Developed an on-demand appointment system, enabling patients to obtain appointments with their own doctors, when needed;
- Reduced cycle time (time from when a patient first walks into the clinic to when she or he has been seen and leaves the office) by 93%;
- Reduced patient no-show rate.
The Brownsville Multi-Service Family Health Center, in Brooklyn:
- Increased reimbursement per visit by 55 %;
- Improved operations to eliminate lag times between service and billing;
- Decreased insurance claim rejections;
- Increased patient visit volume in the adult medical care unit by five percent, turning around several years of decline in patient volume.
Urban Health Plan in the South Bronx:
- Created an in-house marketing effort to increase and sustain patient volume through outreach to the community;
- Significantly improved both employee and customer satisfaction.
The Commonwealth Fund is a private foundation supporting independent research on health and social issues. To read or download publications, visit our website at www.cmwf.org.