Wednesday, February 29, 2012

Lean in Ambulatory Care: Report Outs Friday

This week teams will begin to develop and refine work flows and standard work to refer patients to public health nursing.

The group divided up into three teams with different areas of focus related to pulblic health nurse referrals, specifically for our pediatric and homeless populations.

Trigger Team: refining the mechanism for triggering a referral to public health nurses, which includes form refinement and ingraining referral trigger mechanisms within clinic flow.

Communication: developing a feedback loop between the health home and public health nurses, which includes a dashboard to identify those
patients currently being followed by public health nurses.

Education: developing an education strategy to convey what public
health nurses can do for patients at risk.

The Report outs on Friday, March 2 are as follows:

7:45-8:15 AM - Richmond Health Center Lobby
10-10:30 AM - CCRMC Hospital Lobby
12:15 - 12:45 PM - Pittsburg Health Center Lobby

Sunday, February 26, 2012

Cut, withhold or improve?

This week brings the opportunity to speak with members of US Congress to discuss the importance of public hospital and health systems and California's Medicaid program — known as Medi-Cal — which provides health insurance and long-term care coverage to low-income children, their parents, elderly, and disabled people in our state. Medi-Cal is the cornerstone of our health care delivery system and supports critically needed care for over 7 million Californians.

Cuts to Medicaid, whether in the form of caps, or other across the board limits, translate into a potential dramatic reduction in core services for low-income and vulnerable Medi-Cal patients. This is a particularly complex issue as cuts of this nature not only undermine public hospital and health systems ability to care for our community, but challenge coverage expansion efforts under health reform.

This week I will urge members of Congress to resist significant cuts to Medicaid as a strategy. While cutting services and staff, or withholding benefits may seem like an easy way to reduce costs, there is another way: remove defects, duplication, inefficiencies and rework from our health care systems; provide the care that people want and need; produce health.

I applaud The Centers for Medicare & Medicaid Services (CMS) for their leadership in supporting pursuit of continuous improvement and innovation through the 1115 Waiver and Delivery System Reform Incentive Payments Program (DSRIP) in California and most recently in Massachusetts. In contrast to cutting service as a cost containment strategy, improvement, isn't easy: it takes time, it can be difficult to identify which specific changes led to improvement and it requires skill and discipline in improvement methods.

“We can't solve problems by using the same kind of

thinking we used when we created them.” ~Albert Einstein

We are at a critical crossroads. We stand at the threshold of a new era with the real possibility of a reformed health system, but it will take local and national leadership and supporting policy. We can pursue the historically unsuccessful and unsustainable approaches to cost containment we have typically applied in health care, or we can become better. We can cut service in our country, increasing human suffering and despair, or we can improve our health systems and provide the care our communities want, need and deserve.

I am proud of our system and our partners commitment to continuous improvement. I will be following closely the efforts of this weeks upcoming Rapid Improvement Event (Kaizen). I look forward to hearing about the work at this weeks report out and hope you can join me.

More very soon.

Thursday, February 23, 2012

What is a CCRMC and Health Centers, Patient-Centered Health Home (PCHH)?
Primary care is a foundation of the health care system.
The The National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) standards reflect elements that make primary care successful. Primary care clinicians are often the first point of contact for an individual; thus, patient access to care is an important issue.

Based on the NCQA PCMH standards, CCRMC and our Health Centers are actively moving forward in our design efforts. We will begin our fourth Rapid Improvement Event (Kaizen) to advance the PCHH next week. The team which consists of health workers and patient and family partners who use our system will build on the improvement efforts of their colleagues.

Improving quality of care by organizing care around patients (NCQA)
I'm delighted that NCQA revised their standards to be clearer and more specific about involving patients and family members in improvement and design activities. They acknowledge that "some practices may find the program more challenging."

Here is the update from the NCQA:
Through a comprehensive review of new evidence on effective care practices, NCQA PCMH 2011 Advisory Committee discussions, feedback on our earlier programs and a public comment period, we have taken the program to a new level.
Robust patient centeredness is an important program goal: There is a stronger focus on integrating behavioral healthcare and care management Patient survey results help drive quality improvement Patients and their families are involved in quality improvement. (this is fantastic)
We have added a new, standardized patient experience survey and an accompanying standardized methodology. Practices that use this survey will receive extra credit for doing so. Although this is not required, the survey lays the groundwork for broader reporting and benchmarking and makes data available to PCMH program sponsors across the country. This new survey is a tool to track patients’ ratings of the care they get in the PCMH.
Coordinating care and managing information
Just as patient-centeredness is an integral part of the program, so too is a practice’s ability to track care over time and across settings. The amount of clinical information for some patients—particularly those with chronic illnesses—and the fragmented nature of the U.S. health system make this aspect of primary care challenging. Experts agree that health information technology can help clinicians coordinate patient care, but merely having an electronic health record system in a practice is not enough. The health information system itself must be useful, and practices must use it to achieve the goals of coordination and high quality of care.

Fresh air!

More very soon.

Sunday, February 19, 2012

Many thanks to Kaiser Family Foundation for hosting and making available this important discussion on health, care and cost.

Saturday, February 11, 2012

Wednesday, February 8, 2012

Postcard from the Kaizen Team

Dear Colleagues and Partners,

Please find the "postcard" below from the recent Kaizen team addressed to all of you. The team would like you to know about the Kaizen week and related efforts.  I applaud the team for this creative communication test and hope you will provide feedback and suggestions for improvement. Click on the images below and they will appear in full size.


Saturday, February 4, 2012

Congratulations to the 2010/2011 Contra Costa Regional Medical Center Change Agent Fellows

Friends, family and colleagues packed our Regional Medical Center’s lobby last month to celebrate the graduation of the 2010-11 Change Agent Fellows.  Known for their thirst for learning and a desire to lead change, fellows embark on a 15-month journey to become transformational leaders who lead continuous quality improvement in our health system and beyond. This year’s class included Nurse Katherine Heinen, Secretary Wendy Katchmar, Nurse Miles Kotchevar, Employment and Human Services’ Director of Administration Michael Roetzer and Clerk Vernita Travis.
From left to right: William Walker, Vernita Travis, Michael Roetzer, Anna Roth, Kandy Heinen,
 Miles Kotchevar, Wendy Katchmar, Don Goldmann
Joining us in celebration of the completion of the first leg of the fellow's journey was Dr. Don Goldmann, Senior Vice President, Institute for Healthcare Improvement; Clinical Professor of Pediatrics, Harvard Medical School; Professor of Immunology and Infectious Disease and Epidemiology, Harvard School of Public Health. Dr. Goldmann talked about the future of health care and the importance of innovation.  His discussion led us through the foundation of improvement and innovation and toward a call to action. His talk was thought provoking and inspiring.
I am grateful to the fellows, their families and colleagues and to all who have helped to make this year a rich experience for each of them. Many thanks to all who came out to celebrate this wonderful milestone for the fellows and for our system.
I'll post the link to the video the fellows put together which demonstrates how creative this group is and reveals their lighter side.

To find out more about the Fellowship Program, contact Olivia Stringer at

I've got some catching up to do after a long pause. To those emailing reminding me I'm slow to post, I apologize. I reckon it's a case of Bloggers "block."