The Virginia Mason Medical The Virginia Mason Medical Center Center ’ ’ s s “ “ Medical Home Medical Home ” ” A team approach to safe and reliable A team approach to safe and reliable patient care patient care Ingrid Gerbino, MD, FACP Washington Patient Safety Coalition May 4, 2010 Seattle, WA
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The Virginia Mason Medical Center’s “Medical Home” Virginia Mason Medical Center’s “Medical Home” A team approach to safe and reliable patient care Ingrid Gerbino, MD,
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The Virginia Mason Medical The Virginia Mason Medical CenterCenter’’s s ““Medical HomeMedical Home””A team approach to safe and reliable A team approach to safe and reliable
patient carepatient care
Ingrid Gerbino, MD, FACPWashington Patient Safety Coalition
The Virginia Mason Production System• There is an obsession with
safety• The patient is always first• There is engagement of all
employees to produce the highest quality
• We strive for the highest staff satisfaction
We adopted the key philosophies of the We adopted the key philosophies of the Toyota Production System and applied Toyota Production System and applied
Urgency: Urgency: ““adults receive 54.9 percent of adults receive 54.9 percent of recommended care.recommended care.””
“The deficits we have identified in adherence
to recommended processes for basic
care pose serious threats to the health of
the American public. Strategies to reduce
these deficitsin care are warranted.”
The Quality of Health Care Delivered to Adultsin the United States
Elizabeth A. McGlynn, Ph.D., Steven M. Asch, M.D., M.P.H., John Adams, Ph.D.,Joan Keesey, B.A., Jennifer Hicks, M.P.H., Ph.D., Alison DeCristofaro, M.P.H., and Eve A.
Kerr, M.D., M.P.H.n engl j med 348;26 june 26, 2003
URGENCY: The Time FactorURGENCY: The Time Factor
• Estimates are that it would take a physician 7.4 hours per day to provide all recommended preventive services to a typical patient panel
• Plus, 10.6 hours per day to provide high-quality long-term care
Source: Yarnell et al, Primary care: is there enough time for prevention, Am J Public Health 2003; 93:635-41
Enhanced Health MaintenanceEnhanced Health Maintenance
Dear Dr. Dipboye,
I wanted to write and thank you for scheduling a routine colonoscopy for me this June. A cancerous tumor was discovered and I had surgery on July 9th removing this mass before it had the opportunity to spread. Without the screening, I would not have known about this tumor as I had no symptoms.
Without a team and a system, the burden of Without a team and a system, the burden of delivering safe care is virtually impossibledelivering safe care is virtually impossible
2
6
8
10
4
16
14
12
Physician(Based on a panel size of 2000 patients)
DirectPatient
Care
Prevention
PatientEducation
Care Coord.
“Practice improvements often fail because they rely on the willingness of physicians, who are already too busy,to take on additional work.”
A primary care delivery system that leverages the skills and training of MDs, medical assistants, RN care managers and pharmacists so can each do what they are best suited to do for the patients served.
Team RolesTeam RolesMedical Assistant:• Standard rooming sequences (vitals, review medication list and updating
as appropriate)• Review Health Maintenance Module for patient’s needed preventive care• Interventions, prompting/coordinating scheduling of these interventions• Shared documentation• Coordinating provider “flow” through the dayRN:• Patient assessment• Empowerment of patient for self care• Protocol driven-teaching and coaching for chronic conditions• Nursing proceduresPharmacist:• Medication management for chronic conditions • Advanced protocols for disease state managementProvider:• Diagnosis and treatment of new problems• Oversight of complicated problems• Minor surgical and diagnostic procedures• Mentor and coach for team based care
We are building a model which allows us to We are building a model which allows us to provide safe, effective and appropriate careprovide safe, effective and appropriate care
The program included the following design The program included the following design specifications:specifications:
• Provide proactive services 24/7 access by phone Detailed patient education Personalized care plan Email access EMR Care coordination between PCP/Hospital/
Our Primary Care/Planned Care team approach Our Primary Care/Planned Care team approach provided the infrastructure for success.provided the infrastructure for success.
• We provide prevention interventions at every contact
• We create enhanced access to care• We provide planned care for patients with
chronic/complex conditions• We develop informed and activated patients• We coordinate information and services for our
Continuous learning through the yearsContinuous learning through the years• While creating a culture that embraces change,
some individuals will ‘deselect’ out of the organization.
• Fully leverage the skills of all of your team members – all have invaluable contributions to safe and excellent care.
• Develop reliable tools that “fool-proof” the delivery of care - this will require continuous tests of change.
• Use simple interventions that can have a powerful impact (e.g., prevention at every interaction, impact of follow up phone calls by a caring team member).
““In times of change, In times of change, learners inherit the learners inherit the earth, while the learned earth, while the learned find themselves find themselves beautifully equipped to beautifully equipped to deal with a world that deal with a world that no longer exists.no longer exists.””