Phase 1. Getting Started

Integrating Chronic Care and Business Strategies in the Safety Net: A Toolkit for Primary Care Practices and Clinics

Key Change 1.1. Organize Your Lead Quality Improvement Team

The Chronic Care Model calls for a paradigm shift in the way we think about medical care. Instead of focusing on the acute needs of individual patients, the Chronic Care Model calls practices to a thoughtful, organized, proactive approach to improving the healthcare of a population of patients. The goal of focusing on a population of patients, such as people with diabetes, is to ensure that every patient receives optimal medical care. Initiating and sustaining this kind of shift in thinking requires strong and effective leadership and a clear strategy for improving care. Based on our research and experience working with teams, effective quality improvement is a team sport. The most effective teams include at least three categories of members. These can be summarized as:

  1. Senior leaders: These organizational leaders allocate resources, remove roadblocks, and support spreading the changes to other practices.
  2. Clinical champions: Practicing providers, usually physicians or nurses, these individuals are respected opinion leaders who understand the environment and processes of care, drive improvements and motivate colleagues.
  3. Day-to-day champions: These team administrative leaders keep up momentum, convene and coordinate colleagues, and oversee implementation of change ideas.

It is important to ensure that this work is done, even if your improvement effort doesn't have three separate individuals in these roles.

Safety net clinics experienced in implementation of the Chronic Care Model say that one of the most important steps is to assemble and use your lead team well. This team will include representation from clinical, administrative and financial settings in your organizations. The team will be active in identifying the area to be improved, discussing resources needed, and coordinating the moving parts of whatever improvement you select.

ActionsTools
Assemble a lead team to represent all disciplines and roles in your practice, ensure regular meetings, and work to actively engage all staff and patients.Forming the Team (guide)6
Focus leadership attention on improvement.Seven Leadership Leverage Points (white paper)7

Additional Resources

  • The Health Disparities Collaboratives spent considerable time thinking about team functioning. Here is a presentation they used entitled, the Zen of Teams.8 

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Key Change 1.2. Familiarize Your Entire Team With Key Improvement Strategies

Experience tells us that for change to be successful, a team needs to have a vision of both where they are trying to go and how they are going to get there. In this key change, your team will want to acquaint itself both with the vision of a high quality practice—through the Chronic Care Model—and with the strategy to get there—through the Model for Improvement. The resources listed below will provide a succinct primer on the essential elements of these two models. Many of you have undertaken Chronic Care Model-based improvement collaboratives on your own, and this information will be familiar to you. If not, consider that peers in your area, or even other parts of your own system, may already be experienced in these areas and can provide valuable information.

ActionsTools
Learn the Chronic Care Model as a system for redesigning your current care delivery.Chronic Care Model Primer (guide)9
Learn the Model for Improvement as a quality improvement strategy that teaches the team how to make rapid changes to their practice and measure their progress.A Model for Accelerating Improvement (online)10
Acquaint the team with efficiency concepts including process mapping.Going Lean in Health Care (white paper)11

Additional Resources

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Current as of August 2008
Internet Citation: Phase 1. Getting Started: Integrating Chronic Care and Business Strategies in the Safety Net: A Toolkit for Primary Care Practices and Clinics. August 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/primary-care/businessstrategies/busstrat1.html