We know the judges want to hear about squeezing an extra 15 percent from managed-care organizations, purchasing endoscopes and X-ray equipment for 10 cents on the dollar, and inventory reduction. The Allergy and Asthma Center does all this like everyone else," the practice wrote in their entry for Physicians Practice's first annual Physician Practice of the Year competition.
But then they went on to showcase so many other innovative, efficiency-building, patient-friendly, and staff-oriented undertakings that our panel of seven judges deemed The Allergy and Asthma Center the Grand Prize Winner for 2002.
"If there's a long-term vision" for the practice, says director William Smits, MD, "it's a freestanding, comprehensive respiratory care center which is the best in the world. And I don't mean that arrogantly. That's the ultimate long-term vision. If people — both patients and staff — realize that, I think they would choose to come here."
Smits refers to the practice as "a yes organization. If anyone is ever saying 'no' to a patient, they need to step back and ask why." Staff flourish in an environment where "people are OK with making mistakes because that's how we learn," and where Smits himself — the sole physician on staff — is far from being the center of the universe.
"It's not Dr. Smits' office," he says. "The importance of that is to spread the responsibility and have people take more ownership. Ideally I would love to see this place run without me, in the sense that [it] would be beyond any single personality. That speaks to a very healthy organization and team."
And clearly, a key part of the team is the patients. "Fundamental to everything that occurs is that we make the interaction between the provider and patient perfect," says Smits. "We want it to accomplish everything that the patient would possibly imagine and then maybe even more. So rather than just walking away satisfied, they're actually — possibly — delighted. That's a formidable goal to do that with every visit."
But like a professional athlete who runs that extra mile or makes that tough goal, this practice does it with a skill and finesse that makes it look almost easy.
• Personalized charts and care plans
• Visit follow-up and surveys
• Patient advocacy
Of the five categories that formed the basis for this year's Physician Practice of the Year competition — technology, office management, finance, personnel, and patient satisfaction, Smits says patient satisfaction is the most important — "all the others hinge on that."
In fact, the practice's mission statement is "We're building relationships to last a lifetime." A personalized section in each patient's chart is one way the practice lives up to that goal. In it, there is something personal noted about that patient — a hobby or pastime, for example — so the physician or nurse practitioner can spend the first few minutes of a visit connecting with a person, not just treating a condition.
Because conditions that the practice treats frequently, like asthma, require ongoing patient involvement and self-monitoring, patients receive a personalized Asthma or Allergy Action Plan in the form of a binder containing a detailed regimen for their condition. Smits and his staff find that standard educational materials, such as a one-sheet with instructions, are ineffective.
"If you just give somebody a piece of paper and say, 'Do this whenever you have trouble,' eventually it gets lost or forgotten," says Smits. "The patient has to be able to identify with this and find it. So we glamorized it; we put it in a three-ring binder with a picture of the patient on the front so it makes it their own. It gives that little extra sense of ownership."
This approach to education is a hit with patients as well as nurses. "People can take control of their asthma and treat it on their own before having to come in," says RN Taryn Ealey. "If they begin to flare up, they know what to do. The patients like it, especially children, and it helps parents feel more at ease, knowing that if something happens they have the information right in front of them."
Calls from patients needing help controlling their conditions dropped off significantly once the personalized plans were in place. "That was how the nurses bought into it," Smits notes.
Follow-up is essential to the overall patient experience. New patients receive a phone call one week after their initial visit to make sure medications are being used properly and are effective; selected existing patients may receive a call from a staff member within two or three days of a visit to see that they are improving and retaining the treatment information that was discussed.
In addition, patients who cancel appointments or who have not returned to the practice for a full year are surveyed as to why. About 70 percent of nonreturning patients say their primary-care physician has renewed the regimen because it is working well; 15 percent say they have gotten better and no longer need medication. Ninety percent of nonreturning patients report being satisfied with the care they received, and the practice has only one or two no-shows a day.