Greg Long, MD, says positive change is possible in today's healthcare environment.

The proof is in his practice's nearly 30 percent reduction in daily patient visits — along with a $12,000 jump in the monthly operating margin of ThedaCare, a 90-physician integrated delivery system in Wisconsin, where Long is medical director.

Making some key changes in the patient-flow process has also translated into a more manageable workweek for Long. With the scheduling bottlenecks largely cleared and office efficiency ramped up significantly, he finds he no longer spends hours at the end of the day catching up on paperwork and phone calls.

"I'm keeping up on dictation, documentation, and coding. So when the end of the day rolls around the majority of things are done," he says, adding that while his practice life is "still hectic and packed, it's a different kind of busy."

Thanks to more efficient, targeted use of staff and improved communication using technology, patients in Long's practice no longer have to wait — either for appointments or in the waiting room. As a result, they're visibly more satisfied, and that is reducing stress on everyone else. "When the patient feels more satisfied, and the whole interaction the patient has with the system is positive, the doctor feels better and the staff feels better," he says.

Long's experience is not unique. Practices of all sizes and in all corners of the country are finding that, by making some fundamental changes to office operations, they are reaping the rewards of greater efficiency and career satisfaction. Incoming results from a three-year-old initiative by the Institute for Healthcare Improvement (IHI) on the way care is delivered at the practice level indicate that embracing change and encouraging innovation are not only possible but, ultimately, profitable.

The practices interviewed in the following article have all seen their bottom lines stabilize or improve as patient and staff satisfaction rise, the quality of care increases, and — wonder of wonders —inefficiencies decline. If they can do it, why can't you?

Starting over

It may sound simple, but to change the way care is delivered in most physician practices requires a whole new mindset.

"If we want to rid the current system of its defects, we have to start with a clean slate," says Charles Kilo, MD, a fellow of the Institute for Healthcare Improvement (IHI), a Boston-based nonprofit organization whose mission, as its name suggests, is to improve the quality of healthcare. The group heads up initiatives that find ways, for example, to improve clinical outcomes, broaden access, and lower costs.

The IHI's formula for problem-solving is simple: Rather than try to fix problems as they happen, look at the big picture, then break it down into several smaller elements to be worked on as parts of the whole. It's the same method many educators suggest for completing large or multipart projects. It works. And it's the guiding principle behind the IHI's Idealized Design of Clinical Office Practices (IDCOP), which seeks to re-engineer the way care is delivered in the most common ambulatory setting — the doctor's office.

The successes that these evolving practices are enjoying shouldn't come as a surprise. The reality is, many of the IDCOP ideas aren't new: streamlining patients' movement through a visit by better use of staff and space; using technology to manage processes and patient data; getting rid of schedule backlogs by making office visits more productive and fewer in number; and delegating to staff more effectively, freeing up physicians to focus on the work that requires their expertise. But when practices try to implement change in a system with well-known constraints, like limited time with patients and capitated payments, it's tough to make progress.

"So much of what we have seen has not been a failure of the concept, but more a failure of the culture to implement the concept," Kilo says.

Under the aegis of IDCOP, however, ThedaCare and about three dozen other practices — ranging from solo-practitioner sites to 200-physician clinics — are implementing the concept, and producing impressive results. Participating practices, which pay approximately $25,000 per year over three years to access IHI's expertise and assistance, are encouraged to embrace the IDCOP model's four key themes — access, interaction, reliability, vitality — in a manner that best meets the needs of the patients they serve, while tapping the knowledge and experience of their staff members. That may sound like Customer Service 101, but as most practices know too well, the "system" (and all of its flaws) often gets in the way — and staff feel powerless to change it.

Try something different