Learning Labs : Report from CEO Terry McGeeney

Real-time Lab, Real-time Learning

The goal of the TransforMED initiative is not only to prove the value of implanting the entire new model of care to patients and payers, but to Family Physicians as well.  Another goal is to make the project a real-time lab with real-time learning so that practices can begin the process of transformation and learn from each other.

We have learned early in the TransforMED journey that some Family Medicine practices are doing quite well while others are really struggling.  Many times the two disparate practice experiences are in similar or even the same practice environments.  There is no question that Family Medicine is facing issues of identity and value.  Unfortunately that is the world we live in today.  Family Medicine is faced with quickly changing that world but also learning how to survive and maximize opportunities in the changing practice world we live in.  The AAFP is working hard to advocate for change and TransforMED is working hard to prove value and learn how to maximize current opportunities while minimizing current challenges.

It is clear that many of the obstacles that Family Physicians and their patients face are from within the practices themselves.  Often the physician understands the need for change and is motivated to change, but is poorly equipped to understand and manage the barriers to change.  Often the barriers are from the office staff themselves or partner physicians.

Over the next several weeks it is my goal to continue to identify the issues and offer suggestions based on what we are learning.   We will also ask the external evaluators of the project to share their learning as it becomes available.

Early on several things are becoming obvious:

• Change needs to be anticipated and aggressively managed.  Allowed to simply evolve, change processes will fail and practices will revert to old, ineffective and even detrimental behaviors.
  
• Communication is critical to success.  We have seen great early successes in practices that implement daily "huddles" between physicians and staff as well as regularly planned meetings to address critical practice issues.  It is amazing how many practices do not have meetings either between staff, between physicians, and as importantly, between physicians and staff.
  
• Saying you do something doesn't make it so.  Just because you did it once doesn't mean you are still doing it even though you think you do.  Practices that claim to have advanced or open access scheduling really don't and often don't understand the issues and opportunities.  Practices that say they have an EHR possibly have some components of an EHR but rarely use it to its maximum potential and efficiency.
  
• Many providers appear to recognize that a medical practice is a business.  Even more, it is a complex, ever-changing business.  We all went into medicine to "save lives" and many don't want to deal with complex business issues, but someone within every practice must assume that responsibility.  It is the responsibility of the stakeholders of the practice to insure the business aspect is managed to the fullest.  We are finding that is not occurring in many of the less than successful practices.
  
• There many common sense efficiencies or "low hanging fruit" for reducing office overhead that are often overlooked.
  
• Practices that are successful don't send income out the door to someone else.  The "comprehensive practice" concept advocates that practices do everything they can within the practice.  It makes good economic sense and is good patient care.  Sending a punch biopsy out to the Dermatologist so that the NP can do it makes no sense for the practice or the patient.
  
• Retail clinics are a major concern for practicing Family Physicians.  The way to effectively deal with them is to out service/out perform them.  The TransforMED model of care provides a roadmap to do just that.

I encourage all Family Physicians to take a step back, analyze their practice environments and be brutally honest with what is seen.  Then learn, create a culture of change within the practice and go slowly but deliberately.  

For more information on how to take action on the 7 steps above, click here.  Over the coming weeks, we will get more specific on the issues noted above, but it is never too soon to start reflecting and learning and creating that culture of change that will be so critical to a successful transformation.