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Stories of Change :
Transforming Teams in Tennessee

by Randall C Rickard, MD
Family Practice Partners - Murfreesboro, Tennessee

TransforMed has indeed brought transformation to our four-doctor practice working in two sites in Murfreesboro, Tennessee. Family Practice Partners began the demonstration project as a disjointed amalgam of two practices sharing a common tax ID number and accounts payable system. We were advanced in our technology implementation with a running EHR, Web site, and capacity for on-line visits.

We came to realize that our greatest need and challenge was to establish the team concept both within each practice site and between them. We began by improving communications. Various groups of individuals met to discuss particular areas of their team's focus. We formed teams on leadership, billing, finances, practice integration. These "team meetings" introduced the concept of teamwork by presenting actual problems in need of solution. Through mutual problem solving, members rose to a different level of participation than previously had been expected of them. Fresh ideas for improved access and efficiency began to be implemented as a result of their work.

Progress was achieved in all areas, but two in particular stand above the others in terms of what was achieved. One was the concept of the "huddle". Once a foreign idea, regular and quick huddles are now an integral part of the workday. Huddles are basically mini-meetings between doctors, nurses, and receptionist. We use them as a way to begin each workday. Team members are empowered and directed toward day-specific goals to reduce patient wait times and improve our team's efficiency.

The second area of immense progress has been the integration of our two practice sites. We realized at our first joint meeting that some of the staff had never even been introduced before. Now the staff at our two offices acts as if they are from a common site, engaging in lively dialogue from the moment they get together. We coordinate efforts in billing, staffing, and supply acquisition in a way that we never thought possible before.

This did not come easily. Our efforts were met with resistance by some individuals who, due to individual abilities and personality types, were comfortable in their niche before we began our TMED innovations. Co-workers are not necessarily team members by nature. A true "team" needs to function at a higher level than coworkers, and insisting on a team forces people to change. A co-worker can grow into a good team member, or may feel more comfortable moving on to another work environment.

Those who grew and adapted continue with us and have become more satisfied in their new work environment. Some staff chose to leave for various reasons and our new hires have been selected with an emphasis on team skills. Selecting employees for team attributes and having them come on board with the team concept in place can have advantages over evolving into a team, and the resulting changes have been phenomenal.

Our workplace is now a more satisfying place for doctors, employees, and patients alike. Hope and pride now trump frustration and ennui. Our patients can't help but notice, even though the process of change has just begun to solidify the new face we are projecting.

From our efforts to redesign our practice, we have learned that to lead a group to this better place, the vision must first be clear. Our TransforMED facilitator helped us solidify our vision. This vision became an inspiration that in turn created a natural motivation and commitment to see the changes through– which helped a lot when new ideas seemed foreign to us initially. The improved communication provided by our teamwork allowed this motivation to spread to the team members and accelerate our change by showing positive benefits more rapidly.

It has taken courage to deal with the resistance to change we have faced, but adhering to the goals has helped to truly transform our practice. I am excited to think what this new team can accomplish as it addresses the future needs of our practice.

Visit the Family Practice Partners Web site

Read Dr. Rickard's bio