Hud­dling up

UC Davis aims for ‘ex­cel­lent’ pa­tient ex­pe­ri­ence

Modern Healthcare - - Special Section -

Team hud­dles have be­come part of the daily rou­tine among physi­cians and staff at the fam­ily and com­mu­nity medicine depart­ment of UC Davis Health Sys­tem, since the clinic sys­tem un­der­took a “pa­tient-cen­tered med­i­cal home” ap­proach start­ing about two years ago.

Tired of see­ing merely “good” to “very good” re­sults on pa­tient sur­veys, the clin­ics launched the project to fig­ure out how to change their cul­ture and im­prove the pa­tient ex­pe­ri­ence when­ever pos­si­ble, an ef­fort that also has in­cluded the im­ple­men­ta­tion of an elec­tronic health-record sys­tem through­out its net­work of 100-plus physi­cians. These ef­forts have earned UC Davis the Spirit of Ex­cel­lence Award for Ser­vice.

“We wanted to get be­yond the good and very good scores” on sur­veys by Pro­fes­sional Re­search Con­sul­tants, a com­pany that mea­sures pa­tient and em­ployee sat­is­fac­tion, says An­gela Gan­dolfo, per­for­mance im­prove­ment ad­viser for the Sacra­mento, Calif.-based sys­tem. “We fa­cil­i­tated fo­cus groups to find out what pa­tients wanted from us. … We wanted to know, ‘How do we live in a pa­tient-cen­tered world?’ ”

Pa­tients who rated their over­all qual­ity of care as “ex­cel­lent” hit a new high of 78% in July af­ter ris­ing steadily, with oc­ca­sional ups and downs, from 55% in Fe­bru­ary 2009. Sim­i­larly, the abil­ity to sched­ule timely ap­point- ments hit a new high of 88% in July, up from 29% in Fe­bru­ary 2009.

A key part of that jour­ney has been the twice-daily team hud­dles—among fac­ulty teach­ing physi­cians, res­i­dents, nurs­ing and med­i­cal as­sist­ing staff, cler­i­cal staff and su­per­vi­sors—that give ev­ery­one a chance to go over a “mini-agenda” for pa­tients com­ing up in that ses­sion, such as spe­cial needs and teamwork-re­lated goals.

“Medicine isn’t very good at … hav­ing di­a­logue across si­los,” ob­serves Tom Bals­baugh, the res­i­dency pro­gram di­rec­tor at UC Davis. “That’s prob­a­bly one of the key in­ter­ven­tions—do­ing it in a way that’s break­ing down roles, so that each per­son has the abil­ity to have dis­cus­sions and to ask ques­tions.”

In ad­di­tion to putting doc­tors and pa­tients on the same page with re­gard to med­i­cal his­tory, the elec­tronic health-record sys­tem has freed med­i­cal as­sis­tants from cler­i­cal du­ties and en­abled them to be­come more pa­tient-fo­cused, Bals­baugh says.

“Peo­ple be­gan to un­der­stand that hav­ing fewer clerks wasn’t a prob­lem; it was an op­por­tu­nity,” he says.

While res­i­dents read­ily adapted to the new technology, physi­cian cham­pi­ons helped to over­come re­sis­tance among their more tra­di­tional fac­ulty-physi­cian peers, Gan­dolfo says.

“We still have some of that chal­lenge,” she says. “It’s the old school vs. the new school. But we’ve come a long way. We’ve tack­led it through the team hud­dles, get­ting one cham­pion at a time—but you also need a com­mu­ni­ca­tion plan and solid sup­port from hos­pi­tal lead­er­ship.”

Next up: ex­pand­ing this model to the UC Davis Can­cer Cen­ter, in­ter­nal medicine clin­ics and mul­ti­spe­cialty groups.

At UC Davis, team hud­dles are a chance to go over a “mini-agenda” for pa­tients.

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