March 2008

Practice Networking

"Lean" What does it really mean?

LEAN is looking at the processes that you currently have in place and determining if there are steps (waste) that can be eliminated.

I know, you're saying to yourself that the processes you have in place are fine. As a former Practice Manager at a busy PCP practice, I said that myself. But are they really? And are staff who use these processes doing it the same way? I thought my staff were, but I was disillusioned. By going through the process of looking at work processes I can guarantee you it will make your staff and the processes they use more efficient. It will also do something very exciting! It will bring staff together. They will talk processes through, together. They will listen to each others ideas and concerns, together. This fosters teamwork and communication which to me is the foundation of any successful practice. It becomes contagious. Your staff will have a voice in what they do and how they do it and they become the "change-agent". They will be committed to making it work. It will energize them and you get the "buy-in" you need to make the changes for a more efficient practice.

So, you're thinking, "this all sounds really warm and fuzzy, but how do I even start this process?" Let's look at an overview of the steps that need to take place:

• Identify an area of interest, - Are there processes that appear inefficient or lead to frustration?
  o Example: Exam room supplies, are they the same in every exam room? Are draws and cupboards set up the same way? This allows physicians and clinical staff to efficiently use any exam room.
• Convene all involved at the table: providers, clinical and clerical staff
• Make a flow chart of the present protocol/process; start at the very beginning: who does what and in what order is it done
• Take each step and analyze it; does it work? Is there a better way, new idea?
• Make a flow chart of the new protocol/process
• Then do a PDSA (Plan, Do, Study, Act) and try the new protocol/process for 1 week.
• Have staff document concerns in a binder. Reconvene
• Discuss what is working & what is not
• Ideas for rework
• Map out the flow of the updated protocol/process
• Continue the above until all areas of concern have been addressed and changes agreed upon
• Write a new protocol/process for all to adhere to until discussion for change has been addressed, agreed upon and communicated to all involved

Now you're thinking, "how much time and effort will this take?" Let me assure you, the time and effort you put into this process will come back tenfold in the form of increased efficiency! The team work and communication that it will foster, along with the energy it creates, makes it more than worth the effort! You can even team up with another manager and look at each other's processes for ideas to help you get started. Sandi Daigle, Practice Support Specialist, MMC PHO

You Are Invited To Attend Prism 5!!

The next Practice Improvement Series Meeting (PRISM) is scheduled for May 8, 2008 at the Harraseeket Inn, 162 Main Street, Freeport, Maine. It's an all-day conference beginning at
7:45 a.m. through 3:30 p.m. Breakfast and Lunch are included. The theme for PRISM 5 is "Partnering with Patients."

Our Keynote Speaker is Michael Wolf, MA, MPH, PhD, Assistant Professor of Medicine and Learning Sciences within the School of Medicine at Northwestern University. Dr. Wolf's presentation will focus on Health Literacy and what it means to primary care practice teams.

Throughout the course of the day, we'll have 16 Breakout Sessions for you to select from. Topics will include:

• Guiding Your Patients to Good Health: Free Nutrition Resources in Your Back Yard
• Medication Reconciliation: Developing a System of Communication with Primary Care, Hospital, and Patient
• Hands-On Skill Building with Patient Communication Techniques
• Culture Begins Within: Self Reflection and Systems for Partnering with our Diverse Patients
• Making Dollars and Sense out of Quality Patient Care
• Substance Abuse Treatment for Adolescence and Adults
• Patient Experience Surveys: A Practice Perspective
• Patients as Advisors: A "How To" and Lessons Learned
• Personal Health Records:How They will Benefit You and Your Practice
• Promoting Shared Decision Making in Your Practice
• Planned Care Model: A Framework for Quality Care
• Asthma: Impairment, Risk, Control…The 2007 Guidelines
• Diabetes Update: The Most Recent Guidelines on Managing Diabetes
• How to Incorporate an EMR into a Patient Visit

In addition, the topic for our afternoon plenary session will focus on "Consumer Engagement," presented by Rita Zanichkowsky.

Please Join Us!

Primary care practice teams including physicians, clinicians, administrators, care managers and others interested in improving care for patients with chronic disease are welcome to attend.

Our official agenda and registration brochure will be sent out in mid-April. Space is limited so be sure to register today by email mhlc@mmc.org, fax (207.541.7547) or phone (207.541.7569). When doing so, please remember to include your name, credentials, title, practice, address, phone number, and email address.

Geriatrics Day 2008

Ah! Asthma Health: You Asked For It, You Got It.

Two other tools that can help you to provide quality care for your patients are the new Inhaled Medications list and the Asthma Control Test (ACT). The Inhaled Medications list identifies controller and quick relief medications, their class, age recommendation, doses-strengths, and priming protocols.

The Asthma Control Test is a validated, self-administered test using 5 questions for ages 12 and up and 7 questions for children ages 4-11. The ACT was developed by physicians to be consistent with current national asthma guidelines and to help provide a quick assessment of a patient's asthma control. This is a helpful tool to facilitate communication between you and your patients.

Both of these tools are available on the MaineHealth and JS McCarthy websites listed above. Please contact Program Manager, Donna Levi levid@mmc.org or 541-7566 with any questions or comments regarding the AH! Asthma Health Program.

Heart Disease: Women's Public Enemy No. 1

1. Heart Disease 27.2%
2. Cancer 22.0%
3. Stroke 7.5%
4. Chronic Lower Respiratory Diseases 5.2%
5. Alzheimer's Disease 3.9%

The American Heart Association's "Go Red for Women" movement and "Choose to Move" physical activity program offer information, tools and motivation to get risk factors for heart attack and stroke under control. Another wonderful new resource for anyone with cardiovascular disease is the American Heart Association's "Heart Insight" "Heart Insight", an online magazine featuring tips on healthy living for patients, their families and caregivers.

Mental Health Integration Program

Our Phase II sites represent many MaineHealth members and affiliates. They include Greater Portland Medical Group (Cape Elizabeth), Greater Portland Pediatrics (Westbrook), MaineGeneral's Horizon Clinic (Gardiner), Martin's Point (Brunswick), Miles Pediatrics (Damariscotta and Boothbay), St. Mary's Medical Associates (Lewiston), Health Connections of Pen Bay Medical Center (Rockland), and Maine Medical Center Geriatrics (Portland). We will be working with these new participants - and continuing to work with Phase I participants - over the next three years to employ a standardized mental health assessment tool in primary care, integrate mental health services directly into primary care practices, strengthen the link with local specialty mental health resources including psychiatric consultation, maximize the role of care management, and work toward financial sustainability.

Participants were excited and enthusiastic about the program, happy to meet their partners "face-to-face", appreciative about how "complex theory was presented in simple terms", and anxious to get started on the work.

The High Price of Diabetes

The Effects of Therapy with Inhibitors of the Renin-Angiotensin System on Proteinuria in Patients with Renal Disease

A Message from our Ambulatory Program Architect