By Melissa Gerdes, M.D.
When I first read the Future of Family Medicine report in 2004, I was overwhelmed by the degree of change being asked of family medicine. Now, four years later, I am living in the midst of it.
When we were selected to be one of 36 practices from across the country to participate in TransforMed, my partners and I were not sure we could live up to the promises and hopes imbedded in the project. We also were concerned about dedicating the kind of time needed to implement some of the changes.
The collaborative learning conferences in Kansas City we attended with the other participating practices were invaluable. We learned from the nation’s best about same-day access, chronic disease management, group visits, and online services. We also formed close relationships with the other practices and learned from each other. At one meeting, we watched a “mock” group visit for diabetes, where one practice took us step by step through the preparation, meeting, and after-care aspects of the visit.
At first, when we started the project, the focus was very much on selecting and implementing new components and technologies. For instance, were we going to get an EMR first or do group visits first? As the project went on, most of the practices had to back away from these questions and work on strengthening more fundamental aspects of their practices.
Many of the practices had physicians and staff who either did not want to make the changes or could not make the changes. TransforMed helped with some necessary but painful turnover. It also helped create and strengthen communication structures within the practices. Most of the practices now have daily, weekly or monthly meetings with every member of the practice involved.
Measurement of changes was a crucial component. We measured patient satisfaction, employee satisfaction and wait times for patients. We would share this data with our staff, then work together to decide how to act on the data. We discovered quite a difference in cycle times among the three physicians in my practice. This discovery opened up a discussion with our schedulers, physicians and nurses about ways to reduce the times. By our second measurement six months later, we had reduced our cycle times by 15 minutes on average and we were much closer to each other’s times.
Asking for and acting on input from patients is important. In fact, we usually formally or informally survey our patients for their opinions prior to implementing change.
When we started virtual office visits, or VOVs, we formally surveyed our patients to ask them if they wanted and would pay for the service. About 80 percent of those surveyed were interested in using VOVs and they said they would pay $20, so we charge $20.
Having a facilitator for the TransforMed project—the very gifted David Garrett, M.H.A.—was wonderful. David kept us on track to transform our entire practice in only two years. We had monthly phone conferences with five other practices. I got to know these practices very well during the process. We shared our failures, successes and just simple drama with each other. One month, when I faced a staff reduction of 50 percent (and with a staff of eight, that’s major), I reached out to other practices. They really helped lead me through the emotional upheaval as well as the mechanics of replacing the staff.
Going forward, we are fortunate to be part of the Touchstone Group, which are the original 36 TransforMed practices. We will be continuing monthly phone conversations, metrics and a one-year reunion meeting. I sincerely hope we can continue the tradition of friendship, idea sharing and pioneering the changes necessary in family medicine.