The second component of the Model for Improvement is the Plan-Do-Study-Act (PDSA) cycle, the improvement engine or thought process applied to a desired improvement.
Steps include: Plan. Planning an intervention; Do. Testing the change on a small scale; Study. Observing, measuring, and analyzing the test of change; Act. Using the knowledge gained to plan the next steps.
Sustain Change-Imagine you have tested multiple changes using small-scale, rapid PDSA cycles from the Model for Improvement. Some of those tests resulted in the implementation of a successful new process or way of working. How do you effectively sustain the new way of carrying out the work?
•Ensure the change is ready to be implemented and sustained. Allow time for experimentation, since that provides freedom to
A quality improvement (QI) strategy is an approach to change. It provides a framework and tools to plan, organize, and then to monitor, sustain, and spread the changes that data show are improvements.
Patient-Centered Medical Home (PCMH) transformation entails numerous changes—to processes, workflows, scheduling systems and the care team structure, among others. Adopting a stable quality improvement (QI) strategy gives staff confidence, skills and a specific approach to use in making these changes. Measurement is an essential part of QI. Measurement provides feedback to staff, providers, leaders, board members and patients about the organization’s progress toward transformation and the outcomes of the care they provide or receive. Health information technology (HIT) is part of the Quality Improvement Strategy Change Concept because
A key role of leaders during PCMH transformation is to identify and allocate resources to best support PCMH transformation needs. Resources include time, dollars, staffing, equipment, technology and other types of support that either help staff implement or sustain PCMH key changes . Engaged leaders are physically present throughout transformation and sustain staff energy and motivation by working with staff to identify and remove barriers to transformation. Engaged leaders create a work environment supportive of PCMH transformation and give staff protected time and tools to make changes.
Key changes for Engaged Leadership:
Provide visible and sustained leadership to lead overall culture change, as well as specific strategies to improve quality and spread and sustain change.
Ensure that the PCMH transformation effort has the
Implementing care teams is a critical element of transforming a practice into a patient-centered medical home. A care team is a small group of clinical and non-clinical staff who, together with a provider, are responsible for the health and well-being of a panel of patients. Who is on the care team and their specific roles will vary based on patient needs and practice organization.
Key changes for Continuous and Team-Based Healing Relationships:
Establish and provide organizational support for care delivery teams accountable for the patient population/panel.
Link patients to a provider and care team so both patients and provider/care team recognize each other as partners in care.
Ensure that patients are able to see their provider or care team whenever possible.
Define roles and distribute
The relationship between the patient/family and the provider/care team is at the heart of the Patient-Centered Medical Home (PCMH) Model of Care.
Empanelment is the act of assigning individual patients to individual primary care providers (PCP) and care teams with sensitivity to patient and family preference. It formalizes and affirms these partnerships and sets the stage for all of the other components of effective PCMH practice.
For many practices, empanelment is a cultural transformation. Providers and care teams must shift their focus from caring for individual patients to managing the health of a defined population of patients. Empanelment also requires a shift from reactive to proactive care. The goal of focusing on a population of patients is to ensure that every established