Health care systems across the country are undergoing a renaissance. The marketplace is being transformed by Accountable Care Organizations (ACOs) that coordinate and regulate the standards of care, adding incentives to improved outcomes and overall cost savings. The passage of the Affordable Care Act has insured more Americans than ever before. Considering the fact that 13 percent of the population is over the age of 65, the need for primary care physicians, who are often the first line of defense in caring for patients with complex medical conditions, is increasing. As the demand increases, the entire field of primary care must evolve to meet it.

“Here at BMC, we wanted a different model of primary care,” says Ellen Ginman, Administrative Director, Primary Care. “We have focused on team building to take BMC’s primary care to the next level.”

Adhering to the national trend, BMC has embraced the team-based model of care called the Primary Care Medical Home, which focuses on population health management, coordinating care between providers, measuring performance, improving care delivery processes and supporting patient self-management. In studies, the team-based approach has proven to improve clinical outcomes, patient safety, patient satisfaction and workplace productivity. For patients this means the care team coordinates all their health needs; from visits with specialists, to annual preventions and screenings, to providing tools to manage chronic health issues like diabetes.

“Traditionally, primary care across the country has followed the model where a patient comes to see their physician every three months and nothing happens during the three months in between visits,” says Ginman. “When you follow a team-based model, you take an engaged staff and teams that work together who step in, help out and do things based on what the patient needs. All of our staff and clinicians were eager to find ways to work better as teams. As caregivers on the front lines every day, they knew that if we did a few things differently, we could provide even better care to our patients.”

So Ginman, together with Medical Director Charlotte Wu, MD, and the rest of the Primary Care leadership team, pulled the entire Primary Care staff together for a vision-setting meeting. Nurses, physicians and administrative staff teamed up to work on a variety of problem-solving team-building exercises ranging from “get to know your team member bingo” to spaghetti straw activities to building structures out of tinker toys. These out-of-the-box activities lay the groundwork for their regular team meetings, where Primary Care staff come together for education, collaboration and solving challenges at a local level.

“We wanted to bring our staff together to work in teams in ways they haven’t before,” says Ginman. “One thing we’ve learned is that when it comes to achieving something really complicated, it always comes down to how well teams work together, so basic team building activities have worked really well for us.”

Next Primary Care staff put their heads and creativity together to form a visual representation of their shared vision. It organizes their priorities, goals and the steps they need to take to ensure success on a wheel of colors, which represent each of the teams within Primary Care.

Incorporating the team colors was a simple, yet effective rallying point that revved up the energy and enthusiasm in Primary Care. Each suite in the Shapiro Center was assigned a certain color and staff were encouraged to wear their color lanyards and clothing. Even the clinics were decorated in the team colors.

“We picked colors because it is something everyone can rally around and it’s fun,” says Wu. “It has also turned out to be a great directional tool for our patients. Not everyone can speak English or read where their appointment is located, but they can identify colors.”

The hard work has paid off; recent metrics have proven that Primary Care is meeting its goals in the areas of access, volume and physician productivity. Since the beginning of the fiscal year, the group has reported a 90 percent patient access number, above the QUEST goal of 75 percent. Primary Care is also significantly above target on patient volume and has seen an influx of new providers to the practice.

“After making a few simple changes, our numbers have improved dramatically,” says Wu. “Not only are we achieving our goals, we are surpassing them. We attribute this to the great teamwork of our whole care team.”

Primary Care has also focused on staff professional development. Recently they held a weeklong career fair that featured workshops that taught resume writing and interviewing skills and demonstrated the resources BMC has to offer, from tuition reimbursement to college program discounts. The event included a panel of staffers who talked about how they worked their way up the career ladder at BMC.

Recognition has also been a primary focus of staff engagement. After taking head shots of each member of the Primary Care team, the group assembled bulletin boards in each of the staff lounges, complete with the names, faces and titles of each person so employees could get to know one another. They also started a “Shining Moments” campaign, where each month a suite hangs a poster to record things they witness other staff doing that go above and beyond to help a patient or colleague. At the end of that month, the Primary Care recognition committee selects a winner for an award.

Despite all of the progress they have made, Ginman acknowledges work still lies ahead. She says the key will be adhering to regular meetings and keeping the lines of communication open.

“People are starting to understand the importance of teamwork in primary care and how staff engagement plays a huge role in making it stronger,” says Ginman. “Primary care is the hub of health care today and doing it well is a team sport. Over the next year, we’ll be thinking of the best way to achieve our goals with our staff at the table to help us. We don’t want to lose our momentum.”

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Boston Medical Center

Originally Posted: August 15, 2014

Appears on: The BMC Brief, Volume 3, Issue 12

The BMC Brief is a monthly staff e-newsletter that highlights staff and department happenings, research breakthroughs, clinical care, and strategic initiatives. This story describes innovations in the healthcare industry with the advent of the accountable care organization and showcases a specific BMC program and how it ties into healthcare reform. This clip demonstrates my ability to follow national trends and apply it to a specific aspect of the organization in a way that is easy for a general audience to understand.

After the end of World War II in 1945, American soldiers came home and started families. Between the years of 1946-1964, millions of babies were born and they became known as the “baby boomer” generation. Today Americans feel the reverberations of this generation as the group ages into retirement and beyond.

“Today more than 13 percent of the population is over the age of 65 and as a country, we have a shortage of geriatricians,” says Sharon Levine, MD, Geriatrics. “We will never have enough specialists to care for older adults, so there is an overwhelming need to ‘geriatricize’ the other medical specialty areas.”

Older adults typically present complex medical challenges for any care provider as there are usually multiple health issues involved, which can often mean a variety of medications to manage. There also are unique challenges in their personal lives, such as caring for an aging spouse or living alone. This complexity, combined with the shortage of medical specialists who are trained specifically to address these issues, creates a gap and results in a significant number of older people who do not receive adequate care.

To address this gap, Levine spearheaded the Chief Resident Immersion Training (CRIT) in the Care of Older Adults program at BMC. The program brings rising chief residents to an intensive, two-day retreat to discuss common challenges in caring for older adults, enhance their knowledge and create awareness of geriatric issues. The program, held in May, attracted 15 rising chief residents and two fellows as participants.

“An unintended, yet positive effect of the program is the bonds formed between participating residents, who might never have had an opportunity otherwise to meet face to face,” says Levine. “By bringing the residents together from a variety of different specialties through the shared experience of this program, it does wonders to foster collegiality between disciplines, improving care for all patients.”

The program, which has been replicated at 33 institutions nationwide, includes an unfolding interactive case divided into three modules: following a geriatric patient from presentation in clinic, following the patient through his hospital stay, and his discharge. Each module includes evidence-based mini-lectures on topics in geriatrics, group exercises and seminars designed to enhance teaching and leadership skills. Together with their faculty mentor, each chief resident develops an action project related to geriatric care s/he can complete during their chief residency year. These projects, aligned with Graduate Medical Education-mandated quality improvement initiatives, support the hospital in meeting goals around quality improvement, patient safety, transitions of care and other key focus areas.

Jolion McGreevy, MD, MBE, MPH, a chief resident in emergency medicine at BMC and member of the hospital ethics committee, participated in this year’s CRIT program. He worked with his advisor to devise a training program in BMC’s Alan D. Solomont & Susan Lewis Solomont Clinical Simulation and Nursing Education Center that explores end-of-life care for patients in the Emergency Department. While the program is not yet finalized, participants will work in different stations, each presenting different scenarios typical in an ED, such as a patient from a nursing home with unclear advance directives or a patient accompanied by their family receiving a catastrophic diagnosis, complete with mock-patient encounters.

“In the Emergency Department, we get a lot of complex scenarios where it can be difficult to know how to move forward with end-of-life care. The goal is to make the culture in the ED more conducive to end-of-life discussions, similar to how it is in intensive care,” says McGreevy. “By opening these lines of interdisciplinary communication in an educational environment, we will establish best practices that will improve patient care.”

There are many projects descended from the CRIT program, spanning from procedural to educational like McGreevy’s, that have been implemented as a standard in caring for older adult patients at BMC. The award-winning CRIT program, now in its tenth year, was first funded by the Hartford Foundation and is currently funded by the Donald W. Reynolds Foundations and the Hearst Foundations through the spring of 2015. Due to the overwhelmingly positive outcomes resulting from the program, going forward Levine says she will focus on methods to sustain the program indefinitely, citing the importance of being prepared for the prevalence of retirement-aged baby boomers.

“Most doctors, no matter what specialty, will be taking care of older adult patients,” concludes Levine. “It takes a village.”

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Boston Medical Center

Originally Posted: July 1, 2014

Appears on: The BMC Brief, Volume 3, Issue 10

The BMC Brief is a monthly staff e-newsletter that highlights staff and department happenings, research breakthroughs, clinical care, and strategic initiatives. This story highlights an innovative program unique to BMC that has since spread to other institutions across the nation. This demonstrates my ability to write an informative feature story for a general audience.