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355th Medical Group increases patient access through collaboration

JOINT BASE LANGLEY-EUSTIS, Va. (AFNS) -- Leadership from medical treatment facilities across Air Combat Command met at Joint Base Langley-Eustis, Virginia, to share their patient access to care success stories April 5-6, 2017.

Lt. Col. Jennifer Garrison, the 355th Medical Support Squadron administrator, was among those briefing at the ACC conference. Her journey, and that of the staff at the Davis-Monthan Air Force Base Medical Center, in Arizona, began in the fall of 2016 when Air Force partnered with the Institute of Health Improvement.

Patient access to care is a priority in military medicine; however, there are some military-wide obstacles to reaching patient access goals. Some consistent challenges to patient access are meeting health care personnel deployment requirements, permanent change of station cycles and recruiting physicians to remote military treatment facilities.

The Air Force determined, with the right training and approach, its military treatment facilities could pursue changes at the local level to mitigate some of these broader challenges. This meant working with the IHI to transform its MTFs into High Reliability Organizations, improving patient care to access in the process.

Garrison attended the Improvement Science in Action workshop in Washington, D.C., in September 2016 and was subsequently identified as the IFI-MTF team lead at the 355th Medical Group.

The 355th MDG goal is to improve patient continuity with their primary care manager from 65 percent to 90 percent by July 2017.

Garrison and her team of 15 key MTF personnel met weekly to discuss “plan, do, study, act” measures or PDSAs aimed at improving patient access. One hallmark of HROs is the constant scrutiny of internal processes which leads to innovation and improvement over time.

“The first step we needed was staff buy-in. After the (hospital) teams (understood) change can lead to an increase in staff morale and increase access for their patients; the MDG-IHI Team took off,” explained Garrison.
She cited one family health provider, Capt. Maggie Smith-Davidson, as a champion for the cause despite her initial skepticism.

“She took out all her carve out detail codes in her templates to be utilized for acute and routine appointments. This increased access by 10 percent. She also had the appointment clerks call her patients the day prior before their appointments to decrease no-shows,” said Garrison.

Other staff noticed Smith-Davidson’s positive attitude regarding the IHI collaboration and Garrison noticed an uptick of PDSA suggestions from officers, enlisted and civilians across the MTF, she said.

“It really has started what I hope will be a complete paradigm shift -- where we don’t hear process improvement and change and immediately knee jerk to negativity, but that it allow us to refocus on taking care of our patients and increasing access to care, which is what we’re all here to do,” said Smith-Davidson.

Along the way the DM team implemented additional PDSAs to include embedding nurses with appointment takers to ensure they were booking patients into the correct type of appointment, consolidating the team structure to maximize resources, and leveraging Secure Messaging technology to respond to patient queries in a timely manner. The staff reached out to RelayHealth to get additional training on Secure Messaging, which in turn decreased the number of overdue messages from 72 to zero.

“One of our biggest focuses was to improve on our patient experience with trust. We instituted the 20th Medical Group’s Patient Integration Program, and the 355th MDG now has seven patients sitting on our MDG committees to give us the feedback to enhance their patient experience,” said Garrison. “We (also) hired a patient and family experience coordinator. The purpose of the PFEC is to implement methods to increase patient and family engagement among the MTF beneficiary population.”

Currently, the 355th MDG has increased access to care by 21 percent in PCM continuity, which puts the group at 86 percent and on track to meet the 90 percent goal.

“Patience is a virtue and do not be afraid to fail,” she said. “In order to be a High Reliability Organization, design a system that is consistent in accomplishing your goals and avoid potentially catastrophic errors.”

The next round of IHI collaborations slated for rollout across the Air Force are dental safety and maternal health. Different MTFs will also be selected for another collaboration on patient access.