Analyzing the Strategic Planning

¶ … Strategic Planning May Successfully Aid the Patient-Centered Medical Home Model's Implementation and Value to Our Health Care System

How Using Strategic Planning May Successfully Aid the Patient-Centered Medical Home Model's Implementation and Value to Our Health Care System

In 1967, the AAP (American Academy of Pediatrics) introduced the concept of Medical Homes. These homes were at first assigned for obtaining children's medical records. Several decades later in 2002, the Academy expanded its policy statement on the concept, making it more comprehensive, accessible, compassionate and culturally-effective. The new policy also changed the focus of medical home from the child to the family. The ACP (American College of Physicians) and the AAFP (American Academy of Family Physicians) have also developed their own patient-care models which they refer to as "advanced medical home" and "medical home," respectively (PCPCC, 2007).

Many health care experts agree that the basic components of medical home definition include accessibility, teamwork, comprehensive care, patient-centered care and a focus on safety and quality. The medical home model is now accepted universally as a framework for how primary care ought to be structured and delivered. Some have described the medical home concept as a philosophy of care delivery that allows physicians and other HCPs (Health Care Providers) to meet clients and patients at their resident location. Medical homes have become places where patients are treated with compassion, respect and dignity. This enables building strong relationships based on mutual respect between the patient and the providers. Though, initially, some individuals did think of Medical Homes as final destinations or resting places, the homes have improved to the extent that they are now considered a framework for efficient primary care where patients can get the right care at the right time. In recognition of the important role played by medical homes in the provision of health care, the major American physician associations jointly developed and published Joint Principles of the Patient-Centered Medical Home. This jointly released framework has been revised and is now referred to as the PCPCC (PCPCC, 2015).

The medical home concept has the power of transforming how health care is delivered in the United States. Using data from many different medical homes in the country, the AHRQ (Agency for Healthcare Research and Quality) described medical homes as a concept for the structuring and delivering of important functions of primary care. As stated earlier, primary care medical homes have five unique characteristics:

(1) They offer comprehensive care

Many medical homes are responsible for providing almost all of their clients' mental and physical medical needs, including the chronic care, acute care, wellness, and preventative services. For a medical home to effectively offer comprehensive care there is a need for a multidisciplinary team of care providers. Such a team may include medical doctors, care coordinators, educators, social workers, nutritionists, pharmacists, nurses, physician assistants, and nursing practitioners. Even though medical homes may employ huge teams to provide the best and most comprehensive care in their target market, many more practices have formed virtual (contractual) teams and they can possibly combine efforts any time so as to offer their clients the right care at the right time and at comparatively lower costs.

(2) Patient-centered

Many medical homes provide care focused on the whole person. Such care is often based on strong working relationships with patients based on giving the patient respect and dignity. It has been shown that partnering with Medical home clients and their loved ones entails the comprehension and respect for the special preferences, values, culture, needs and beliefs of every individual patient. Medical homes also actively support their clients in trying to organize and manage their personal care at the level of that the clients choose. In recognition of the fact that both patients and their loved ones are core members of the care team, the medical home concept guarantees that they be fully informed in coming up with care plans.

(3) Coordinated care

The medical home model ensures that all aspects of the general healthcare system including community support, home healthcare, medical facilities (hospital care), and specialty care are coordinated. Such coordination is important for continuity in care during transitions between different health care sites such as when patients are discharged from hospitals. The Medical home model also advocates for the building of open and clear communication channels between patients, the care team, the patient's family and the medical home.

(4) Accessible Services

Medical homes have been known to provide more accessible services for individuals with urgent needs including phone access to selected members of the care team, 24/7 telephone access to the home, increased in-person hours and alternative channels of communication such as Skype, email or phone. Simply put Medical Home practices are highly responsive to their clients' preferences regarding how they want to access their care providers.

(5) Quality and Safety

Medical home practices are often committed to ensuring that they provide the best quality services. Many such institutions have continuous quality improvement initiatives that use tools such as clinical decision-support tools and evidence-based care to help in their interactions with patients and their families. For instance, many medical home practices have been known to carry out performance measurement surveys and conduct other forms of performance-evaluation so as to get know their clients' experiences and level of satisfaction. Some practices even go ahead to publicly share their safety data and quality improvement measures. Such homes are often regarded as the practices which are most committed to quality and safety (AHRQ, n.d.).

A. Strategies leaders may utilize to ensure their organizations achieve primary care medical home transformation

They create and manage system-level objectives at the executive level. Moreover, they develop practical and realistic plans of how they aim to attain their system-level objectives and run these strategies from the very top. Thereafter, they direct leadership focus to system-level enhancements: transparency, leadership systems and personal leadership. Plus, they incorporate the input of both the patients and their families in the improvement plan. In addition, they make their CFOs (Chief financial officers) their quality champions and engage the medical doctors and other providers. They do so in order to build their organizations' capability for improvement

They establish regular improvement meetings highlighting their progress and challenges being faced. Moreover, they ensure that their organizations have data reporting capabilities so as to assess if their changes in progress are having any effect in transforming health care provision. They then use data to report their successes and then continue to push for transformations in their organizations. Publishing reports will have to take into account the different needs of the audiences for whom the data is intended. Knowing the audience and helping them understand what is happening can help increase the impact of transformation projects.

What is even more important is that leaders ought to encourage their followers to continuously improve and innovate to transform their medical homes. Thus, to be successful in managing medical homes there is a need to be a visionary and a motivational person who can help his or her staff to move collaboratively towards the desired performance and service-provision levels (SNMHI, 2010).

Start with a Team

The leaders ought to start assembling their Primary Care Medical Home teams immediately. The ability to put together a good team composed of a CCQO (chief compliance and quality officer), CMO (chief medical officer), CFO (chief financial officer), COO (chief operating officer), deputy COO, practice managers and the CEO (chief executive officer). The team ought to immediately start transforming their practice if they are to meet CMS benchmark.

Commitment

Commitment is much more than just making declarations of loyalty. Commitments have to be shown in the drafting of strategic plans through allocation of funds to improvement projects, for instance, a more promising show of commitment would be the drawing of profit-sharing plans based on quality performance indicators. For instance, such a plan could reward workers for meeting certain patient care milestones. This would not only ensure that quality is improved throughout the practice's services but it will also ensure that workers are motivated to contribute more in their day-to-day activities.

Electronic Health Record

One of the best ways to improve performance is training workers in the use of EHR (Electronic Health Records). Moreover, buying the CCMR (Care Coordination Medical Record) system, which is a form of electronic health record, can also improve performance. The CCMR can not only increase documentation efficiency, but also reduce data redundancy. Once a leader explains why buying such a system / module would be important and when everyone start seeing improvements in their work processes, then providers will definitely join in and start using the systems to help improve care delivery.

Staff Engagement and Buy-In

Getting staff-buy in is important, particularly when making changes in primary care medical homes. Convincing them to come onboard and work together in the implementation of transformation projects plays a key role in determining whether or not a transformation process will succeed.

Comprehensive and Seamless Service Coordination

To enhance the provision of health care, it is important for the service providers to offer an all-round care package. Care providers from different disciplines have to be hired or contacted to be on standby so as to offer the most comprehensive healthcare at the homes. However, comprehensive care alone will not do it; there is also a need for team members to act with agency and in a flexible manner to provide the best care.

Quality Focus

The aim of PCMH approaches is to improve the health outcomes of patients. Thus in any PCMH service improvement process, it is important to hire or delegate duties to individuals with the right talents and skills to provide the best quality.

Effective Use of Technical Assistance Resources

Cooperating with TA (Technical Assistance), resources provided by different organizations such as AIR (American Institute of Research), can help in the provision of learning resources, coaching strategies, documentation reviews and implementation of NCQA (National Committee for Quality Assurance) standards (Indiana Health Centers, Inc., 2014).

II. Engaged leadership

To transform any organization into a PCMH would require wide organizational changes. Different system leaders such as clinical managers, C-suite executives and management boards have to be engaged and tasked with different responsibilities to help in the effective implementation of changes. Employees at all levels of the organization's structure must also integrate the care delivery model change. Any kind of change is difficult and most of the time the reason why such changes do not succeed is lack of effective leadership. Since patient-centered medical home change is an organizational level kind of transformation, it cannot be achieved without the continuous engagement of leaders throughout the entire transformation process. Leaders and managers ought to draft and convey to their staff how PSMH makes business sense and how implementing it would help enhance health outcomes, patient satisfaction, the efficiency of the organization (SNMHI, 2010). Simply put, leaders must be committed to the transformation process for it to be a success. They have to believe in the process and believe that the practice is doing the right thing. The right leader to oversee a transformation process would believe in teamwork and encourage his or her staff to put every effort into the process. The right leader would make sure that the staff is constantly engaged in the process and that their opinion on the changes is taken into account (Indiana Health Centers, Inc., 2014).

Leaders facilitate patient-centered medical home transformation by mapping the path for transformation and maintaining the new changes. One of the most important responsibilities for leaders during these transformation processes is allocating the right amount of funds, technology, equipment, staff and time to support the change needs. The proper amount of resources would help staff to integrate or sustain key organizational changes. Engaged leaders are constantly involved in the change process, they make sure that everything is implemented as was planned. Key responsibilities for leaders during the change process are:

Ensuring that the transformation process has the right amount of resources to succeed.

Offering visible and continuous leadership by being physically present to ensure that strategies are implemented as was planned and that change is sustained.

Making sure that enough time is allocated to providers and other staff to be engaged in other activities prescribed in the medical home model

Making sure that new training processes and hiring policies take into account the new values of the now patient-centered medical home (SNMHI, 2010).

A. Role of leaders during PCMH transformation

Leaders have to manage the transformation process effectively if it is to succeed. The management process involves motivating employees, removing all encountered obstacles and providing the necessary resources. The following are some of the key roles and responsibilities that leaders have during the transformation process:

1. Identify and allocate resources

As mentioned before resources include money, technology, time, equipment, staffing and other kinds of support that may be used to integrate and sustain key transformation changes.

Staff

Sourcing for the right employees for patient-centered medical home employees might involve hiring or retraining existing employees. Effectively communicating to employees the purpose of the retraining or redeployments within the organization can help increase the buy-in and self-confidence among them. In some cases, it may be necessary to let go of staff who cannot adapt to the new changes. Some of the new employees who can be hired to boost the organization's team could be: care managers / social workers -- help coordinate care for hard-to-reach or high-risk clients; health IT experts; health coaches -- to help patients to learn how to care for themselves; medical assistants -- to act as outreach personnel or to help in patient tracking; medico-legal experts; office managers' / program consultants - to help manage the transformation process.

Funding

Funding for Patient-centered medical homes is perceived as necessary, even though not every health service provider interested in this kind of transformation will have access to multi-payer state supported initiatives. Other sources of funds include applying for grants and maximization of different incentives such as the pay for performance initiative. In many practices most of the funds are allocated to education, training and support (Bleser, et al., 2014). A study done in Pennsylvania shows that participants from different disciplines reported that their joint training and education processes made them buy-in to the transformation (Pupillo, 2014).

a. Types of support that help staff implement PCMH key changes

The biggest lesson learnt is that only through effective communication can a leader get his or her staff to buy-in to the transformation process;

1. Leaders have to communicate clearly and effectively so as to get the employees to buy-in

Clearly communicating objectives can help individuals to put more efforts towards achieving the desired objectives. Furthermore, leaders should provide support to their employees by making it clear that they are for teamwork. This can help employees to work collectively to achieve the organization's objectives. The leader should also frequently meet with the employees and ask them for their opinions on the ongoing transformations and what they think could be done better with regards to the practice, the new changes, roles, and/or policies.

2. Teach about Patient-centered medical home

Educating staff and other stakeholders about the importance of PCMH model would facilitate additional buy-ins. Teaching about the benefits of this optimal care model and comparing it with the current model can help staff to see it as more effective, as having more financial benefits to the organization (in terms of more revenue) and as a model that would result in better health outcomes for patients. Elements of the PCMH changes that are more complex such as the use of new health IT systems or modules might require additional training, education and/or campaigning.

3. Provision of information about the techniques that bring about PCMH-like care practices

Huge changes require the challenging act of breaking habits and starting to do things in a different way. PCMH transformations might also require one to reorganize his or her staff composition and roles. If this is the case, then one may need to provide more information on how to do more PCMH-like practice. Some of the information that may be needed includes new tactics introduced in other practices and evidence-based practices. For instance, one might need to provide information on ways: of using new technologies, teaching self-care and motivational interviewing as a way of getting information from clients.

4. More campaigns should be made on staffs who are hesitant or skeptical about the changes

Even in the face of the very best efforts, not all stakeholders can be convinced to support the transformation process, particularly in large organizations. Thus, there is a need for the change proponents to continue communicating the benefits that the new model offers in contrast to the model in use. Reports and data of where PCMH has been successful can be published to show the efficacy of the models. Meetings should also be organized with individuals who are skeptical about the transformation. However, in cases where most of these methods fail it might be wise to let go of such employees (Bleser, et al., 2014)..

B. Create a work Environment-Supportive of PCMH transformation

When implementing huge changes such as the patient-centered medical home transformation, it is important to present an environment in which all staff feel as if they are part of the process. This can be achieved through implementing the following strategies.

Create a workflow of well-defined and flexible duties and responsibilities within the transformational plan

For a transformational plan to succeed, there is a need to clearly define the duties of every team member. Furthermore, the plan ought to be composed of small incremental measures and not just one big step. Thus, the plan development process ought to involve extensive consultations with all the relevant stakeholders.

Encourage an atmosphere of openness in which every member's opinion or feedback is considered

An atmosphere of openness in any organizational culture will help make everyone comfortable. With such comfort levels, employees will feel free to criticize, give ideas, thoughts and suggestions on the PCMH transformation process. Other incentives such as suggestion boxes, regular meetings and rewarding of interesting ideas can also help staff to feel free to contribute to the process.

Establish a culture of creativity

A culture of creativity is one that not allows but also facilitates innovativeness, creativity, and generation of new ideas among employees. Many have employees have been advocating for organizations to incentivize creativity, through giving rewards, benefits or special recognition / consideration for individuals who come up with new ideas.

Use the PCMH champions to achieve even higher percentages of buy-in

Individuals who are passionate about patient-centered medical home transformation have emerged during many change processes in different practices. In some practices such individuals are appointed. Giving such individuals special recognition and helping them to advocate for the change process among their colleagues can help to dissociate the PCMH transformation process from the executive. Instead individuals will be more patient and will try even harder to learn about the new practices since they will think that if "one of their own" has mastered the practices of the new model, then they too can do it (Bleser, et al., 2014).

a. Sustaining employee energy and motivation

The following measures can be taken to sustain employee motivation and energy

i. Constantly provide Feedback on progress of PCMH implementation

When employees hear or read of how the process has helped earn their organization higher revenues, or has brought about higher levels of satisfaction among their patients, then they will be more motivated to continue putting effort. Evaluating teams and offering constructive criticism can also help teams to rectify what they were doing wrong and to come up with even better ideas of carrying out their assigned tasks. Giving praise where it is due can also increase problem solving and productivity among employees.

ii. Utilization of internal and external data to highlight success, reinforce benefits, benchmark

Good use of data can help increase commitment to the change process and also create a higher sense of buy-in, ownership, pride and accomplishment among those responsible for the successes. External data is important for showing the benefits of the new model compared to the old model in other practices where it is still being used. Internal data is important to benchmark the best practices within the organization and to share the practices with all other employees. However, though regular assessment has its own benefits, it shouldn't be done every few days or weeks, instead an ample period of perhaps eight weeks or two months should be allowed to help the employees to make the necessary changes. This can help to quell the anxiety among employees (Bleser, et al., 2014).

III. Vision statement

The very first step to ensuring the success of a PCMH implementation process is to identify and communicate a clear vision for the practice. All leaders regardless of the industry they are operating in, must understand the basic components of visioning and how to effectively communicate their visions.

A. Importance of vision statement in organization.

Clinic leaders must always ensure that they set visions that capture the essence of a PCMH transformation. For example, a leader should ask himself whether his or her vision clearly indicates that the transformation process involves turning the practice into a patient-centered home. If not, the vision should be reworked to capture that important detail. Leaders must also ensure that the PCMH transformation is included in the business and strategic plans of the organizations that they run. This is important if the transformation process is to be sustained in the long-term. A vision is defined as an idealized imagery of the future that is desired for an organization. Writing a vision can have several benefits for the PCMH transformation process: