Thursday, August 7, 2014

How to Effectively Manage Significant Changes in Your Practice

The situation: a team at your site has developed a new process or program at your site that will lead to improved outcomes for your patients or your practice itself. Examples of these are improved care of patients with chronic diseases, improved copay collections, and implementation of ICD-10 coding and billing. Change, whether dictated from external regulations or created as part of a cycle of continuous improvement of patient outcomes, seems to one of the constants at most care sites. What should you do to effectively implement the new processes or programs? Let me share with you what I have found to be some elements of successful implementation of programs and processes.Champion. Choose a champion to oversee the implementation of the program or process. The champion should be a member of the team that designed the new process or program. That way, he or she would have a good understanding of the details of the goals and elements designed by the team. The champion should be supported by a clinician (if he or she in not one) with enough authority at the site to enable the champion to effectively carry out the implementation. There are several traits that the champion as leader should possess:

Communication skills

Coaching skills


An ability to put things in context

Emotional intelligence
An example of a champion at work is a nurse who is a member of a team seeking to improve the outcomes of patients with coronary artery disease. The nurse communicates to the clinicians and support staff that the team wants to collect data on the percentage of patients with coronary artery disease who take a low dose aspirin each day. The goal of the team is that at least 75% of patients will do this. She also communicates the plan to raise the percentage over time.Communication. Effective communication to all staff affected by the changes is vitally important. Before any changes are effected staff should know what changes will occur and a timeline for implementation of the changes. Staff should also be informed of the reasons for the changes and the expected outcomes of the changes. Communication of these can be the responsibility of the champion or a communication committee if the practice is large enough.To effectively implement new ICD-10 coding it will be necessary to inform billing and coding personnel what training they will be expected to take and where, to inform clinicians what are the expectations of them in detailing diagnoses and procedures as well as audits of these along with feedback. Communication with staff using patient management systems will also be necessary.Training. To correctly implement new processes or programs it will be necessary to train those affected. It will be necessary to set aside some time for training. I suggest that training can take place before the workday begins if feasible. It may be necessary to have some temps substitute for staff if training takes place off site. Also, funds should be set aside for training.

If a site wants to have patients get their lab work done before appointments it will be necessary to train staff how patients will be contacted with information about getting the labs done and how to track the percentage of patients who do get their labs done ahead of time.Auditing. Along with training staff on new processes or programs it will be necessary to occasionally audit the staff to see if they are adhering to their training. It is very easy to fall back into old habits and not follow through with training. It will be up to the champion or a designee to carry out the audits. If a staff member(s) are found not to be compliant the auditor should point out the deficiency and inquire as to why the staff person is not performing his or her task according to the training. It may be that the staff person did not clearly understand some of the training information. For example a physician may not understand that it is necessary to indicate laterality when possible for ICD-10 coding.Another component of auditing is collecting data on the metrics that were defined to be used to measure the success of the implementation. For instance, in a coronary artery disease program designed to improve the lives of patients with this disease a metric might be the percentage of patients who exercise vigorously at least four times a week. Results of the metric audits should be posted for all affected staff to see.Modify. As the implementation proceeds the champion may find that the outcomes are not what were expected. That is, the goals of the changes may not be attainable with the newly implemented processes. Then, it may be necessary to modify the new processes or the program so that it will be possible to attain the project goals. For instance it may be necessary to modify the contact method being used to notify patients of lab work that needs to be completed before their appointment.Celebrate and maintain. After a successful implementation, the team and rest of the staff should acknowledge and celebrate the achievement. At the same time it will be necessary to put into effect a plan to monitor the metrics used in implementation so that best outcomes can be maintained. This may be the time to design an improvement of the newly implemented program or process that leads to even better outcomes and that adapts well to the skills of the staff at the site.As you can see, it is not enough to just design a new process or program. Great care should be taken to implement the program according to the design team's specifications. It will take a lot of effort from the champion or team to oversee the implementation using the components detailed. Careful adherence to the implementation will enable a careful analysis of the progress as well as point out directions for future changes. Successful implementation is a win for both the patients and the practice.

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