Changing the Culture

Practice transformation is really about changing a health care practice’s culture from one that is passively responsive to proactively anticipating and implementing changes that support ongoing, high-quality diabetes management. Instituting and maintaining a proactive approach to care in a clinical setting requires dedicated leadership and buy-in, commitment, and effort from the entire health care team. A whole office team approach helps when brainstorming potential solutions and encourages a division of labor among team members during improvement efforts.

Learn more about improving diabetes care and team-based care.

Identify Gaps in Care and Set Goals for Improvement

Assessment is an essential first step toward making system changes. Assessment focuses on the process of change and provides a roadmap to order priorities and direct energies.

The overall goal of health care quality improvement is to eliminate the gap between current and optimal clinical performance in an effort to improve diabetes outcomes, such as the incidence of complications. To achieve improvements, goals and objectives should be based on reducing gaps identified by the assessment.

Healthy People 2020 lists national health goals, many of which relate to diabetes, blood pressure, cholesterol, obesity, nutrition, and physical activity. Three goals for diabetes are to increase the proportion of:

  • Adults with diabetes whose condition has been diagnosed
  • Persons with diabetes who receive formal diabetes education
  • Adults with diabetes who have an A1C measurement at least twice a year

To achieve any chosen goal, a health care practice team or planning group needs to determine an achievable target, baseline measures, and an appropriate time frame. Then the team must select and implement a plan. A plan should include a number of small steps or objectives that lead to achievement of the goal over time.

Tools such as flowcharts, cause-and effect diagrams, and registry data are used to achieve clinical improvements. For example, to increase the proportion of patients with diabetes who receive diabetes education, a health care practice might:

  • Secure financial support for patient education services
  • Determine when and where a small group of patients could meet with a certified diabetes educator

Use the Plan-Do-Study-Act (PDSA) Cycle

The Institute for Healthcare Improvement recommends the use of rapid cycle improvement for clinical settings. PDSA rapid cycles involve small-scale local tests of change in health care practices. The PDSA cycle describes the growth of knowledge through making changes and then reflecting on the consequences of those changes.

PDSA cycles help inform three fundamental questions:

  1. What are we trying to improve? (i.e., the aim)
  2. How will we know that a change is an improvement? (i.e., the measurement)
  3. What change can we make that will result in an improvement? (i.e., the plan)

Learn more about the specific steps of PDSA cycles and find examples in IHI Model for Improvement.