Objective of Section
To provide tools and resources that will enable practices engaged in transformation to assess their current practice delivery system and develop a plan to improve it.
- Current models of care delivery do not adequately reach the needed and desired outcomes of all patients.
- Tools and resources are available to assess current practice structures and processes against desired states and models.
- Multiple domains should be assessed in the journey for transformation.
For many health care practices, the journey of transformation may begin with data they receive from insurers or other entities that provide scorecards of physicians, practices and health care organizations. When these data suggest that outcomes are not at top decile (or some other desired target), the next natural question to ask is: “Why not?” For other practices, different types of data can be used to show a gap in the current state of care delivery – such as patient, staff, or provider satisfaction as the world aligns to pay for improved outcomes.
In some cases, the need for transformation does not come from data at all. Instead, anecdotes, stories, singular events or other outside forces may trigger the need for practice transformation. Examples of this could include: 1) a practitioner who reflects on a recent patient who suffered a second heart attack and realizes he was never prescribed aspirin; 2) a patient who was admitted with a diabetic foot ulcer whose medical chart does not show any evidence of a foot exam; or 3) a practitioner who may be recertifying for the boards and performing an improvement model and wondering how to begin.
Regardless of the impetus for change, practice leaders should have access to tools and resources that will assist them in performing a “self-assessment” that will ultimately create a roadmap for change that meets current and future demands. Increasingly there is a coalescence, convergence and harmonization around common structural and process elements that are deemed to be attributes found in the idealized primary care practice. This section introduces some self-assessment tools and resources, as well as the attributes of certain desired structures and processes.