In Pursuit of Quality: Teaming Up with One of Our “Star” Accounts

This quarter, Tom Finnerty and Susan Marr describe their success in creating patient safety–focused quality initiatives for Kids Health First.

—Robin Diamond, MSN, JD, RN; AHA Fellow–Patient Safety Leadership; Senior Vice President, Patient Safety

Kids Health First (KHF) is comprised of 197 primary care pediatricians in 36 independent practices who came together to collaborate on and ensure the highest standards of health care for Atlanta’s children and teens. Since 1997, these physicians have continued their efforts to advance pediatrics through participation in research studies, ongoing medical education, the establishment of “best medical practices,” and by undertaking significant quality initiatives.

KHF is led by 13 physician board members and 30 physicians serving on nine committees, with the key committee being Quality and Utilization Management. Physicians receive no compensation for their service on the board or a committee, but they actively commit their time in order to advance the quality of care that the member practices deliver. The risk management function is part of the Quality and Utilization Management Committee’s process, and a designated subcommittee addresses specific risk management needs and shares best practices.

Collaboration with The Doctors Company
An essential KHF objective in its relationship with The Doctors Company was to develop a comprehensive patient safety/risk management program consistent with KHF’s desire to continuously improve quality while enhancing its customer service focus. The kickoff of the program began with educating the physicians on patient safety and risk management principles and on the kinds of processes and systems that would be examined during individual site visits. In order to gather a large amount of information quickly about how the practices were doing, each practice was asked to complete a self-assessment survey, and feedback was provided to each participating location.

Identification of Top-Quality Initiatives
What followed was an ongoing dialogue between The Doctors Company and the Kids Health First member practices, primarily using the vehicle of the monthly practice administrators’ meetings. We determined that we would focus on these top-quality initiatives:

• Tracking mechanisms for lab and diagnostic test results and consultation reports to assure that they were returned to the practice, reviewed by a provider, and that the test results were provided to the patient/family. Specifically, the system should not be solely reliant on “holding the chart” or on a return appointment, nor should the practice philosophy be “no news is good news” in relation to communicating test results to patients.
• Documentation of after-hours calls.
• Medication management.

We held roundtable discussions with the practice administrator group, allowing them to share successes and ideas with one another about what had worked (and not worked) in their practices. As the site visits were implemented, feedback was provided on a regular basis so the practices were aware of the findings.

Customer Service as Part of Quality
During this time, we also turned our attention to the issue of customer service since this is a key component of the Kids Health First quality strategy. Over the course of multiple presentations to the practice administrators and office staff, there was discussion about managing complaints, dealing with challenging patients, and embracing good customer service as a risk reduction strategy. We used the video It’s a Dog’s World to inject entertainment and humor into the discussions. (The video is produced by CRM Learning. For more information, visit www.crmlearning.com/its-a-dogs-world.)

In order to educate office staff members as to the importance of their role in patient safety and risk management strategies, Kids Health First made a video of a “Patient Safety/Risk Management 101” presentation by Susan Marr. Every employee at each of the KHF practices is now required to view the video, and it also became part of new employee orientation. The Doctors Company is producing a similar product that will soon be available to all insured members.

Developing the Process to Measure Quality
As we continued to move forward, we prioritized the initiatives so that the practices would know which issues should take precedence. Thus all recommendations made across the KHF groups were reviewed and categorized by Susan as either “Critical Elements” or “Important Elements.” If she felt that not having an element could reasonably result in a patient injury, she placed the element in the Critical category. Examples of the Critical Elements in this case were:

• A system to assure the return of results and reports on all lab and diagnostic tests ordered not contingent on holding the chart or a return appointment.
• Test results reviewed and initialed by the provider prior to filing or scanning.
• All patients/families advised of all test results, whether normal or abnormal.
• Sample medications given noted in the medical record.

Physician Response
Most of the practice administrators “fixed” the things within their control that were necessary to address the quality initiatives, but some physicians were resistant to making operational changes. However, once a few physicians jumped on board and the risk management subcommittee endorsed the changes, physicians no longer resisted.

Conclusion
The bottom line is that the patient safety–focused quality initiatives encouraged tremendously positive changes in the 29 Kids Health First practices insured with The Doctors Company. The success of these initiatives has provided the momentum to move forward with setting even more aggressive patient safety goals.

Working with the visionary leadership of KHF and the talent in its practice administrator group, we have made great strides together. For Kids Health First, The Doctors Company has provided resources and a customized plan that not only helped them identify where improvements could be made but also supported them in executing the necessary changes.

Are you interested in having one of our professional patient safety/risk managers assist in designing a program that fits your practice? Put our expertise to work by contacting your regional patient safety/risk management representative or by calling us at (800) 421-2368, extension 1243.