Dramatic Performance Improvement: What’s in it for you?
By Carlos Aviña
It was 2009 when our medical director, Dr. Robert Moore, first told us about the upcoming Rapid Dramatic Performance Improvement (RDPI™) project at Clinic Ole (now Ole Health). He and the rest of our leadership team explained that RDPI’s aim is to implement radical change and move organizations closer to a cost effective Patient Centered Medical (Health) Home within four days. It wasn’t a surprise that we needed outside help by then; our leadership team was very open about our financial troubles. My coworkers and I were willing to do anything to keep our health center open and stay employed. Maybe you’re in a similar situation and can easily relate, or perhaps a grant came along and a DPI™ is knocking at your door. Either way, change is coming and I want to share my story. I’m a perfect example of how great this change can be.
I started working at my health center as a senior in high school; my brother had been working there for some time already and loved the work and people there, so I figured I’d give it a shot, too. At that point in my life, I had no clue what I wanted to do as an adult. I had barely started considering college as a real option although I knew my grades from early in my high school career could prohibit me from attending my top choice school. My decision to work at a health center was probably one of the best decisions I could have made. As an employee, I found a sense of purpose, and I rose through the ranks rather quickly. I believe this success was largely due to the fact that I identified with our patient population. I’m a first generation Mexican American and most of my family, including my dad, worked in the wine industry, so I saw a little bit of them in the patients with whom I interacted.
I knew that healthcare wasn’t a priority for many of our patients until it had to be. Many postponed care because it meant taking unpaid leave from work to keep appointments. Unpaid leave meant less money for food or to help support their families’ basic needs. It meant they’d likely be unable to properly manage their health in the future because they wouldn’t be able to afford the cost of medications or buying quality foods. Knowing this, I was always bothered (prior to the RDPI™) by how long our patients spent in our building and how many times they had to go back and forth to multiple appointments due to our segmented care. It always felt like we were taking their time for granted.
As you can imagine, having to say “no” or deny access to patients when they needed it, because we were “too busy” or had limited appointments available, was a pretty rough task. I can only imagine what those patients would have had to deal with if we had closed down (due to financial strain). We were the safety net provider in the community with the mission to serve them. Where would they have gone?
Flash-forward to RDPI™ time. By then I had taken an interest in Quality Improvement, thanks to some in-house training provided by our leadership team and the consortium of clinics we belonged to. I had learned how to collect data, track it over time, and begin to make sense of it. After learning how significant a role data plays in DPI’s™, I was excited to be a part of the RDPI™ team that was designated to lead the charge on improvement. A RDPI™ Team is a group of in-house leaders and change agents identified by the organization with guidance from the Coleman team. Our team included management, providers, a nurse, a Medical Assistant (MA), operations staff, and front office representation; it was a powerhouse group within our health center. We could have added more people to represent every department, but that would have made us too big, and decisions would have become difficult to make. We had to move quickly to gain momentum.
When the Coleman Team arrived—boom—It all happened so quickly! (You can read about that side of the story in our related article I Went through a Rapid DPI™.) I’m here to tell you about how the process impacted me personally, including the opportunities it created for me and the potential opportunities it can create for you as well.
Prior to DPI™, we had to say ‘no’ so often that we lost the spark we came in with. We became desensitized to our patients’ experience in order to get through the day, and we viewed the problems as being insurmountable. Healthcare became a job and not a mission. RDPI™ revived my drive to help the people who need it the most, as it has for many others who have gone through the process themselves. I know that every member of the Coleman Team’s internal light shines a little brighter every time another health center succeeds.
RDPI™ will expose you to a whole new way of seeing how your health center runs. You’ll have a platform to impact patient care directly with or without a clinical background. Whether you choose a RDPI™ or a DPI™ collaborative, you’ll learn how to spot the bottlenecks and realign your workflows to ensure they serve the patients the best you can. Not only that, but do you recall the reason you came to health care in the first place–to help people? You’ll feel that passion rekindled. That’s what DPI™ has done for so many of us.
Here’s what you will learn:
- How to assess and align your processes with the patients’ perspective in mind
- How to execute a Rapid Redesign Test (RRT): The Coleman version of a “PDSA” cycle, which offers a quicker turn-around that yields fast improvement (http://colemanassociates.com/tool/hows-rrts-rapid-redesign-testing/)
- An in-depth understanding of key operational metrics used to evaluate the efficiency of your health center
- A variety of Coleman tactics to improve access, care team efficiency, and improve your patients’ experience
- The skillset and language to effectively communicate as a team
- A better understanding of best practices in healthcare nationwide
The bullet points above just barely scratch the surface of the learning opportunities you’ll encounter. Management, front line staff, and clinical staff all take away something unique and different that will benefit them and the community they serve.
The experience gave me the opportunity to grow professionally. It drove me to go back to school to finish my undergraduate degree and then apply that knowledge to the work we do. It opened my eyes to what’s possible; I realized that our patients deserved more and that with a team of like-minded individuals we can provide better care for them. It showed me that by improving our patients’ experience and team dynamics, we also increased our own engagement in the work we do.
In my case, it opened up an opportunity to join the Coleman team and work with health centers across the country, including a team that I greatly admired during our RDPI™ and now have the privilege to work with side by side with every few weeks. For you, it can outline a path for personal growth within your organization or it may spark your interest to pursue further education. At the very least, it can improve the relationship you have with your organization and your patients, and thus improve your daily life.
- For providers, it may enable to you to go home as scheduled and spend more time with your loved ones
- For front office and phone staff, it may enable you to say “yes” more often than you have to say “no” to your patients. And that means dealing with fewer complaints and happier patients
- For MA’s, it will leverage your skills to better serve patients and better support your provider
- For RN’s, it can put you back at the center of patient care and off the phone; You didn’t grind through all of those clinical hours to spend the majority of your time calling in medications or managing schedules
- For leadership, it will engage your staff and enable them to see things the way you do from a quality perspective as well as a business one
- For your patients, it will improve the quality of care they receive every day, through improved access, less wait time, and a more engaged staff
RDPI™ is hard work, and it’s a challenging timeline, but it can yield so much for you and your patients if you allow it. I can say without a doubt that RDPI™ changed my life for the better.