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Systems Change, Keeping It Simple

Systems Change, Keeping It Simple. Virginia Warren Office Chief, Cancer Control Programs Arizona Department of Health Services Systems Change=Improving Patient Outcomes June 27, 2014. Systems Change. The process for sustainable change in policy, program and resource allocation

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Systems Change, Keeping It Simple

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  1. Systems Change,Keeping It Simple Virginia Warren Office Chief, Cancer Control Programs Arizona Department of Health Services Systems Change=Improving Patient Outcomes June 27, 2014

  2. Systems Change • The process for sustainable change in policy, program and resource allocation • The process of improving the capacity of the public health system to work with many sectors to improve the health status of all people within a community.

  3. Your Community • Community is defined as your geographic area with a strong focus on those using services from your providers

  4. Why Participate in Systems Change? • Proactively serve your patients • Prepare for environmental changes • Affordable Care Act • CMS reimbursement changes

  5. Systems Change Participation (cont.) • Position yourself in a competitive market • Maintain/increase revenue • Prepare for the Baby Boomer Tsunami

  6. Getting Started • Success will not be achieved doing this by yourself, Gather Your Champions • Who is Involved: • Leadership, absolutely • Operations staff, yes • IT support, yes

  7. The Starting Point Start Small and Start Smart Pace Yourself • Decide on the area of focus • Prioritize the focal point through clinic policy • This is a process, it takes time, thought, planning

  8. Policy is Set • Example – “Increase breast cancer screening rates.” • Determine baseline screening rates for your clinics

  9. Policy Example • How do you do that? • How many women 40 and older have received a mammogram in the past two years? • Do you have the capacity to determine this electronically? Or is a chart audit needed? • If you have an electronic system, do you have staff to build the query?

  10. Determining Baseline • How many women 40 and older use your clinic? • At what age are you going to cap the review? 65? 70? • Are you going to look at biennial or annual mammograms?

  11. Don’t Be Surprised • There will be room for improvement 81.1% 4%

  12. Review and Discuss Baseline • Baseline results will not be what you expect • Example: HealthCheck Program baseline data compared to Healthy People 2020 Goals

  13. Provider Reactions • Providers in a large practice may believe their results will differ from others • Determine baseline rates separately: A Provider may emerge as a champion of the project

  14. Discussion and Disagreement Lead to Discovery • The results will lead to a realization that: • Screening rate leaves room for improvement • Evidence based strategies are necessary • Many insured women are not being screened • Many insured women are not even having annual visits – this is a missed opportunity

  15. Baseline Determined • Preserve Process – be careful, thoughtful • Share Results • Schedule the same process for the subsequent year • Assign responsibility for next steps • Who is driving?

  16. Evidence Based Strategies • Research Evidence Based Strategies • Community Guide To Preventive Services • Client Oriented or Provider Oriented • Decide on EB strategies providing best fit • Use them wisely

  17. Selection: Patient Reminders • How many do you send out? • What is the follow up process? • Send a letter and forget? Or follow up?

  18. Patient Reminders(cont.) • When they schedule appointment, is follow up complete? • Where are screening results recorded? • How can you improve process for the next group?

  19. Division of Responsibilities • Who does the audit? Or EHR report? • Who defines the audit/report guidelines? • Who decides on the strategy to increase screening rates?

  20. Assignment of Roles • Who tracks the women referred to mammography and navigates or “stalks” them? (Patient Navigator?) • Who is driving the bus? If you don’t have a driver you won’t get far.

  21. Critical Elements • Set the policy • Assign responsibilities • Allow discussion and debate over results • Monitor process and tweak to improve • Allow flexibility for improvements • Celebrate success! • Expand to the next topic – Colorectal Cancer Screening

  22. Will Patient Outcomes be Improved? • Regular screening • Monitoring timeliness of services provided • Receiving credit for the work that is done • Application to other measures?

  23. Breast and Cervical Cancer Treatment Program Expansion

  24. www.wellwomanhealthcheck.org

  25. My Usual Photo

  26. Daytona - 2013

  27. Hurricane Lillies - Japan

  28. Thank You Virginia Warren Virginia.Warren@azdhs.gov 602-542-1222 Emily Wozniak Emily.Wozniak@azdhs.gov 602-364-0214

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