With clinic sites in Skid Row in downtown Los Angeles and the Pico Aliso district of East Los Angeles, Los Angeles Christian Health Centers (LACHC) is a source of hope and healing to thousands of low-income and homeless Los Angeles residents. Since its founding in 1995, LACHC leadership and staff have labored to provide more and better service to their patients, a goal that often meant accepting risk and embracing change. In February 2011, with the support of a $200,000 UniHealth Foundation grant, LACHC undertook its boldest change initiative, the Patient Care Team Redesign Project.
With the goal of increasing access to quality care and improving health outcomes for the underserved, the redesign focused on improving provider support, increasing provider-patient continuity, improving efficiency and productivity, and increasing the role of support staff in the medical visit, particularly through the use of Electronic Medical Record tools. LACHC engaged the consulting firm of Coleman and Associates to teach and coach staff through an intensive process that resulted in the successful implementation of an efficient and effective system for delivering timely quality care using consistent patient care teams. As a result of the redesign project, productivity has increased by 50% from 12 patients to an average of 18 patients per provider a day, and 89% of the time, patients see their own care teams.
We were set in our ways. We thought we were doing good. We were serving patients. Then we realized that we can do better.
But this change wasn’t easy and required enormous effort and focus to accomplish. Katy White, M.D., Chief Medical Officer, reflecting on the experience said, “At the end of it all, my day didn’t get easier. But I see more patients and I do more for each patient in the same amount of time. And quality has improved.” Dr. Abdishoo added that morale difficulties were balanced by successes as the patient care teams jelled. George Hernandez, Patient Navigator, said “Medical Assistants and Patient Navigators really feel they are part of patient care. Small logistical changes like moving charting stations and where team members sit made a big difference. We do a lot less running around and we can communicate with patients.”
Patient care is now a complete team effort—physician, medical assistant, registered nurse, patient navigator and front office staff—working to benefit the patient. “I feel a lot closer to everyone now and I feel a wonderful sense of support. We know our patients better, we’re more efficient,” noted Sherieda Stewart, RN, FANP, Director of Nursing. Team huddles, in her opinion, have been a “really good component of this whole change process.” These quick, focused team meetings happen at the beginning of every day and give the team an opportunity to review the schedule and discuss strategies for each patient visit.
Success with the redesign project has not diminished the drive to improve. “We still have a ways to go,” insists Dr. Abdishoo, “but now we have a different mindset.’ George Hernandez attributes much of the project’s success to Dr. Abdishoo’s leadership. And he adds, “We did it and so can other clinics.” His advice, “Pay attention, it moves quickly. Be open to change. Give the coaches an opportunity to show you. Ask questions. Be patient and let it happen.”