As a rural healthcare provider in a frontier area of Colorado, Yuma (Colo.) District Hospital executives used to face trouble recruiting physicians who would stay for the long haul. "It was difficult to find a qualified provider who was willing to live out here," John Gardner, CEO of Yuma District Hospital, says. In fact, the hospital spent about $1 million in one year alone on locum tenens recruiting.
To solve the expensive recruiting problem, Mr. Gardner began using part-time, long-term employment as a way to attract physicians. "The physicians work for three days and the other four days a week, they get to enjoy the mountains," he explains.
But that style of physician employment led to some issues at the hospital. Transitions of care were not going smoothly when physicians switched shifts, which affected patient satisfaction and led to some patient safety issues. So, Mr. Gardner found a solution to that issue as well: become a patient-centered medical home.
"I had the opportunity to visit Group Health in Seattle where they have adopted the PCMH model and they use a lot of part-time providers in their facilities," Mr. Gardner says. "And it occurred to me that this might be the magic bullet for us to provide patients with a better care experience."
"We're trying to find the right blend of physicians with compatible personalities," Mr. Gardner says. "To my surprise, that hasn't really been a struggle." He allowed the providers to choose their own care teams and has tried to keep administrators out of the process.
The team model has improved the communication problem at Yuma. "The providers in the teams work with the same nurses, so there is a better opportunity for communication," Mr. Gardner says. "And now the [providers] are more conscientious about communicating before they leave the building."
Yuma also added two care navigators as part of the patient-centered initiative. The two navigators were already Yuma employees, but their roles were modified to help patients navigate their care. Both navigators went through a healthy living training program. "Their role is to remind at-risk patients what they need to be doing to protect their health," Mr. Gardner says. The navigators focus on type-2 diabetes education because of its prevalence in the area.
"It was a much bigger project than what I expected it to be," Mr. Gardner says. "One of our problems in the first year was doing everything at once. We were all overwhelmed." He recommends that other hospitals considering the move to patient-centered care take baby steps to achieve their goal.
Another challenge was communicating the change to Yuma's patients. According to Mr. Gardner, patients were having a difficult time grasping the care navigator role. "Communication is a work in progress," he says. The hospital has had articles in local newspapers about the move to patient-centered care and included information in its annual report. The care navigators were also part of a recent local health fair, so patients could meet them face-to-face.
Patients have also been more satisfied with their care since the changes were implemented. "We are seeing positive movement already, so that is good," says Mr. Gardner, who tracks patient satisfaction through HCAHPS scores.
Even though the hospital is still in the process of seeking PCMH certification from the National Committee for Quality Assurance, Mr. Gardner is sold on patient-centered medical care. "I'm absolutely convinced that the community will be a far better place due to the PCMH concept," he says. "The care we give is going to be far better, and it is the right thing for the community."
To solve the expensive recruiting problem, Mr. Gardner began using part-time, long-term employment as a way to attract physicians. "The physicians work for three days and the other four days a week, they get to enjoy the mountains," he explains.
But that style of physician employment led to some issues at the hospital. Transitions of care were not going smoothly when physicians switched shifts, which affected patient satisfaction and led to some patient safety issues. So, Mr. Gardner found a solution to that issue as well: become a patient-centered medical home.
"I had the opportunity to visit Group Health in Seattle where they have adopted the PCMH model and they use a lot of part-time providers in their facilities," Mr. Gardner says. "And it occurred to me that this might be the magic bullet for us to provide patients with a better care experience."
Care teams, navigators
The main thrust of the changes at Yuma involved placing its primary care providers into care teams to ensure smooth transitions of care. Yuma has six primary care physicians and one nurse practitioner who are now divided into three care teams."We're trying to find the right blend of physicians with compatible personalities," Mr. Gardner says. "To my surprise, that hasn't really been a struggle." He allowed the providers to choose their own care teams and has tried to keep administrators out of the process.
The team model has improved the communication problem at Yuma. "The providers in the teams work with the same nurses, so there is a better opportunity for communication," Mr. Gardner says. "And now the [providers] are more conscientious about communicating before they leave the building."
Yuma also added two care navigators as part of the patient-centered initiative. The two navigators were already Yuma employees, but their roles were modified to help patients navigate their care. Both navigators went through a healthy living training program. "Their role is to remind at-risk patients what they need to be doing to protect their health," Mr. Gardner says. The navigators focus on type-2 diabetes education because of its prevalence in the area.
Words of wisdom
Though the PCMH transition has been mostly smooth for Yuma District Hospital, there were a few hiccups in the process, especially in the first year."It was a much bigger project than what I expected it to be," Mr. Gardner says. "One of our problems in the first year was doing everything at once. We were all overwhelmed." He recommends that other hospitals considering the move to patient-centered care take baby steps to achieve their goal.
Another challenge was communicating the change to Yuma's patients. According to Mr. Gardner, patients were having a difficult time grasping the care navigator role. "Communication is a work in progress," he says. The hospital has had articles in local newspapers about the move to patient-centered care and included information in its annual report. The care navigators were also part of a recent local health fair, so patients could meet them face-to-face.
Results
Yuma District Hospital has seen great results after implementing the changes to become a PCMH. The physicians are already seeing patients control their diabetes and hypertension more effectively. Pneumonia admissions have also declined.Patients have also been more satisfied with their care since the changes were implemented. "We are seeing positive movement already, so that is good," says Mr. Gardner, who tracks patient satisfaction through HCAHPS scores.
Even though the hospital is still in the process of seeking PCMH certification from the National Committee for Quality Assurance, Mr. Gardner is sold on patient-centered medical care. "I'm absolutely convinced that the community will be a far better place due to the PCMH concept," he says. "The care we give is going to be far better, and it is the right thing for the community."
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