Question

Managing Change

Jennifer Kowal, a family nurse practitioner, moves to a small rural community in Michigan. There is no primary health care office within a 50-mile radius. She decides that she will open a community health center and provide primary care services. Nurse Kowal has never managed or owned a business. She has negotiated a collaborative agreement with a family practice physician in a major urban area. Nurse Kowal begins to review the literature on best practices in primary care settings.

1. What activities should Nurse Kowal undertake before opening the health center?
2. Nurse Kowal’s dad is a prominent business owner in the city she grew up in. When she tells him what she is trying to do, he asks what her mission statement and business vision are. When she tells him, he warns her, “That’s all very well, but make sure you build in a way to be flexible, too.” If Nurse Kowal’s core purpose and core values will be unchanging, how can she keep her organization flexible as well? Is it possible her father is wrong because he does not understand how health care must work?

Answer 1

Best Practices in primary care settings;

The practices shared six statistically significant common characteristics. The attributes of high-value primary care practices were:

1.Decision support for evidence-based medicine: care teams ensure patients receive evidence-based care and treatment, frequently making guideline-based reminders in the EHR to other providers, office managers regularly generate reports to identify care gaps, and physicians consciously avoid test orders not linked to change management.

2. Risk care Management each patient receives care based on his or her unique needs, with high-risk patients receiving monitoring and guidance from a care manager as well as longer office visits, frequent phone checks, and in some cases, home visits from clinicians

3• Careful selection of specialists: clinicians use a narrow list of specialists with whom they trust to follow evidence-based guidelines and remain in contact as treatment plans develop.

4• Care coordination: care teams monitor patients outside of primary care visits and ensure patients complete specialist referrals, schedule timely follow-up after unexpected hospitalizations, and in some cases, track medication adherence

5• Standing orders and protocols: practices create standing orders and protocols for uncomplicated acute illnesses and chronic disease management, as well as encourage non-clinician team members to use standardized workflows for patient care without requiring direct clinician intervention

6• Balanced compensation: physician compensation based on value instead of just volume and compensation accounts for at least care quality, patient experience, resource use, or participation in practice-wide improvement activities.

Objectives of Public Health Standards for Primary Health Centres (PHC)
The overall objective of PHS is to provide health care that is quality oriented and sensitive to the needs of the community.
The objectives of PHS for PHCs are:
i. To provide comprehensive primary health care to the community through the Primary Health Centres.

ii. To achieve and maintain an acceptable standard of quality of care.
iii. To make the services more responsive and sensitive to the needs of the community.