Performance Improvement Rounds Enhance Understanding Between Clinic Staff and Leadership

A new initiative at the Department of Family Medicine (DFM) is helping to improve communication, education, and support between organizational leadership and clinic staff.

Performance improvement (PI) rounds consist of a series of in-person clinic visits by DFM and/or UW Medical Foundation (UMWF) leadership.

The visits are a way for each clinic to share how they are succeeding—and struggling—with implementing organizational and clinic-specific priorities. They're also an opportunity to recognize individual contributors and identify common issues across clinics.

The Importance of Face Time

Launched last year and in progress now, PI rounds were first suggested by DFM Quality Improvement Manager Stephanie Berkson, MPA, who used a similar model in a previous position.

"The idea of PI rounds is that as we roll out a variety of initiatives across the department, it will be useful to go to clinics and see how they're working," Berkson said. "We always talk with clinic leaders, but it's different to see hands-on how they're actually doing it."

Berkson, Vice Chair for Clinical Care Sandra Kamnetz, MD, and Assistant Administrator for Clinical Care Susan Kaletka, MPH visited all eight DFM-managed residency clinics from August 2009 through January 2010. A second round of visits is underway now into the fall.

A similar team, consisting of Dr. Kamnetz and representatives from the UWMF's clinical operations and quality improvement teams, also began visiting UWMF-managed clinics this summer.

"Our experience thus far has been educational and informative," said UWMF Director of Clinic Operations Lori Hauschild. "[PI rounds] allow one-on-one dialogue with clinic operations management, quality improvement staff, and front line staff."

"I also think it benefits quality improvement staff to spend time in our clinics seeing first-hand how we interact with each other and patients," she added. "It also gives us a perspective on how system-wide initiatives impact patient care and staff workloads."

Toward Better Education, Communication, and Recognition

The rounds are informal, though each clinic now receives a document in advance listing organizational priorities for observation and discussion.

Clinic staff are encouraged to share their strategies for implementing those priorities and other clinic-specific initiatives. They're also encouraged to discuss challenges or barriers met along the way.

The visits also celebrate individual staff contributors, such as the HealthLink "superusers" who've found ways to use the electronic medical records system more effectively.

For example, a recent visit to the UW Health McFarland clinic focused on an anticoagulation nurse care management program, colorectal screening, pay-for-performance issues, and progress of a new diabetes management initiative.

"It was great for our clinic staff to meet the administration and ask them questions," said clinic manager Lynn Larsen, RN, BSN. "It puts everybody on the same team."

Larsen added that PI rounds help clinic staff and administration alike better understand what's really involved in changing a process.

"On paper, an initiative looks like it's going to work, but with implementation it doesn't always run as smooth," she said. "So it helps that administration can come and see the front line staff morphing what they'd like to see into a workable product. The two-way, immediate face-to-face communication is great."

Berkson also emphasized that although the visits involve different levels of clinic staff—physicians, nurses, medical assistants, and receptionists—the rounding team is very sensitive to patient care. "It's our first priority," she said, "and we're careful not to interrupt or disrupt it in any way."

Themes and Variations

Dr. Kamnetz said that long-term goal of PI rounds is to identify common themes across clinics. "This project is about building relationships, learning what is going well, what is working, and who has been helpful," she said.

"It's also about identifying process improvement areas ('What systems can be working better?'), and repairing and monitoring systems to ensure chronic issues have been resolved ('Do you have the tools and equipment to do your job?')", she added.

For example, the first set of rounds showed that Kanban inventory management (see related story) has been working quite well at most clinics, though specific implementation strategies have varied to meet clinic needs.

Rounds also revealed best practices, such as the new flat-screen monitor that replaced a paper bulletin board at the Eau Claire Family Medicine clinic, or rotating monthly patient education at the Verona Clinic.

Down the road, PI rounds may influence a change in policy or new educational initiatives. But for now, it's about getting out and fostering partnerships with clinic staff.

"Rounding provides an opportunity for me and other leadership to collect and pass on recognition for physicians and staff who have been helpful," Dr. Kamnetz said.

"The pride evidenced at each site creates increasing momentum for a positive work culture," she added. "By doing this, we build in opportunities to notice what's right for better service and for the patient care outcomes in which we are all invested."