Primary Care Practice Characteristics Associated With Medical Assistant Staffing Ratios.

This study characterized adult primary care medical assistant (MA) staffing. National Survey of Healthcare Organizations and Systems (n = 1,252) data were analyzed to examine primary care practice characteristics associated with MA per primary care clinician (PCC) staffing ratios. In 2021, few practices (11.

Associations Between Lean IT Management and Financial Performance in US Hospitals.

Background And Objectives: To understand the relationship between Lean implementation in information technology (IT) departments and hospital performance, particularly with respect to operational and financial outcomes.

Methods: Primary data were sourced from 1222 hospitals that responded to the National Survey of Lean (NSL)/Transformational Performance Improvement, which was fielded to 4500 general medical-surgical hospitals across the United States. Secondary sources included hospital performance data from the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS).

Lean Performance Indicators and Facilitators of Outcomes in U.S. Public Hospitals.

Goal: This study investigated the association between Lean and performance outcomes in U.S. public hospitals.

Transformational Performance Improvement: Why Is Progress so Slow?

In this chapter, we identify three distinct transformational performance improvement (TPI) approaches commonly used to redesign work processes in health care organizations. We describe the unique components or tools that each approach uses to improve the delivery of health services. We also summarize what is empirically known about the effectiveness of each TPI approach according to systematic reviews and recent studies published in the peer-reviewed literature.

Managing Through a Pandemic: A Daily Management System for COVID-19 Response and Recovery.

Goal: This study explored the use of a Lean daily management system (DMS) for COVID-19 response and recovery in U.S. hospitals and health systems.

Lean Practices for Resource Use, Timeliness, and Coordination of Care in Breast Cancer Navigation.

Background: Cancer care is described as insufficiently patient-centered, requiring improved accessibility and coordination. Breast oncology nurse navigators may help provide timely patient care by improving care coordination.

Objectives: This study evaluated a breast cancer navigation (BCN) program in a large ambulatory healthcare system.

Road to Better Work-Life Balance? Lean Redesigns and Daily Work Time among Primary Care Physicians.

Purpose: To assess the impact of Lean primary care redesigns on the amount of time that physicians spent working each day.

Methods: This observational study was based on 92 million time-stamped Epic® EHR access logs captured among 317 primary care physicians in a large ambulatory care delivery system. Seventeen clinic facilities housing 46 primary care departments were included for study.

Breast Cancer Navigation: Using Physician and Patient Surveys to Explore Nurse Navigator Program Experiences.

Background: Patient navigators can improve patient experiences of care and outcomes, but little is known about how navigation programs may affect physician workflows and experience.

Objectives: This study aimed to understand patient and physician experiences with a breast cancer navigation (BCN) program using Lean design principles.

Methods: Surveys were developed and distributed from 2019 to 2020 to 255 patients diagnosed with breast cancer and 128 physicians in primary care and cancer-related specialties.

Patient experiences after implementing lean primary care redesigns.

Objective: To examine the effect of Lean primary care redesigns on patient satisfaction with care and timeliness of care received.

Data/setting: We used patient surveys and time-stamped electronic health record (EHR) data in a large ambulatory care system.

Design: Lean-based changes to clinical spaces and care team workflows were implemented in one pilot site and then scaled to all primary care departments across the system.

Implementing Lean Quality Improvement in Primary Care: Impact on Efficiency in Performing Common Clinical Tasks.

Background: Many primary care practices have adopted Lean techniques to reduce the amount of time spent completing routine tasks. Few studies have evaluated both immediate and sustained impacts of Lean to improve this aspect of primary care work efficiency.

Objective: To examine 3-year impacts of Lean implementation on the amount of time taken for physicians to complete common clinical tasks.

Contextual Conditions and Performance Improvement in Primary Care.

Background: Although organizational context can affect the implementation of quality initiatives, we know less about the influence of contextual conditions on quality outcomes. We examined organizational features of primary care clinics that achieved greatest performance improvements after implementing Lean redesigns.

Methods: We used operational data and baseline (ie, pre-Lean implementation) surveys of 1333 physicians and staff in 43 primary care clinics located across a large ambulatory care system.

Sustainment of Lean Redesigns for Primary Care Teams.

Background: Quality improvements are notoriously followed by "backsliding" or relapse to the status quo. This mixed-methods study examined the sustainment of Lean workflow redesigns for primary care teams several years after being implemented in a large, ambulatory care delivery system.

Methods: We conducted qualitative interviews of 57 leaders and frontline providers, and fielded post-Lean implementation surveys to 1164 physicians and staff in 17 primary care clinics across the system.

Nurses' Perspectives on Lean Redesigns to Patient Flow and Inpatient Discharge Process Efficiency.

As hospitals around the world increasingly face pressure to improve efficiency, "Lean" process improvement has become a popular approach to improving patient flow. In this article, we examine nurses' perspectives on the implementation of Lean redesigns to the inpatient discharge process. We found that nurses experienced competing demands and tensions related to their time and professional roles and responsibilities as a result of Lean.

Physician Engagement With Metrics in Lean Primary Care Transformation.

Objective: Data and metrics play important roles in quality and process improvement efforts. For one specific process improvement method, Lean or Lean health care, data and metrics are central components, allowing users to identify areas that need improvement and to assess the degree to which improvements have been realized. This article explores the role that metrics and measurement played in a wide-reaching "Lean"-based continuous quality improvement effort carried out in the primary care departments of a large, ambulatory care health care organization.

Experiences of primary care physicians and staff following lean workflow redesign.

Background: In response to growing pressures on primary care, leaders have introduced a wide range of workforce and practice innovations, including team redesigns that delegate some physician tasks to nonphysicians. One important question is how such innovations affect care team members, particularly in view of growing dissatisfaction and burnout among healthcare professionals. We examine the work experiences of primary care physicians and staff after implementing Lean-based workflow redesigns.

Scaling Lean in primary care: impacts on system performance.

Objectives: We examined a wide range of performance outcomes after Lean methodology-a leading strategy to enhance efficiency and patient value-was implemented and scaled across all primary care clinics in a nonprofit, ambulatory care delivery system.

Study Design: Using a stepped wedge approach, we assessed changes associated with the phased introduction of Lean-based redesigns across 46 primary care departments in 17 different clinic locations. Longitudinal analysis of operational metrics included: workflow efficiency, physician productivity, operating expenses, clinical quality, and satisfaction among patients, physicians, and staff.

Shared Medical Appointments: A Promising Innovation to Improve Patient Engagement and Ease the Primary Care Provider Shortage.

The Affordable Care Act has extended coverage for uninsured and underinsured Americans, but it could exacerbate existing problems of access to primary care. Shared medical appointments (SMAs) are one way to improve access and increase practice productivity, but few studies have examined the patient's perspective on participation in SMAs. To understand patient experiences, 5 focus group sessions were conducted with a total of 30 people in the San Francisco Bay Area.

Leveraging electronic health records to develop measurements for processes of care.

Objectives: To assess the reliability of data in electronic health records (EHRs) for measuring processes of care among primary care physicians (PCPs) and examine the relationship between these measures and clinical outcomes.

Data Sources/study Setting: EHR data from 15,370 patients with diabetes, 49,561 with hypertension, in a group practice serving four Northern California counties.

Study Design/methods: Exploratory factor analysis (EFA) and multilevel analyses of the relationships between processes of care variables and factor scales with control of hemoglobin A1c, blood pressure (BP), and low density lipoprotein (LDL) among patients with diabetes and BP among patients with hypertension.

Overcoming challenges to adoption of shared medical appointments.

Although research has shown many benefits of Shared Medical Appointments (SMAs) or group visits, uptake by physicians has been quite limited. The objective of this study was to explore the facilitators and barriers to implementing SMAs in a large multispecialty medical group. This was a comparative analysis of SMAs at 3 geographically distinct, semiautonomous divisions of the medical group based on qualitative themes identified in audio recorded key informant interviews with medical and administrative staff (n=12) involved with the implementation of SMAs.

Recognition as a patient-centered medical home: fundamental or incidental?

Purpose: Little is known about reasons why a medical group would seek recognition as a patient-centered medical home (PCMH). We examined the motivations for seeking recognition in one group and assessed why the group allowed recognition to lapse 3 years later.

Methods: As part of a larger mixed methods case study, we conducted 38 key informant interviews with executives, clinicians, and front-line staff.

What's in a setting?: Influence of organizational culture on provider adherence to clinical guidelines for treating tobacco use.

Background: Organizational culture is an important but underinvestigated feature of the work environment that can impact provider behavior, including adherence to clinical practice guidelines. There is substantial evidence that physician assistance to smokers can produce significant reductions in tobacco use. However, this evidence has not been well translated into practice, as only a small proportion of smokers receive recommended treatment during medical visits.

Paying for prevention: associations between pay for performance and cessation counseling in primary care practices.

Purpose: To examine associations between pay for performance (P4P) and recommended cessation counseling among primary care practices (PCPs).

Design: Cross-sectional survey of 89 PCPs participating in a joint Robert Wood Johnson Foundation (RWJF)-Agency for Healthcare Research and Quality (AHRQ) health promotion initiative.

Setting And Participants: 100% response rate from PCPs participating in the RWJF-AHRQ initiative.

Assessing the impact of behavioral risk factors and known-groups validity of the SF-12 in a US Chinese immigrant population.

Background: Health status measures are being used in increasingly diverse populations. However, there are no known studies to date that examine the SF-12 in US Chinese populations. This study reports on the performance and validity of the SF-12 among Chinese immigrants residing in New York City, and evaluates the impact of multiple behavioral risk factors on physical and mental health status.

Common measures, better outcomes (COMBO): a field test of brief health behavior measures in primary care.

Background: Primary care offices have been characterized as underutilized settings for routinely addressing health behaviors that contribute to premature death and unnecessary suffering. Practical tools are needed to routinely assess multiple health risk behaviors among diverse primary care patients. The performance of a brief set of behavioral measures used in primary care practice is reported here.