AMA's Vice President of Practice Transformation, Christine Sinsky, MD, shares the origins of the AMA STEPS Forward® program and how this program supports organizations, physicians, and their teams. Learn more about practice innovation strategies by visiting stepsforward.org.
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Speaker: Hello and welcome to the AMA STEPS Forward® podcast series. We'll hear from health care leaders nationwide about real-world solutions to the challenges that practices are confronting today. Solutions that help put the joy back into medicine. AMA STEPS Forward® program is open access and free to all at stepsforward.org.
Sayers: Hi, I'm Alek Sayers at the American Medical Association. Today on the STEPS Forward® podcast series, we will hear from the AMA's Vice President of Practice Transformation, Dr Christine Sinsky, on what STEPS Forward® is and how it came to be a program at the AMA. Well, so good to hear and see you today. How are you doing Dr Sinsky?
Dr Sinsky: Terrific. Thanks, Alek. It's lovely to be here together.
Sayers: I just want to ask you a couple questions that are on my mind about the STEPS Forward® program. First off, what's the genesis of this? Why was STEPS Forward® created?
Dr Sinsky: Well, we created STEPS Forward® to have for physicians and their teams a set of resources that could help them work smarter, not harder. To have a set of resources that were practical, actionable one-stop resources, so that they could come in and fix or improve one aspect of their workflow.
Sayers: That is absolutely wonderful to hear. I've had the good fortune to check out a few and, and work on a few of these modules, helping them get formatted and put up after the day has been put together. And especially for me as an onlooker, a person without a medical degree, running a practice, there's so much wonderful content in there that it seems like it's been put together to tackle all sorts of different needs physicians may have in trying to improve their practice. So, what would you say is the purpose and the thesis of why we have these modules and so many different modules for access?
Dr Sinsky: So, we have created this library of, of resources, if you will, and some are on how to develop stronger teamwork and how to improve workflows. So, under practice efficiency and others are around organizational culture, how do you build stronger teams? How do you communicate through daily huddles or team meetings with your team? And the overall purpose is to be able to enhance joy in work, joy in medicine, for physicians, and for the teams that they work with.
Sayers: Yeah. And all sorts of different aspects of that team, too. How do you go about, how do we go about deciding which parts of a practice we want to tackle and look at the efficiency and joy of that we could improve?
Dr Sinsky: Sure, sure. Well, I suggest that most teams start by looking at practice fundamentals. And one of the things we have on the STEPS Forward® website is a practice assessment tool. So, you could sit down with your team and go through this 10- or 12-question set, and it helps you reflect on what you're doing now and how that compares with what you could do. And then if you go through that practice assessment exercise, we recommend specific modules to you that could be specifically helpful for you.
Sayers: I love hearing about the assessment and how people start accessing it. So that brings me to wonder who exactly can use it? What parts of different organizations are able to get a handle on STEPS?
Dr Sinsky: Well, one of the things we're most pleased about, about STEPS Forward® is that it is open to all. You don't have to be an AMA member. You don't have to even be a physician. You can be a nurse, a medical assistant, a practice manager, or a physician, or an APP, or anyone else who's interested in this work. You don't need a username or a password. We've made it completely open access. So that hopefully there's nothing between you and your interest in learning how to do things in a more optimal way and your ability to access some guidance for that.
Sayers: And what was that, where was that, uh, that all these are located for the open access.
Dr Sinsky: So, they're all at stepsforward.org. So pretty easy name to remember stepsforward.org. And then when you get to the site, we do have the over 60 modules that we currently have available clustered in themes. So, we have the practice fundamentals clustered under team-based care and workflow. And there, you can get ideas to bring back to your own practice on how to do pre-visit planning, pre-visit lab, how to have expanded rooming and discharge responsibilities for your, uh, clinical partners, your staff, the medical assistants, and the nurses, how to do prescription management in a more effective way. That sort of thing.
Sayers: We've talked a lot about how to access it, what it can do. But do you have any examples of specific things that STEPS Forward® has led to practices saving time or changing the physician experience?
Dr Sinsky: Sure. We have a lot of those examples, and we estimate that most physicians in most practices can save three to five hours a day by re-engineering the way the work is done, that is working smarter, not harder. And then by more strategically delegating the work to the team. So, sharing some of the care with an upskilled set of team members. Now, with each of the modules, we have a number of success stories. These are case studies where an organization shares with us what they've done in this realm. One example would be under prescription management. Um, one of our, uh, physicians, our physician director, Dr Marie Brown, had visited an organization in Rockford, Illinois, Crusader Health. She shared with them some of the practice fundamentals. They got turned on to doing prescription management in a more efficient and effective way. And within six months they had saved between 30 and 60 minutes per physician, by having just re-engineered the way they managed the workaround prescription renewals and their success story is, accompanies the module on prescription management.
Sayers: That's an incredible amount of time. And I'm sure most of that time gets turned back into quality time with a patient at these, physicians, with these physicians. Right?
Dr Sinsky: Well, it, it's my recommendation that if you're able to save, say three hours a day, give one hour back to the time you spend with patients to either provide access to more patients, to see you and, or to spend more time with those patients that are in your practice. Give one hour back to your practice to just considering how you can improve additional workflows and then give one hour back to yourself and your family and friends.
Sayers: So, we've talked a lot about the plethora of modules and all sorts of different topics that are covered. Do you have any examples of the ones that you recommend the most, a practice you should start with?
Dr Sinsky: Sure. I, I do. I think that, um, there are some core concepts, the, what we've been referring to as the practice fundamentals that have the low-hanging fruit. So, for practices that are just beginning this journey, I recommend looking at prescription management, pre-visit planning, pre-visit lab, expanded rooming, and discharge. These are all modules that are under the umbrella of team-based care and workflow and there, where you can save quite a bit of time by just doing the work more efficiently. But then I also have another favorite. Under the umbrella of organizational culture, we have several that I think are quite effective, but one is called Getting Rid of Stupid Stuff and Getting Rid of Stupid Stuff is a module that was written by Dr Melinda Ashton of Hawaii. And she wrote an article that was in the New England Journal of Medicine with the same title, Getting Rid of Stupid Stuff. And it helps leaders start to de-implement outdated policies and policies that don't have a good evidence base, but that have been adding to the administrative burden on their, on their physicians and staff.
Sayers: So, I'm very curious. I was checking out the pre-visit labs STEPS Forward® module, and there's a wonderful video in there in which Dr Mead specifically talks about the value of having test results for the in-person consultation, as opposed to later having to try to convince his patients that they need to get on medicine on the phone. How else does patient care quality increase through these pre-visit labs?
Dr Sinsky: The common workflow in many, many practices is that the patient comes for their appointment, the physician and the patient reviews six-month-old lab. And then after the appointment, the patient is sent for a new lab and over the next several days, those results trickle in and then the physician or his or her team needs to contact the patient and try to give them advice and guidance and medication management over the phone. Patient doesn't have a chance to be highly engaged in that model. If you do the labs ahead of the visit, then at the visit, when you're face to face, you can talk about current results and you can engage the patient in their own self-management. You can say your diabetes numbers were a little off. Here are some of our options, which one would you like to do? Or I would recommend this.
And then the patient has a chance to, um, have a say in their management. And when they have a say, they're much more likely to be adherent to the plan that you've agreed on together, and it's much more efficient because then you can close the loop of care for that patient, right at the visit and not have any loose ends that have to be addressed over the next several days as lab comes in, because you did the lab beforehand. In addition, it allows you to have just-in-time information processing, you look at the lab one time and just at the time where you're going to take action on that lab result, which is when you're with the patient.
Sayers: I've been lucky enough that, uh, my primary care doctor participates a lot. And I find, especially as a patient, that I feel more informed and comfortable with my own health.
Dr Sinsky: We actually even have our nurses review the lab with the patient during the rooming process. So, the patients had a chance to think about their results for a few minutes before I come in the room. And they may actually already have some thoughts about perhaps why their diabetes isn't as well managed as it had been the last time. And then that helps them come up with a plan.
Sayers: Well, I'm so thankful you just mentioned the rooming process, because the other STEPS Forward® module I checked out recently was the expanded rooming discharging one. And one of the things that it highlights a lot to me as a consumer was the value in empowering team members. Is there anything to that that you'd like to speak on?
Dr Sinsky: Yeah, I think when we invest time in up training our staff so that they have more autonomy and more individual responsibility, they're able to make so much more substantial contributions to care and really take great pride in the work that they do. So, when medical assistants or nurses have expanded rooming and discharge responsibilities, which they do according to established protocols, they can do more for the patient. They can close care gaps. That is a patient is due for certain prevention activities. They can go ahead and schedule the colonoscopy or administer the immunization. And then at discharge, they can be very instrumental in making sure that we've set up the next appointment for however it was that the patient and the physician had agreed upon. So perhaps it was in three months with diabetic lab ahead, and then we'll make sure that the patient gets all that set up before they leave so that we know that they'll be all ready, ready to go for the next appointment.
Sayers: Well, I think that concludes all the questions I had today.
Dr Sinsky: Well, Alek, it was a pleasure to speak with you. Thanks so much.
Sayers: Thank you, Dr Sinsky.
Speaker: Thank you for listening to this episode from the AMA STEPS Forward® podcast series. AMA's STEPS Forward® program is open access and free to all at stepsforward.org. STEPS Forward® can help put the joy back into medicine by offering real-world solutions to the challenges that your practice is confronting today. We look forward to you joining us next time on the AMA STEPS Forward® podcast series, stepsforward.org.
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If applicable, all relevant financial relationships have been mitigated.
Disclaimer: AMA STEPS Forward® content is provided for informational purposes only, is believed to be current and accurate at the time of posting, and is not intended as, and should not be construed to be, legal, financial, medical, or consulting advice. Physicians and other users should seek competent legal, financial, medical, and consulting advice. AMA STEPS Forward® content provides information on commercial products, processes, and services for informational purposes only. The AMA does not endorse or recommend any commercial products, processes, or services and mention of the same in AMA STEPS Forward® content is not an endorsement or recommendation. The AMA hereby disclaims all express and implied warranties of any kind related to any third-party content or offering. The AMA expressly disclaims all liability for damages of any kind arising out of use, reference to, or reliance on AMA STEPS Forward® content.
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