Russell Phillips, MD, Director of the Harvard Medical School Center for Primary Care, worked with 20 practices affiliated with Harvard to lead positive culture change. The important drivers of this positive culture change were identifying and adopting a quality improvement framework, having improvement-focused team meetings, and creating an environment that supported continuous learning.
In their quality improvement focus area, the practices utilized Plan, Do, Study, Act (PDSA) performance improvement framework cycles and tracked the results on run charts. Their first initiatives were to improve follow-up on test results and referrals and to measure the impact of the changes. Creating capacity for improvement gave the team a shared vision and enabled them to work together to attain common goals to build the team's culture. This had the added benefit of improving practice efficiency and reducing physician burnout.
Dr. Phillips says, “A big source of professional dissatisfaction comes from feeling that systems are not supporting us in the work that we need to do. We experience a lot of undue worry about whether important aspects of patient care are falling through the cracks. Building capacity for quality improvement creates opportunities in the practice to work together to make processes better.”
Team members across the 20 practices participate in learning sessions, which are forums to help team members work together and develop their ideas. The Center has also created an academy to help leadership teams develop their skills for leading change and improvement in the practice.
Dr. Phillips cites an example from his own practice: “Our team leader created an initiative to improve our processes for recording health care proxies. Together, we came up with a redesigned process where medical assistants (MAs) would offer information to patients. The MAs also received training in witnessing the forms. Patients started appearing at visits with the forms in hand so they could be discussed with the physician, then completed, witnessed, and scanned into the record by the MA after the visit. As a team, we monitored our progress using run charts and continually worked to improve the process. The team came together to share in the success of implementing this new process. It helped everyone on the team recognize that even changing systems is possible with the help of the team. The doctor doesn't have to do everything, and the other members of the team rise to the challenge to take on new roles.
The practices in the Harvard Medical School Center for Primary Care are creating a culture where all feedback, including bilateral feedback between manager and staff and among team members, is welcome. “We now have huddles and we disrupt hierarchy so that everyone has an opportunity to contribute.”
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