Creating and Fostering a Culture of Change

Gregory A. Elkins M.D.Medical Director

Lincoln Primary Care Center

Rural Quality Program ConferenceSeptember 2, 2009

Washington D.C.

Lincoln Primary Care Center 1975

•Established in Former Grocery Store•2 National Health Service Corps Providers

LPCC 2009

• 33,000 Encounters• 11 Providers• 4 Sites

Well Center

• Meals • Exercise Sessions• Other Services

Population Served

• Rural Appalachia

• Town of Hamlin- population 1,000

• Lincoln County- 24,000

• Additional Surrounding Counties

• Nearest Hospital 40 minutes away

Change

Not a 4 letter word!

Why Change?

• “Things are fine like they are.”• “We have always done it this way.”

Health Care Delivery System • Based on 1900 Needs

Physician CentricAcute CareDoes Not Meet Needs of 2009!

• Based on 2009 NeedsChronic Disease and Its Consequences

Why Change?

To Improve!

Quality Improvement

•What We’ve Done•Where We’re Going

• Fall 2002• First Step

•Manual Chart by Chart Review• Individual Patient Information • (Very Limited)

Chronic Disease Manager

Chronic Disease ManagerObstacle: $

• Team Approach

• Patient Centered

• Standardized Goals

• Clinical Information System

NHDCNHDC

NHDCBiggest Accomplishment – Learned How to Change

What are we trying toaccomplish?

How will we know that achange is an improvement?

What change can we make thatwill result in improvement?

Model for Improvement

Act Plan

Study Do

Spread•Obstacles:–Fear of Change–$$$

Overcoming Obstacles• Show the Data:–Starting A1C- 9.5–Current A1C- 7.4

Allow Staff to Work to Their Potential

EHR Implementation

http://www.cartoonresource.com/hpm111pw.htm

Growth• Recent Retreat with

Management Team and Board of Directors

3 Key Questions•Where are you?•Where are you going?• How are you going to get

there?

Questions ?Gelkins@LincolnPrimaryCare.com