1. New Community, New Practice: Redesign of Physical Space to Support the New Model David B. Graham, MD University of Colorado Denver STFM Practice Improvement PA22: November 10 th, 2007

2. PA22: November 10th, 2006 Physical Design Supports Practice Redesign David B. Graham, MD 2 Objectives On completion of this session, the participants should be able to… Discuss elements of the New Model of practice that enhance patient-centered practice. Integrate concepts of the Chronic Care Model into clinical practice the redesign of physical space. Utilize resources for assistance with practice redesign and transformation.

3. PA22: November 10th, 2006 Physical Design Supports Practice Redesign David B. Graham, MD 3 Future of Family Medicine Annals of Family Medicine in 2004 “…brings together the enduring values of family medicine with new technologies and approaches for practices to better serve the needs of patients in the 21st century. It involves providing patients with a personal medical home emphasizing a patient-centered care approach that eliminates barriers to access. “ The Future of Family Medicine: A Collaborative Project of the Family Medicine Community. Ann Fam Med 2004 2: S3-S32.

4. PA22: November 10th, 2006 Physical Design Supports Practice Redesign David B. Graham, MD 4 Future of Family Medicine Patient-Centered practice  Open/Advanced Access  Advanced Information Systems Electronic Health Record Asynchronous Communication  Redesigned, more Functional offices  Focus on Quality & Safety  Community context

5. PA22: November 10th, 2006 Physical Design Supports Practice Redesign David B. Graham, MD 5 Movements to Improvement & Change Innovation Collaboratives Idealized Design of the Clinical Office Practice (IDCOP) Patient-Centeredness Idealized Teams Chronic Care Model Lean Production (Toyota model) NIH funded research ongoing TransforMED & P 4

6. PA22: November 10th, 2006 Physical Design Supports Practice Redesign David B. Graham, MD 6 TransforMED – Medical Home Quality & Safety Continuity of Care Services Point of Care Services Team-based Care Access to Care & Information Information Systems PRACTICE MANAGEMENT Medical Home

7. ICIC Chronic Care Model Resources and Policies Community Delivery System Design Decision Support Clinical Information Systems Self- Management Support Health System Health Care Organization Informed, Activated Patient Prepared, Proactive Practice Team Productive Interactions Improved Outcomes CC

8. PA22: November 10th, 2006 Physical Design Supports Practice Redesign David B. Graham, MD 8 AF Williams Family Medicine Center Academic residency training clinical practice 18 residents (6-6-6) 14 faculty 3 NP/PA 21,000+ visits per year Previous location since 1991 Moved November 19 th, 2006

9. PA22: November 10th, 2006 Physical Design Supports Practice Redesign David B. Graham, MD 9 AF Williams Family Medicine Center Initial change efforts with Innovation Teams  2001  Lean Principles/ IDCOP Open Access Scheduling  January 2003 EHR implementation  November 2003 Asynchronous Communication  March 2005

10. PA22: November 10th, 2006 Physical Design Supports Practice Redesign David B. Graham, MD 10 Innovation and Improvement Teams Lead Team Front Office Team Back Office Team Provider Team Clinical Teams Residency

11. PA22: November 10th, 2006 Physical Design Supports Practice Redesign David B. Graham, MD 11 AFW Physical Space Redesign

12. PA22: November 10th, 2006 Physical Design Supports Practice Redesign David B. Graham, MD 12 AFW physical redesign details Borrowed concepts from many places  IHI – IDCOP  Lean concepts  Safety and functionality at the heart of design Co-location of people and tasks Standardized exam spaces Small waiting room – all activity centralized  Patient as the center of care Clinica Campesina experience

13. PA22: November 10th, 2006 Physical Design Supports Practice Redesign David B. Graham, MD 13 AFW physical redesign details Pod Work zone 9 “standard” exam rooms

14. PA22: November 10th, 2006 Physical Design Supports Practice Redesign David B. Graham, MD 14 Stapleton becoming a reality

15. PA22: November 10th, 2006 Physical Design Supports Practice Redesign David B. Graham, MD 15 Stapleton becoming a reality

16. PA22: November 10th, 2006 Physical Design Supports Practice Redesign David B. Graham, MD 16 AFW physical space concepts – year 1 Personal Health Assessments Integrated Registry and practice data Xpress Patient Services  Electronic Check-in  Forms emailed prior to visit  My Doctor’s Office Printers in every room Phones in every room Extended hours (M-W 8a-7pm, Saturday AM) Emphasis on comfortable exam rooms

17. PA22: November 10th, 2006 Physical Design Supports Practice Redesign David B. Graham, MD 17 AFW redesign – year 1 Community driven initiatives Continuous evaluation Collaborative & integrated healthcare  Psychiatry  Podiatry & Sports Medicine  Obstetrics & Midwifery  Integrative Medicine  Pharmacy links

18. PA22: November 10th, 2006 Physical Design Supports Practice Redesign David B. Graham, MD 18 AFW planned concepts – year 1-3 Community Advisory Council Health Information Resource Center Full transparency of data  Web portal for viewing personal medical record Dual-zone WiFi connectivity  Patient education materials on desktop Continuous evaluation  Iterative improvement and innovation Community driven initiatives

19. PA22: November 10th, 2006 Physical Design Supports Practice Redesign David B. Graham, MD 19 Maintaining the momentum Difficult to sustain change without support and leadership at ALL levels of the organization. Plan regular meetings and always keep them. Small PDSAs  Don’t waiting for the big event. Involve ALL members of the care team.

20. PA22: November 10th, 2006 Physical Design Supports Practice Redesign David B. Graham, MD 20 Resources Institute of Medicine  www.iom.edu www.iom.edu AAFP, STFM, TransforMED  www.transformed.org www.transformed.org Institute for Healthcare Improvement  www.ihi.org www.ihi.org AAMC – Institute for Improving Clinical Care  www.aamc.org/patientcare/iicc www.aamc.org/patientcare/iicc Improving Chronic Illness Care  www.improvingchroniccare.org www.improvingchroniccare.org Stapleton Foundation  www.stapletonfoundation.org www.stapletonfoundation.org

21. PA22: November 10th, 2006 Physical Design Supports Practice Redesign David B. Graham, MD 21 Thank you Contact me with questions or comments:  David.Graham@uchsc.edu David.Graham@uchsc.edu  grahamdga@msn.com (after 12-07-07) grahamdga@msn.com Remember course evaluations Slides on Family Medicine Digital Resource Library (FMDRL)  www.fmdrl.org www.fmdrl.org Be leaders for Patient-Centered change, improvement and transformation.