1. Scrubbing the Panels: Using the FMEA Process to Improve Continuity of Care Chris Benavente, MD Santina Wheat, MD, MPH Mary R. Talen, Ph.D. Northwestern Family Medicine Residency Program STFM 2016

2. Disclosures The presenters have nothing to disclose

3. Objectives Identify the systematic steps toward diagnosing empanelment and continuity in a PCMH using the FMEA process. Describe strategies to engage key stakeholders in the FMEA process Identify leadership and organizational challenges in implementing an FMEA process for continuity of care.

4. Background Continuity of care between patients and providers and maintaining these relationships over time is essential for quality care initiatives and coordinated care. Scheduling follow-up visits with a PCP in a multi- provider and residency practice, however, is riddled with loop holes of discontinuity of care. The goal of this project is dissect the ways that continuity of care between providers and patients is derailed in our scheduling process.

5. FMEA Method A team-based systematic and proactive approach for identifying: – ways that a process can fail, –why it might fail, –the effects of that failure, and –how it can be made safer/better A nine step process using the IHI FMEA (Failures, Modes, and Events Analysis) (http://app.ihi.org/Workspace/tools/)

6. Step 1: Select a Process Continuity of Care: –What is the process for scheduling follow- up appointments with the same provider or healthcare team

7. Step 2 Providers Call Center Staff: MA, RN, PBA IT/EMR Facilitator

8. Step 3: Mapping the Process of Scheduling

9. Step 4: Identify Failures in the System The Team describes the causes and the consequences of each failure using the IHI FEMA interactive tool kit

10. Step 4: Identify Failures in the System

11. Step 5: Risk Priority Number RPN Calculation On a scale of 1-10, the Team rates how often the failure occurs, the severity, and how likely it is detected. IHI Interactive Toolkit calculates RPN

12. Step 5: Risk Priority Number

13. Step 6: Evaluate the Results Top 3 RPNs 1.Patient must initiate a call to reschedule 2.The robo re-call to remind patient’s to re-schedule is not placed. 3.PCP does not identify when, with whom and what the visit is for on visit summary

14. Step 7: Planning Improvement Pre-Measurement of Continuity of Care Ratios Implement Process Improvement Plan Post Measurement of Continuity of Care Ratios

15. Lessons Learned and Future Directions Balancing Access of Care with Continuity Balancing panel sizes between providers Leadership buy-in and engagement

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