Primary Care Plans More Integrated Approach to Staff/Patient Experience
"Primary care plays a critical role in improving population health outcomes," said Bill Brinkman, MD. "Working together as One Cincinnati Children's is the only way we're going to achieve that."
Primary Care Plans More Integrated Approach to Staff/Patient Experience
"Primary care plays a critical role in improving population health outcomes," said Bill Brinkman, MD. "Working together as One Cincinnati Children's is the only way we're going to achieve that."
Pediatric primary care at Cincinnati Children’s is a growing arm of the medical center’s services that includes the Division of General and Community Pediatrics; the Division of Adolescent and Transition Medicine and the Community Health Services Network (CHSN). While primary care providers don’t get the headlines that subspecialists or researchers do for innovative procedures or bold breakthroughs, they do immensely important work that impacts more than 80,000 lives locally and plays a key role in improving population health.
It's the recognition of that important work, coupled with the launch of Pursuing Our Potential Together a few years ago, that has shifted the focus and understanding of what primary care should and can be.
In the fall of 2021, leaders from each of the three groups formed a core planning team and steering committee to establish a clear picture of the desired future state of primary care at Cincinnati Children’s. From that vision, they would then develop a new strategic plan.
The core team sought input from various stakeholders, including frontline staff in all the primary care areas and school-based health centers. They interviewed leaders and held listening (or “dream”) sessions at individual sites. Participants had a lot to say regarding what they loved about their work and the changes needed to make it even better.
The feedback made it clear that while our primary care staff were highly committed and strongly connected to the community, they were experiencing compassion fatigue, burnout and staff turnover, especially given the pressures created by the COVID pandemic. In addition, some of the newer practices that had joined CHSN were not as familiar with the Cincinnati Children’s culture. Each division and practice were dealing with challenges in their own way.
Some common themes quickly emerged as to what was necessary for a successful strategic plan:
- Develop a common North Star. All primary care outlets need to be on the same page, embracing Cincinnati Children's vision, mission and core values and bring them to life.
- Communicate better. Break down the silos by openly sharing information and resources. Messaging should be consistent and facilitate collaboration across all practices and divisions.
- Include the patient/family voice. Keeping patients and families at the forefront and getting their input at every stage of planning is crucial in creating a strategy that works.
- Value our people. Staff have been extremely stressed throughout the pandemic. It's important to find ways to care for and support each other and offer opportunities (and time) for career growth and development.
- Elevate primary care. Many people don’t understand the breadth and depth of the work primary care providers do, yet it is extremely important. They are the guardians of population health and the funnel for subspecialty care. Having executive champions would help raise awareness and increase understanding of the role primary care plays in child development and health literacy.
- Improve access. There must be easier and smoother access to care and resources for patients and families.
- Ensure health equity. Recognizing that patients have different needs and social determinants of health, all patients are entitled to receive the same, high-quality care, regardless of whether they are covered by Medicaid or private insurance.
In April, the core planning team hosted an afternoon design forum at Great Wolf Lodge to develop dream session feedback into an actionable format. More than 60 participants showed up to define an “ideal future state” and identify strategic priorities needed to achieve this vision. (see sidebar)
Participants in the design session at Great Wolf Lodge last April brainstormed ways of achieving an "ideal future state" for primary care across all our locations.
Primary Care Objectives and Strategies
Elevate Our People
- Conduct a compensation and career pathways analysis to identify disparities for primary care clinical team members across different levels and sites of care.
- Create streamlined communication mechanisms across all primary care groups and sites of care.
- Identify opportunities to enhance workplace culture, safety, and support.
- Create a standardized repository of on-boarding and orientation resources for all providers across all groups.
Drive Clinical Outcomes and Experience
- Identify standardized outcomes metrics to be integrated and equitable across all divisions and sites of care through a multi-disciplinary steering team inclusive of patient families.
- Identify areas of opportunity to significantly improve access across all primary care groups.
- Identify opportunities to standardize or improve our human resources to create a welcoming and child-focused patient/family experience.
- Create a concierge-style patient scheduling service to enhance intake of patient scheduling requests.
Grow and Cultivate Research and Education
- Create systems to easily disseminate research and education information, opportunities, and experiences across all primary care groups.
- Create opportunities to integrate historically marginalized groups to participate in and join research teams.
- Invest in skill and educational development to advance staff professionally, ensure best clinical practices, and promote research opportunities.
Activate Operations and Care Model
- Define consistent patient experience and standards of care across all groups.
- Design a model to enhance collaboration and operations between primary care groups.
- Define the future scope of practice footprint and identify gaps in care based on the defined scope.
Primary care at Cincinnati Children's has worked to offer a more holistic range of services to patients and families, including behavioral health and resources to address food insecurity.
What’s Different This isn’t the first time efforts have been made to improve our delivery of primary care. But those involved in the planning sense a difference this time and are confident that they are poised for greater success in achieving their goals.
Said Bill Brinkman, MD, MEd, MSc, director, General and Community Pediatrics, “We had such a robust response when we asked for participation. Folks gave us enough ideas to work on for the next five years, so we’re trying to be realistic in how much we can implement in the coming year.”
Added Kenton Reason, project management specialist, Planning, “We went through an intentional process of looking at our key priorities and choosing the ones that build off each other. We did it in collaboration with our steering committee, which consists of members from all the primary care areas, instead of our individual silos.”
Breaking down the silos between groups and practices may be the most beneficial result of the strategic planning process so far.
“As we develop that common North Star around outcomes and how the individual groups are working together to achieve them, we’re forging relationships and ensuring that we’re not working at cross purposes or, at the very minimum, not duplicating efforts,” said John Morehous, MD, medical director, CHSN.
Explained Anne Marraccini, RN, BSN, clinical director, Adolescent and Transition Medicine, “We now have a better understanding of what each of us are dealing with. We’re reaching out to one another and saying, ‘Hey, what have you done in this kind of situation?’ instead of trying to reinvent the wheel. I see greater partnerships and networks being built, which is hugely important. We’re trying to find those common goals and values and how we can help each other succeed in our very specific practices, even though it might look a little different for each one.”
Making It Happen The pandemic and all its repercussions have slowed the implementation of the primary care strategic plan a bit, but the increased collaboration among divisions has proved helpful.
“The group has strengthened us as a source of empathy and compassion around the shared struggle of dealing with the triple-demic of COVID, influenza and RSV,” said John. “We know we’re not out on an island alone. At the leadership level, the partnering has become a source of resilience.”
The team has identified short- and long-term goals, some of which are already in motion.
“We have fallen into a rhythm of working together,” said Bill, “a cycle of planning, goal setting and achieving. But we’re trying to shift from the idea that this is a three-year or a five-year plan. This is a vision we’re all working toward collectively, and you can’t put a time frame on it. If our mission is to improve child health and transform care delivery through fully integrated, globally recognized research, education, and innovation, you can’t say it’s going to be done in two years, three years or five years. It’s a continuous movement that we’re always striving for—how do we continue to be better? How do we continually align ourselves to meet our objectives, and once we achieve them, what’s next?”
Along with goal setting, the team is looking at appropriate ways of measuring success.
“Each time we get into a more granular area for improvement, having metrics we can follow across all of our operations is going to be important,” said Bill. “For example, the first area we’re going to go deep on is access. The institutional measures we’ve used are helpful, but some things they measure, like next-available appointment, aren’t the be-all and end-all for primary care. We also look at continuity of care or access to your continuity provider for a well-child visit.”
Team engagement will also be an indicator of success. Bill cites the groups’ participation in the Ohio Department of Medicaid Comprehensive Primary Care Program as a plus.
Said Kenton, “I am so impressed by the sheer passion of the team for this work, for their willingness to dive in and find solutions. They step up to the plate, share ideas—and this is outside of their day-to-day work. They do it because they care about improvement and finding solutions for patients and families. They aren’t afraid to try something new, to learn and fail fast—all so we can get to where we want to be as primary care providers.”
Added John, “Our intention is to create an excellent experience of care for patients and an excellent experience of work for employees.”