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Putting Joy Into Practice: A Journey Into Primary Care
Dr. Christine Sinsky is on a mission to improve the work-life of primary care physicians and clinicians to improve care and attract physicians to primary care.
A member of the Board of Directors of the American Board of Internal Medicine, Dr. Sinsky is a board certified internist who practices internal medicine at Medical Associates Clinic and Health Plans in Dubuque, Iowa, a level-3 Patient-Centered Medical Home since 2008. She is deeply committed to solving the ills of primary care and has a clear vision of what should be happening in primary care practices in this country.
Dr. Sinsky and her colleagues visited 23 high-functioning primary care practices and came away with some interesting findings. As the work of a primary care physician is now constructed, too much of their time is being spent performing functions that do not require professional training. Yet at these high-functioning practices, Dr. Sinsky et al. noted several innovations that had been put into place which resulted in replacing clinician burnout and patient dissatisfaction with joy of practice, improved patient care and a better patient experience. What did these practices have that others didn’t?
The findings Dr. Sinsky and her colleagues uncovered included innovations that freed physicians and clinicians from administrative duties and better organized their work. They removed things that didn’t add value to their patients and put clinicians more in control of their work environment. Such innovations included:
- pre-visit planning;
- improved team communication through co-location;
- in-visit scribing for medical record documentation;
- expanding health care coaching, care coordination and integrated behavioral health to non-physician members of the team and
- re-engineering prescription renewals.
Dr. Sinsky et al.’s findings will be presented to invitation-only conference sponsored by the ABIM Foundation to a group of influential health care leaders on March 12. Attendees will be charged with spreading these innovations among the primary care workforce.
As I prepare for the March 12 meeting, I can’t help wondering what led these practices to improve primary care and make vital investments in support of the Triple Aim (population health, quality and reduced costs)? I have some ideas and they vary largely due to the context of their practices:
1) Leaders within these practices had the vision to realize that by improving the work of their primary care physicians, they improved the quality of their lives, which in turn produced higher quality patient care.
2) Much of the practices’ financial success is linked to strong, functioning primary care.
3) Some of these practices understand that the future state of health care will have primary care at its core.
4) Some of these practices are in rural areas where efficient use of primary care is essential to the well-being of those served.
5) Last, but not least, is that the concept of the patient-centered medical home is taking hold and appropriate incentives are being put in place.
I look forward to discussions on the “whys” of these innovations as well as the “what” with Dr. Sinsky and the 20 or so practice innovators whom I consider heroes of primary care.
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