FOCUS: Primary Care
OPPORTUNITY OR PROBLEM
The Medical Center’s Primary Care Service had not been consistently meeting their preventive measure goals. As an effort to improve preventive care, hypertension was chosen as a priority because it had the lowest success rate within all of the preventive indicators. The scope of the project focused directly on Primary Care blood pressure monitoring and documentation. The main goal of the project was to reduce the number of Primary Care patients that do not have documented blood pressure within an acceptable ranged from 30% to 15% by December 31, 2015 in order to improve the Medical Center’s diabetes blood pressure composite.
APPROACH TAKEN
The project team was composed up of multi-disciplinary group of professionals concerned about the health and quality of care which patients were receiving. Additionally, the project had oversight from the Primary Care service as well as the Quality Management Director. In order to gain a better understanding of the process, several Primary Care teams were studied. After gaining an understanding of the current state and how each of the teams played a major role in providing preventive health care, a high-level Value Stream Map (VSM) was constructed. Numerous gemba walks revealed that the process of blood pressure monitoring was flawed. Preliminary data showed that the current blood pressure process was defective and inconsistent. Variation from month-to-month concluded that blood pressure monitoring in Primary Care was not being recorded properly due to lack of standardization in documentation, which has impacted the facilities quality scores in preventive health care. The process of taking a blood pressure and recording it, occurred properly 58.32% of the time. However, to meet the National target of 95%, patients must have a blood pressure reading of <140/90. Unfortunately, the facilities data reports showed that hypertension preventive care did not meet the target 100% of the time.
The blood pressure handoff results between the Health Technicians and Primary Care Providers were not communicated effectively, resulting in poor performance scores. Improvement options were education and training. Deliverables were established to reduce the waste and variation identified in the process. First, a standard operating procedure (SOP) was established. Secondly, an annual/biennial review was established. Next, handoff of elevated results was identified and addressed between support staff and providers. Finally, an annual skills fair will be conducted to engage staff and maintain standard work. In order to create a sustainable process, monitoring will be performed monthly through the an external peer review. Audits will also be initiated by the Chief of Primary Care on a regular schedule. A service huddle board will also be utilized to keep employee’s engaged. All other strategies of sustainment will be continued by the department leads.
OUTCOME
Statistically overall improvements were realized only several months after the solution to implement an SOP occurred. Results from the primary measure confirms that the Primary Care service is seeing an increase in the blood pressure documentation within an acceptable range. As improvements continue to occur within the next few months, the impact of this project will be significant. In May of 2015, blood pressure monitoring averaged at 67% with fluctuations from month-to month. As of the date of this report, blood pressure monitoring averages at 76%, which is a 14% increase due to discussion, education, and standardization with an SOP.
* Due to nondisclosure agreements, the organization referenced in this example cannot be disclosed.
