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Idaho clinics working to ensure that preventive services truly are routine

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This article was originally published in February 2010.

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It’s no secret that preventive services are important but easily overlooked. A team at Terry Reilly Health Services (TRHS), a group of community health clinics located in southwestern Idaho, has begun tackling this problem by figuring out ways to make preventive services happen routinely—even when the patient or provider hasn’t thought to address the issue during a particular visit.

By revising their workflow, making better use of their electronic medical record (EMR) system, actively monitoring their progress, and responding to the needs of their mostly uninsured patient base, TRHS has made substantial improvement—more of the clinic patients are now receiving mammograms. At one clinic, they’ve already achieved a 150% improvement.

“In our everyday practice, we’re all so busy that it’s hard to take a step back and look at quality,” said TRHS medical director Jonathan Bowman, MD. However, the team has been rewarded with numbers that clearly show the project is making a difference. Plus, they experienced a very important success: early in the project, a mammogram caught one woman’s breast cancer. “That was a giant motivator,” Bowman said.

“As a general rule, people like to work on things that get better and to do good things,” Bowman continued. With the full support of upper level leadership, TRHS’ interdisciplinary project team was empowered to identify and make the changes necessary to increase the number of patients receiving mammograms.

Qualis Health provided some tools and expertise to help them along their way. Qualis Health staff Helen Stroebel, RN, MPH and Jeff Hummel, MD, MPH, introduced the TRHS team to process mapping and other concepts from Lean methodology. Working together, they mapped the current process in which a patient arrives at a clinic, is referred for a mammogram, completes the testing, and receives the results.

“I work with excellent clinicians and staff, but these tools are not taught in medical school,” Bowman said. “This is a new and different way to approach change.”

Viewing a graphical representation of all the twists and turns in the process helped the team find the focus they needed and recognize where the greatest opportunities for improvement could be made.

Now, there are multiple built-in opportunities for clinic staff to discuss mammograms with a patient during a typical visit, and to provide details about the various grants which may pay for that patient’s screening. In addition, streamlining the ordering and results processes is an ongoing focus. As Bowman explained, “The work of quality improvement isn’t something you do once and it’s over.”