Implementing High-Quality Primary Care Rebuilding the Foundation of Health Care (2021) / Chapter Skim
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11 The Committee's Approach to an Implementation Strategy
11 The Committee's Approach to an Implementation Strategy
Pages 357-368
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From page 357... ...
As articulated in Chapter 2, the committee believes that high-quality primary care deserves status as a common good that merits public stewardship because of its unique capacity among health care services to improve population health and reduce health care inequities. Ongoing stressors in the U.S.
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From page 358... ...
In addition to defining high-quality primary care, the committee's scope requires it to articulate the key proven facilitators necessary for implementing its plan. As first set forth in Chapter 2, the analysis of research and evidence regarding integrated care, digital health care, clinical accountability, payment models, interprofessional care teams, and research constitutes the heart of the committee's report and resulting recommendations that target ways to effectively scale and implement successful innovations.
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From page 359... ...
. The 2019 National Academies report Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being combined the individual and team levels but maintained its emphasis on system levels that TABLE 11-1 Four Levels of Change for Improving Quality Levels Examples Individual Education Academic detailing Data feedback Benchmarking Guideline, protocol, pathway implementation Leadership development Group/team Team development Task redesign Clinical audits Breakthrough collaboratives Guideline, protocol, pathway implementation Organization Quality assurance Continuous quality improvement/total quality management Organization development Organization culture Organization learning Knowledge management/transfer Larger system/environment National bodies (NICE, CHI, AHRQ)
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From page 360... ...
At the health care organization level, leadership and governance creates and maintains the processes and structures in which the frontline care delivery level operates. The external environment includes societal values, the greater health care industry, government, and the policies and standards that establish the parameters that the health care organizations and frontline care delivery levels must operate within.
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From page 361... ...
The micro level includes interprofessional primary care teams that may operate in public- or private-sector organizations, patients, and their families. The implementation science lens focuses on the interconnections, interactions, and necessary bidirectional dialogue between and among actors at all three levels to effectively adopt core recommendations (Côté-Boileau et al., 2019; Fisher et al., 2016)
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From page 362... ...
However, implicit in each recommendation in Chapter 12 is the responsibility for the named actor to plan for building implementation capacity for all three phases. AN ACCOUNTABILITY FRAMEWORK For successful implementation, it is not enough have named actors and specific actions.
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From page 363... ...
population depends on leaders building implementation capacity to support, sustain, and improve the core recommendations. Within a single organization, such an accountability framework is relatively easy to develop: it is implemented through an organizational structure and using tools of change management accountability, such as measurement, communications, and performance reviews and incentives for quality.
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From page 364... ...
. The committee's implementation plan does indeed rest in part on the success of policy entrepreneurs committed to high-quality primary care, but it does recommend strategies for such actors.
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From page 365... ...
, with their mandated primary care spend levels. In each case, policy leaders pointed to an unbalanced health care delivery system with a specialty and institutional orientation in comparison to the best-performing national and international systems, successfully making the case for public policy prioritization of primary care for long-term benefits in terms of lower health care costs and better population health, similar to what is seen in other countries.
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From page 366... ...
Leaders can use the collective experience of the pandemic to demonstrate how it weakened primary care in the United States at precisely the point when it was most needed: to partner with public health; decompress crowded emergency rooms; monitor populations most vulnerable to infection; conduct testing; treat less acute cases and contact trace; administer vaccines; treat long-term sequelae; and prepare for the social and emotional fallout of a distressed and isolated population. Instead, according to a weekly national survey, within 3 weeks of the March 13, 2020, declaration of a national emergency, half of primary care practices reported a severe effect.
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From page 367... ...
2015. Oregon's experiment in health care delivery and payment reform: Coordinated care organizations replacing managed care.
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From page 368... ...
2016. Vermont's community-oriented all-payer medical home model reduces expenditures and utilization while delivering high-quality care.
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