One of the most compelling talks at the Healthcare Forum was from Jennifer Brull, MD Physician Owner and CEO at Prairie Star Family Practice. Dr. Brull practices in a small town of 1900 souls in Kansas and so she provided a unique perspective on quality outcomes in healthcare. As Dr. Brull said, “Quality improvement for me is some about my ego and making sure that I’m a good doctor, but a lot about taking care of my friends who also happen to be my patients.” However, the methods Dr. Brull used to improve outcomes can be applied to any size practice.
In fact, Dr. Brull uses the national Meaningful Use Outcome Priorities as a framework for her practice:
- Improve quality, safety, efficiency, and reduce health disparities
- Engage patients and families in their healthcare
- Improve care coordination
- Ensure adequate privacy and security protections for personal health information
- Improve population and public health
Dr. Brull noted that improving quality was first on her list because of its importance, but acknowledged how difficult it can be to measure. We love to talk about big data and small data in healthcare, but sometimes there is no data. As EHR use increases, the data captured provides valuable insight into opportunities to improve the care process. If the data doesn’t match the provider’s perception of the care being provider, it can be scary. Lots of times doctors get put on a pedestal, but Dr. Brull humbly shared how she fell off her pedestal and how awakening to the fact that she could benefit from the data in her EHRhelped save the lives of her patients.
One of the barriers to improving quality outcomes is convincing other members of the staff to participate. Most people equate quality outcomes with more time per patient, which then translates to seeing fewer patients or more hours working. Neither option is tenable long term. Dr. Brull offered a much better alternative, “By making the right thing to do easy, you actually get more time to do quality improvement and you become more efficient in your processes.”
“If you measure it, you will improve it!” is Dr. Brull’s simple approach to quality improvement. However, seeing the data before you will often illicit the reaction that “This data is not right!” Dr. Brull has learned a simple lesson: “Trust your data, it’s probably right.” Plus, measuring the data and graphing it will let you know if you are improving or not. She shared, “Graphs help point out critical flaws. They help motivate your staff. They help direct your quality improvement cycles. They show the effect of change over time.”
Dr. Brull offered a number of methods she used to improve the quality outcomes in her office. The first is education. She noted, “We don’t hide our poor performance results. We talk about them.” This education on the clinic’s performance can be a great motivator to improve. Alerts in the EHR also proved effective. Dr. Brull tried sending letters to patients, but found they were “A high dollar investment for a low dollar return.”
When trying to improve breast cancer screening, they found that sending a mammogram order directly to radiology proved effective at getting more patients screened. The nurses prompted the doctor to screen for colon cancer by simply placing the Hemoccult kit on the counter. Just by streamlining the referral process they often saw better results. For example, Dr. Brull developed a patient information handout which the nurses gave patients before they were seen by the doctor. This dramatically decreased the amount of time the doctor had to spend educating patients on why they should be screened. These simple changes made doing the right thing easy.
One of Dr. Brull’s lessons learned was to “Never take your eyes off the data, because when you do you start to slip and sometimes you slip really big.” The ultimate goal of EHR adoption is to improve the quality of care. Most clinicians would be shocked to learn how they are performing on some of the standard quality measures. Those who have the courage to use data to drive improvement will create the future of care.
Dr. Brull closed her remarks saying, “My enthusiasm around quality improvement has a lot to do with seeing those graphs. My passion about quality improvement is because of Marilyn [a patient whose life was saved] and because of all the patients that I know every time I improve the care I take of them I make them live longer and healthier lives.”
I recommend watching the full Dr. Brull Healthcare Forum presentation (embedded below) to see and hear firsthand how she improved the quality outcomes in her clinic:
The Breakaway Group, A Xerox Company, sponsored this coverage of the Healthcare Forum in order to share the messages from the forum with a wider audience. You can view all of the Healthcare Forum videos on The Healthcare Forum website.