RE: RE: patient centered, outcomes, IMPs

[Guest guest]

Couldn't agree more. I do believe smaller units are better-best. This is

especially true in medicine.

I worry about the units getting too large in the expense categories, not too

small.

________________________________

From: on behalf of L. Gordon

Sent: Thu 7/5/2007 8:28 AM

To:

Subject: RE: patient centered, outcomes, IMPs

Jim brings up an interesting point. Is " patient centered " independent of

practice size? In theory it is, but in practice, size matters.

" Micro " in IMP is based on the work of Quinn, a Dartmouth Business

school professor (Intelligent Enterprise, Free Press 1992).

He demonstrates the improved service and quality in " small functional work

units. " Batalden and others have extended this idea of " microsystems " to health

care.

Batalden PB. EC. WH. Godfrey MM. Mohr JJ. Microsystems in health

care: Part 9. Developing small clinical units to attain peak performance. Joint

Commission Journal on Quality & Safety. 29(11):575-85, 2003 Nov

In the IMPs project we have clear evidence that IMPs outperform typical health

care. The Commonwealth Fund report identifies New Hampshire and Vermont in the

top ten states for outcomes, and IMPs outperform even these even when adjusting

for financial status, gender, illness burden, age group (Wasson JH. personal

communication 2007).

When I talk about " outperform " I'm talking about patient outcomes and experience

of care. This is contrary to a lot of improvement work going on out there that

appear to be aimed solely at improving finances. Not an unimportant goal, but

doomed to failure from the start if they don't address improved population

health, improved experience of care, and improved overall health care finances.

IMPs are taking on the messed up financing of health care by stepping up to

demonstrably better care.

We are putting our houses in order. We have the data. This is why we're

invited to sit at the table to discuss finances.

Gordon

[P.S. Want YOUR data? You can independently sign up with

www.HowsYourHealth.org <http://www.howsyourhealth.org/> or get it through

participation in the next IMP cohort]

> Micro has always meant small to me. Patient centered is independent of size,

and to

> me that is what you list. So the things you list as not the definition are

the

> things I include in the definition. I have no employees, see 10-15 patients a

day,

> use an EMR, do all my own billing, use same day access, EMR/net at the sight

of

> practice. If you are in a big practice or have employees, I can see using the

term

> ideal, but not micro.

[Guest guest]

you know.

I like Gorodn's challenge to you.

You presetn a model to us- and you can see my dataa- ask me- Jim can we

see yours?Get your aptietns to do HowsYourHealth It is so powerful.

I live in Maine I understand Maine was the fifth best in the country on many

commonwealth scores.

The sign on the trunpike says Maine The Way Life Should Be.

RE: patient centered, outcomes, IMPs

Jim brings up an interesting point. Is " patient centered " independent

of practice size? In theory it is, but in practice, size matters.

" Micro " in IMP is based on the work of Quinn, a Dartmouth

Business school professor (Intelligent Enterprise, Free Press 1992).

He demonstrates the improved service and quality in " small functional

work units. " Batalden and others have extended this idea of

" microsystems " to health care.

Batalden PB. EC. WH. Godfrey MM. Mohr JJ. Microsystems in

health care: Part 9. Developing small clinical units to attain peak

performance. Joint Commission Journal on Quality & Safety.

29(11):575-85, 2003 Nov

In the IMPs project we have clear evidence that IMPs outperform typical

health care. The Commonwealth Fund report identifies New Hampshire and

Vermont in the top ten states for outcomes, and IMPs outperform even

these even when adjusting for financial status, gender, illness burden,

age group (Wasson JH. personal communication 2007).

When I talk about " outperform " I'm talking about patient outcomes and

experience of care. This is contrary to a lot of improvement work going

on out there that appear to be aimed solely at improving finances. Not

an unimportant goal, but doomed to failure from the start if they don't

address improved population health, improved experience of care, and

improved overall health care finances. IMPs are taking on the messed up

financing of health care by stepping up to demonstrably better care.

We are putting our houses in order. We have the data. This is why

we're invited to sit at the table to discuss finances.

Gordon

[P.S. Want YOUR data? You can independently sign up with

www.HowsYourHealth. <http://www.howsyourhealth.org/> org or get it

through participation in the next IMP cohort]

> Micro has always meant small to me. Patient centered is independent of

size, and to

> me that is what you list. So the things you list as not the definition

are the

> things I include in the definition. I have no employees, see 10-15

patients a day,

> use an EMR, do all my own billing, use same day access, EMR/net at the

sight of

> practice. If you are in a big practice or have employees, I can see

using the term

> ideal, but not micro.

[Guest guest]

Does anyone know of an IMP/ concerned care practice near Ft Wayne, INdiana? I have a very nice family moving there. rje

[Guest guest]

RE Defn of "small functional work unit"

What is that definition please-- no access to that reference

Dr Matt Levin

RE: patient centered, outcomes, IMPs

Jim brings up an interesting point. Is "patient centered" independent of practice size? In theory it is, but in practice, size matters."Micro" in IMP is based on the work of Quinn, a Dartmouth Business school professor (Intelligent Enterprise, Free Press 1992).He demonstrates the improved service and quality in "small functional work units." Batalden and others have extended this idea of "microsystems" to health care.Batalden PB. EC. WH. Godfrey MM. Mohr JJ. Microsystems in health care: Part 9. Developing small clinical units to attain peak performance. Joint Commission Journal on Quality & Safety. 29(11):575-85, 2003 NovIn the IMPs project we have clear evidence that IMPs outperform typical health care. The Commonwealth Fund report identifies New Hampshire and Vermont in the top ten states for outcomes, and IMPs outperform even these even when adjusting for financial status, gender, illness burden, age group (Wasson JH. personal communication 2007).When I talk about "outperform" I'm talking about patient outcomes and experience of care. This is contrary to a lot of improvement work going on out there that appear to be aimed solely at improving finances. Not an unimportant goal, but doomed to failure from the start if they don't address improved population health, improved experience of care, and improved overall health care finances. IMPs are taking on the messed up financing of health care by stepping up to demonstrably better care. We are putting our houses in order. We have the data. This is why we're invited to sit at the table to discuss finances.Gordon[P.S. Want YOUR data? You can independently sign up with www.HowsYourHealth.org or get it through participation in the next IMP cohort]

> Micro has always meant small to me. Patient centered is independent of size, and to> me that is what you list. So the things you list as not the definition are the> things I include in the definition. I have no employees, see 10-15 patients a day,> use an EMR, do all my own billing, use same day access, EMR/net at the sight of> practice. If you are in a big practice or have employees, I can see using the term> ideal, but not micro.

[Guest guest]

The smallest reproducible unit (of people

using technology) that can do all the work.  Can be a solo doc w/o staff, a doc

with MA, etc.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

www.PinnacleFamilyMedicine.com

From: [mailto: ] On Behalf Of Dr Levin

Sent: Thursday, July 05, 2007 5:50

PM

To:

Subject: Re:

RE: patient centered, outcomes, IMPs

RE Defn of " small functional work unit "

What is that definition please-- no access to that reference

Dr Matt Levin

RE: patient centered, outcomes, IMPs

Jim

brings up an interesting point. Is " patient centered "

independent of practice size? In theory it is, but in practice, size

matters.

" Micro " in IMP is based on the work of Quinn, a Dartmouth

Business school professor (Intelligent Enterprise, Free Press 1992).

He demonstrates the improved service and quality in " small functional work

units. " Batalden and others have extended this idea of " microsystems "

to health care.

Batalden PB. EC. WH. Godfrey MM. Mohr JJ. Microsystems in health

care: Part 9. Developing small clinical units to attain peak performance.

Joint Commission Journal on Quality &

Safety. 29(11):575-85, 2003 Nov

In the IMPs project we have clear evidence that IMPs outperform typical health

care. The Commonwealth Fund report identifies New

Hampshire and Vermont

in the top ten states for outcomes, and IMPs outperform even these even when

adjusting for financial status, gender, illness burden, age group (Wasson JH.

personal communication 2007).

When I talk about " outperform " I'm talking about patient outcomes and

experience of care. This is contrary to a lot of improvement work going

on out there that appear to be aimed solely at improving finances. Not an

unimportant goal, but doomed to failure from the start if they don't address

improved population health, improved experience of care, and improved overall

health care finances. IMPs are taking on the messed up financing of

health care by stepping up to demonstrably better care.

We are putting our houses in order. We have the data. This is why

we're invited to sit at the table to discuss finances.

Gordon

[P.S. Want YOUR data? You can independently sign up with www.HowsYourHealth.org

or get it through participation in the next IMP cohort]

> Micro has always meant small to me. Patient centered is

independent of size, and to

> me that is what you list. So the things you list as not the definition are

the

> things I include in the definition. I have no employees, see 10-15

patients a day,

> use an EMR, do all my own billing, use same day access, EMR/net at the

sight of

> practice. If you are in a big practice or have employees, I can see using

the term

> ideal, but not micro.

[Guest guest]

The definition doesn't set many parameters as it depends on many local

variables: " Smallest functional unit capable of doing the work "

to which I'd add " and capable of achieving the

results. "

As you can tell, I've been pretty open to variation on the theme, trying

to avoid stipulating specifics where we don't have data to guide our

work, but at this point we have a compelling measurement set that is

within our grasp (HowsYourHealth.org) as well as a compelling set of data

demonstrating the worth of IMPs.

Gordon

At 07:50 PM 7/5/2007, you wrote:

RE Defn of

" small functional work unit "

What is that definition please-- no access to that

reference

Dr Matt Levin

RE: patient centered, outcomes,

IMPs

Jim brings up an interesting point. Is " patient

centered " independent of practice size? In theory it is, but

in practice, size matters.

" Micro " in IMP is based on the work of Quinn, a

Dartmouth Business school professor (Intelligent Enterprise, Free Press

1992).

He demonstrates the improved service and quality in " small

functional work units. " Batalden and others have extended this

idea of " microsystems " to health care.

Batalden PB. EC. WH. Godfrey MM. Mohr JJ. Microsystems

in health care: Part 9. Developing small clinical units to attain peak

performance. Joint Commission Journal on Quality & Safety.

29(11):575-85, 2003 Nov

In the IMPs project we have clear evidence that IMPs outperform

typical health care. The Commonwealth Fund report identifies New

Hampshire and Vermont in the top ten states for outcomes, and IMPs

outperform even these even when adjusting for financial status, gender,

illness burden, age group (Wasson JH. personal communication

2007).

When I talk about " outperform " I'm talking about patient

outcomes and experience of care. This is contrary to a lot of

improvement work going on out there that appear to be aimed solely at

improving finances. Not an unimportant goal, but doomed to failure

from the start if they don't address improved population health, improved

experience of care, and improved overall health care finances. IMPs

are taking on the messed up financing of health care by stepping up to

demonstrably better care.

We are putting our houses in order. We have the data.

This is why we're invited to sit at the table to discuss finances.

Gordon

[P.S. Want YOUR data? You can independently sign up with

www.HowsYourHealth.org or get it through participation in the next IMP

cohort]

> Micro has always meant small to me. Patient centered is

independent of size, and to

> me that is what you list. So the things you list as not the

definition are the

> things I include in the definition. I have no employees, see

10-15 patients a day,

> use an EMR, do all my own billing, use same day access, EMR/net

at the sight of

> practice. If you are in a big practice or have employees, I can

see using the term

> ideal, but not micro.