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May 15, 2001

# Overview of the BPHC Reengineering Collaborative Model

n an article published in March 2001, The Institute of Medicine said,
"Between the health care we have and the care we could have lies not
just a gap, but a chasm."[^1] Francis A Zampiello, MD, Director of the
Quality Center of the Bureau of Primary Health Care (BPHC), spoke to CAP
Grantees on May 15, 2001, about how they can bridge this chasm by
participating in BPHC's Reengineering Collaboratives, also known as
Patient Visit Redesign Collaboratives.

Dr Zampiello discussed this initiative, whose purpose is to dramatically
streamline the patient medical visit through teamwork and improved
productivity. These Collaboratives are open to community health centers
(CHCs), migrant health centers (MHCs), federally qualified health
centers (FQHCs), FQHC "look-alikes," National Health Service Corp Sites,
Public Housing Grantees, and HIV and Homeless sites. The Collaboratives
last 6 months and consist of three intense and innovative learning
sessions. Coaches are available for mentoring services whenever needed
during the 6-month period. The current Collaborative sessions will end
October 1, 2001. So far, sixty-four health centers have completed the
training and eighty percent have successfully redesigned their patient
medical visits.

One case study of the multiple potential benefits of reengineering for
CAP Grantees involved the analysis of a CAP community with 55,000
uninsured patients. According to Dr Zampiello, projecting the success
demonstrated in this redesign model over the six-month study period, an
additional 10,000 patients could be served, primary care homes would be
found for 19% more patients, access to care would increase from 36% to
55%, and 2.28 million dollars would be saved in 100% access costs. It is
clear that participating in the Reengineering/Patient Visit Redesign
Collaborative has significant benefits to offer CAP grantees interested
in reengineering their workplaces.

To direct the Collaborative, BPHC provides experienced coaches who have
successfully reengineered patient cycle times in other health centers,
helping the health care site reach a goal of completing 90% of patient
visits in 45 minutes. Coaches are matched appropriately with carefully
selected teams from among a range of health care center applicants.
Leadership Conferences are held with center CEOs and Medical Directors
before the Collaborative gets underway in order to enlist and ensure
their support and commitment, which is essential for the program to
work. The broad application of redesign principles means that the entire
staff is involved and must function as a team. Collaborative
participants take a "clean slate" approach to solving problems and
implementing strategies on a trial basis during the Collaborative
sessions. Regardless of ownership issues, no system of care currently in
use is considered untouchable, and participants are encouraged to
explore recommended changes with open minds and full commitment to the
process. In order to maintain the 6-month Collaborative time frame,
implementation of recommended changes is immediate, as are any required
modifications that become apparent through the intensive monitoring and
information exchange components of the process.

Dr. Zampiello explained that experience to date has demonstrated the
importance of these 12 redesign principles and Reengineering
Collaborative participants are asked to implement all of them:

-   Do not move the patient. Arrange workflow so that necessary staff
    members come to the patient.

-   Start all visits on time. Re-organization makes this goal
    attainable.

-   Create broad work roles. No one is locked into certain duties. Use
    creative thinking when looking at workflow.

-   Exploit technology. Improvements do not have to mean major
    acquisitions -- several health centers found that the use of
    walkie-talkies by staff saved time, as did actions as simple as
    placing a scale in every examining room.

-   Eliminate waste ruthlessly. Dramatic time saving is the result.

-   Match capacity to demand. Use staff where they are needed. Develop
    reasonable staffing ratios.

-   Increase clinician support. Their commitment is crucial to the
    success of the redesigned workplace.

-   Get all the tools needed. Again, this does not necessarily involve
    major costs, but investigate all possibilities.

-   Plan for the expected. A well-organized workplace and work processes
    result in enhanced productivity.

-   Do today's work today. Process improvement speeds productive
    workflow.

-   Organize patient care teams. This increases quality of care and
    results in time- and cost-savings.

-   Communicate directly. This simple tactic will increase efficiency,
    avoid misunderstandings and save time.

In the model, increased quality time spent with the patient is called
value-added time. Not surprisingly, patients are more satisfied with
shorter wait times and more value-added time in the health care center.
Successful Collaborative participants have found that, after instituting
changes, productivity increased from an average of 40% to a whopping
108%, implying significant cost-savings for the centers.

The Reengineering Collaboratives have been successful because of the
competitive participant selection process, strong support from center
CEOs, aggressive coaching, creative learning sessions, clear performance
goals, and their structured, time-driven framework.

Like the initiative on Disease Management, the Reengineering
Collaboratives radically reexamine the way health centers operate, to
zero in on changes that will improve health care, enhance productivity
and save time for the patients. Patients and staff reap the benefits.
CAP grantees interested in participating in a Reengineering
Collaborative or in a one-day discussion of how the principles of
Reengineering can help their programs may contact Audrey Smolkin at
<asmolkin@hrsa.gov> for application information. You may also contact
Frank Zampiello directly at
[mailto:fzampiello@hrsa.gov](mailto:fzampiello@hrsa.gov).

OVERVIEW OF THE BPHC REENGINEERING COLLABORATIVE MODEL CALL
PARTICIPANTS:

+------------------+---------------------------------------------------+
| ###### Name      | ###### Organization                               |
+------------------+---------------------------------------------------+
| Amy Bartells     | Arizona Board of Regents, University of AZ        |
+------------------+---------------------------------------------------+
| Betsy Buser      | Indigent Care Collaboration, Austin TX            |
+------------------+---------------------------------------------------+
| Ana O\'Connor    | Alameda Medical Center, CA                        |
+------------------+---------------------------------------------------+
| Anne Kircher     | Sangre de Cristo Community Health, NM             |
+------------------+---------------------------------------------------+
| Anne Witmer      | Louisiana Public Health Institute                 |
+------------------+---------------------------------------------------+
| Audrey Smolkin   | HRSA Philadelphia, PA                             |
+------------------+---------------------------------------------------+
| Betsy Buser      | Indigent Care Collaboration, Austin TX            |
+------------------+---------------------------------------------------+
| Bob Kaplan       | Greater Sthn. Brooklyn Health Coalition           |
+------------------+---------------------------------------------------+
| Brenda Theus     | Shelby County Health Care Corp., TN               |
+------------------+---------------------------------------------------+
| Dave Fant        | Shenandoah Valley Medical System, WV              |
+------------------+---------------------------------------------------+
| Debbie Bardin    | Hudson Headwaters Health Network                  |
+------------------+---------------------------------------------------+
| Debra Williams   | Southwest Texas CAP                               |
+------------------+---------------------------------------------------+
| Dennis Williams  | NC Department of Health and Human Service, Pitts  |
|                  | County                                            |
+------------------+---------------------------------------------------+
| Edith Davis      | NY City Health & Hospital                         |
+------------------+---------------------------------------------------+
| Edward Leeds     | BPHC Boston with Ken Brown                        |
+------------------+---------------------------------------------------+
| Erin Grace       | Primary Care Coalition Montgomery County, MD      |
+------------------+---------------------------------------------------+
| Eva Moya         | UA RHO- El Paso Office                            |
+------------------+---------------------------------------------------+
| Gail Urban       | Community Health Council, Manhattan KS            |
+------------------+---------------------------------------------------+
| George E. Ricks, | Erlanger Health System, TN                        |
| Sr.              |                                                   |
+------------------+---------------------------------------------------+
| Gregory Townsed  | Jefferson County Department of Health Birmingham  |
+------------------+---------------------------------------------------+
| James Burnosky   | RWJ: Communities in Charge                        |
+------------------+---------------------------------------------------+
| Jo Paulla Baca   | First Choice Community Healthcare, Inc.           |
+------------------+---------------------------------------------------+
| Joanne Omi       | NY City Health & Hospital                         |
+------------------+---------------------------------------------------+
| John Cragin      | Boston Medical Center                             |
+------------------+---------------------------------------------------+
| Judith Passmore  | Middlesex CAP                                     |
+------------------+---------------------------------------------------+
| Judy Szalapski   | Hennepin County Medical Center, MN CAP            |
+------------------+---------------------------------------------------+
| Kevin Driesen    | UA RHO- Tucson Office                             |
+------------------+---------------------------------------------------+
| Linda Potts      | Comprehensive Community Health Initiative, IL     |
+------------------+---------------------------------------------------+
| Linda Davis      | Kansas City MO CAP                                |
+------------------+---------------------------------------------------+
| Lisa Craig       | Health Improvement Partnership                    |
+------------------+---------------------------------------------------+
| Luanne Nyberg    | Hennepin County Medical Center, MN                |
+------------------+---------------------------------------------------+
| MAC              | Management Assistance Corporation                 |
+------------------+---------------------------------------------------+
| Marcia Jacobsen  | Yuvapal County, AZ                                |
+------------------+---------------------------------------------------+
| Margaret Flinter | Middlesex Hospitals                               |
+------------------+---------------------------------------------------+
| Mark Snyder      | Cherokee Health Systems, TN                       |
+------------------+---------------------------------------------------+
| Marty Galutia    | Kansas City MO CAP                                |
+------------------+---------------------------------------------------+
| Michael Head     | Cincinnati Health Network Inc.                    |
+------------------+---------------------------------------------------+
| Mike DeLucca     | FL CAP                                            |
+------------------+---------------------------------------------------+
| Paul Freundlich  | Middlesex CAP                                     |
+------------------+---------------------------------------------------+
| Ray Greedy       | CHOICE Regional Health Network                    |
+------------------+---------------------------------------------------+
| Ray Knight       | Family Health Center, SC                          |
+------------------+---------------------------------------------------+
| Rev. Lynn E.     | Metropolitan Community Health Services, NC        |
| Bolden           |                                                   |
+------------------+---------------------------------------------------+
| Rhoda Nichola    | Department of Health, UT                          |
+------------------+---------------------------------------------------+
| Ron Cookston     | Harris County Public Health and Environmental     |
|                  | Services                                          |
+------------------+---------------------------------------------------+
| Ronald Beattie   | Oregon CAP                                        |
+------------------+---------------------------------------------------+
| Ruth Woolum      | SKYCAP Hazzard                                    |
+------------------+---------------------------------------------------+
| Sandra McCollum  | Central NM CAP                                    |
+------------------+---------------------------------------------------+
| Scott Otterbein  | HRSA                                              |
+------------------+---------------------------------------------------+
| Seema Verma      | Marion County CAP                                 |
+------------------+---------------------------------------------------+
| Sharon Morris    | Health Care Coalition of Southern Oregon          |
+------------------+---------------------------------------------------+
| Steve Dorage     | HRSA                                              |
+------------------+---------------------------------------------------+
| Tammy Eberly     | Tiahoga CAP                                       |
+------------------+---------------------------------------------------+
| Tammy Stoltz     | PCAP Pima CAP                                     |
+------------------+---------------------------------------------------+
| Tom Brown        | Palmetto Health Alliance, SC                      |
+------------------+---------------------------------------------------+
| Tom Lewis        | MD CAP                                            |
+------------------+---------------------------------------------------+
| Tom Irons        | NC CAP                                            |
+------------------+---------------------------------------------------+
| Valerie          | (With Lisa Craig -- Rep. of an IPA)               |
| Steigerwald      |                                                   |
+------------------+---------------------------------------------------+
| Synthesis        | Synthesis Professional Services                   |
| Writers          |                                                   |
+------------------+---------------------------------------------------+

Summary Developed By: Synthesis Professional Services, Inc.

[^1]: Crossing the Quality Chasm, A New Health System for the 21^st^
    Century