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Section last updated Mar. 2011
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Determining
Needs and Setting Priorities for Systems Change
Clinical practices can be viewed as microsystems that provide health care to specific patient populations. The care they provide should be:
- knowledge-based
- patient-centered
- proactive
- effectively delivered. 1,
2, 3
To achieve these components of care, redesign might be needed in the following areas: 3
- Better methods for finding best practices and assuring that such clinical models become organizational standards.
- Better use of information technology to access information and to support clinical decision-making.
- Improved workforce knowledge and skills.
- More consistent development of effective clinical teams and teamwork.
- Better coordination of care among services and settings.
- More informative measurement of performance and outcomes.
How Self-Assessment Can Help
| Note |
Self-assessment helps us think through what we are doing, why we are doing it, and what we must do next. The process of self-assessment itself stimulates communication and leads to change. (See resource 2: Drucker Found. Self-Assessment Tool) |
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Self-assessment for systems change can help clinical practices:
- Get organized
Identify immediate tasks and long-term goals
Develop insight into unfamiliar aspects of the system
Prepare for agency accreditation
- Set priorities
Identify areas of weakness and strength
Find out what others think are important components of health systems change
- Coordinate efforts
Promote team work and staff development
Encourage interdepartmental coordination
- Monitor change
Consider evaluation from the beginning: What are we trying to improve, how will we know that change is an improvement?
Monitor progress toward desired goals
- Identify resources
Determine resources, collaborations, or partnerships that exist or need to be developed
Clarify budget needs and provide data for discussion with administration
Identify duplication and wasted effort
The Institute of Medicine proposed ten simple rules to enhance change in health care microsystems. Beside each new rule is listed the current rule.3 See toolbox below to print out this chart in Adobe Acrobat format.
|
New
Rule |
Current
Rule |
| 1 |
Care is based on continuous healing relationships. |
Care is based primarily on visits. |
| 2 |
Care is customized according to patients’ needs and values. |
Professional autonomy drives variability. |
| 3 |
The patient is the source of control. |
Professionals control care. |
| 4 |
Knowledge
is shared freely. |
Information
is a record. |
| 5 |
Decision-making
is based on evidence. |
Decision-making
is based on training and experience. |
| 6 |
Safety
is a system property. |
"Do
no harm" is an individual responsibility. |
| 7 |
Transparency
is necessary. |
Secrecy
is necessary. |
| 8 |
Needs
are anticipated. |
The
system reacts to needs. |
| 9 |
Waste
is continuously decreased. |
Cost reduction is sought. |
| 10 |
Cooperation
among clinicians is a priority. |
Preference
is given to professional roles over the system. |
Program Assessment Tools
Health care teams can use the tools below to identify areas for improvement in their care for chronic illness and evaluate the level and type of improvements made in their system.
- MacColl Institute for Healthcare innovation and website Improving Chronic Illness Care provides an Assessment of Chronic Illness Care (ACIC) survey and a Patient Assessment of Chronic Illness Care (PACIC) survey. www.improvingchroniccare.org/
index.php?p=Assessment&s=240
- Indian Health Services Division of Diabetes Treatment and Prevention Program Planning and Evaluation Workbook January, 2010 www.diabetes.ihs.gov/HomeDocs/Training/
WebBased/Basics/Creating/Workbook.pdf
Resources
Please note: Some links on this page take you outside the Better Diabetes Care website. The NDEP does not endorse or otherwise guarantee the accuracy of links that take you out of this website.
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IOM publications
Crossing the Quality Chasm www.nap.edu/catalog/10027.html
Integrative Medicine and the Health of the Public: A Summary of the February 2009 Summit www.nap.edu/catalog.php?record_id=12668
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The Drucker Foundation Self-Assessment Tool. A process for nonprofit organizations to clarify mission, define results, set goals, and develop a focused plan. www.leadertoleader.org/tools/sat/index.html
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Joint Commission on Accreditation of Healthcare Organizations
Publication - 2010 Disease-Specific Care Certification Manual. Fee applies.
store.jcrinc.com/JCRStore/SearchProductAction.do
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Institute for Healthcare Improvement
www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/
The Institute for Healthcare Improvement (IHI) is a not-for-profit organization focused on advancing the quality and value of health care.
Chronic Care Model (or Planned Care Model) summarizes the basic elements for improving care in health systems at the community, organization, practice, and patient levels.
www.improvingchroniccare.org
www.ihi.org/IHI/Topics/ChronicConditions/
www.ihi.org/IHI/Topics/OfficePractices/PlannedCare/
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NDEP Support Behavior Change Resource www.ndep.nih.gov/sbcr/ provides an online searchable database of research, tools and programs that address the “how to” of psychosocial issues, lifestyle, and behavior change. Assessment resources are included in:
- Organizations that accredit (or recognize) diabetes education programs require some program/patient assessment and include:
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