I love the idea of turning a negative approach to improvement in health care—looking for problems—on its head. Appreciative inquiry, a process of focusing on a group’s inherent strengths and fostering positive interactions among group members, is one way of fostering change with a positive approach. Positive deviance (PD) is another.
Basically, PD involves identifying what’s working and usual local solutions owned by the people involved to make improvements. According to Leading Change in Healthcare: Transforming Organizations Using Complexity, Positive Psychology, and Relationship-centered Care, a fascinating book I’m currently reading, PD was first developed as a way to address malnutrition in poor communities—by looking for children who were healthy despite the limited resources, learning what the mothers of these children were doing differently (the “deviance”), and creating opportunities for other mothers to practice these different behaviors.
What if we were to apply positive deviance to the problem of clinician burnout? What might that look like?
In 2017, the flagship multispecialty practice of Oregon Medical Group, moved into its new digs—a 46,000 square foot redesigned medical office building. Practice leaders and the 30-odd clinicians in six different specialties were committed to a coordinated patient experience. They wanted to ensure that patients could move smoothly between sequential visits with different care providers—on the same day. To this end, the group invested in a centralized check-in process. However, the spacious physical plant was a significant obstacle to a smooth, efficient patient flow, even with centralized check-in.
I spoke with two leaders of the group, Chief Executive Officer Karen Weiner, MD, MMM, and Chief Operating Officer Eve Riley, MSN, MHA, about the innovative solution the practice is using to address this challenge: self-rooming using real-time location system (RTLS) technology.
At a recent conference I attended, Christine Sinsky, MD, Vice President of Professional Satisfaction at the American Medical Association, presented data on various time savers that physician practices have tested to streamline clinical processes.
One example she described was pre-visit lab testing. She asserted that the strategy saves time and money. It sounded intriguing. I’ve seen how cluttered processes and time-consuming workarounds can really make you frazzled and sap the joy out of patient care.
As I listened to her presentation, I found myself wondering, “How does it actually work? Does it involve additional needle sticks? How do they get labs done fast enough for the results to be ready at exam time? Do they hold tubes of blood for add-on orders?”