I went to my second meeting for one of the VA primary care quality improvement projects yesterday. Over the past month or so the team thought about some issues in clinic that they think are particularly troublesome for the patients and for the providers and identified improving agenda setting in clinic as a major priority.
They felt that often our veterans travel for several hours to see their primary care doctor and often leave without having had the chance to discuss the most important issue or issues to them. Additionally, they worried that poor agenda setting led to misused time during the visit and actually slowed down their overall clinic day, making them late for other patients and adding to an already overburdened day. Indeed, the literature supports both of these suspicions and outlines the importance of eliciting and prioritizing patient agendas to improve patient care and communication (Epstein, AAFP http://www.aafp.org/fpm/2008/0300/p35.pdf).
Using the IHI’s Model for Improvement (http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx), the team defined their goal as “improving agenda setting in clinic” and selected an initial metric of “percentage of patients with a documented agenda prior to starting the visit” to actually know if that change is an improvement. They then spent the remainder of the meeting creating a process map in which they outlined all of the various steps that go in to a veteran having an appointment with their provider with the goal of identifying certain steps that could be improved upon to create better agenda setting.
The next steps are 1) Improving upon the team goal by making it “SMART” and 2) analyzing the process map that was created to identify a few possible small tests of change for a plan, do, see, act (PDSA) cycle.
The team is meeting again next week to continue to build upon this work and hopes to start trialing at least one small change then. Stay tuned for updates from the clinic!