Patient and Staff Satisfaction and Experience While Transforming Health Center Systems

Abstract

Introduction: Patient satisfaction and experience are important measures of overall quality of care. In 2017, the National Association of Community Health Centers (NACHC) launched an initiative to facilitate changes across organizational systems within Federally Qualified Health Centers (FQHCs) with the goal of improving value-driven care.

Methods: NACHC worked with eight health centers, four in Georgia and four in Iowa, along with their state Primary Care Associations, to apply the Value Transformation Framework (VTF). This framework distills evidence-based practices into practical knowledge for goal-driven systems change. It provides actionable steps to help health centers reach value-driven goals of improved health outcomes, improved patient and staff experience, reduced costs, and improved equity (referred to as the Quintuple Aim goals). This paper reports on the patient and staff experience when applying VTF systems changes to improve colorectal cancer screening rates.

Results: Patient and staff satisfaction and experience remained highly rated even after extensive organizational changes were implemented as part of this project. Implementation of a systems-approach to organizational change, through application of the VTF, did not negatively impact patient or staff experiences.

Conclusion: Patient and staff satisfaction and experience were positive despite the application of the VTF and systems-wide organizational changes. These experience results were alongside improved cancer screening rates, as observed from full project results. Investigators are encouraged that the application of systems change using the VTF may result in the achievement of Quintuple Aim goals without disrupting the experience of patients and staff. Investigators recommend continued exploration of this transformation approach.

Keywords: Quadruple Aim; Quintuple Aim; cancer screening; community health; healthcare experience; prevention; primary care.

Figure 1

Graphic of the Value Transformation Framework (VTF). The VTF helps guide systems change in health centers by translating research and promising practices into manageable steps health centers can take to improve care and outcomes. At the core of the model is the health center and the patients it serves. Health centers’ complex systems are broken down into three manageable Domains: Infrastructure, Care Delivery, and People. Each Domain is divided into more detailed Change Areas, 15 in total (represented by the icons that encircle the 3 Domains). The Infrastructure Change Areas include: improvement strategy, health information technology, policy, payment and cost. The Care Delivery Change Areas include: population health management, patient-centered medical home, evidence-based care, care coordination and care management and social determinants of health. The People Change Areas include: patients, care teams, leadership, workforce and partnerships. The outer circle focuses on the goal of the VTF: to support health centers in making system changes by directing action in the 15 change areas and advancing toward value, defined as the Quintuple AIM (represented on the outer circle by: improved health outcomes, improved patient experience, improved staff experience, reduced cost and equity). The VTF was developed by the author, Modica.