In Pursuit of Bigger and Better Things

Melissa Blakeman, Johns Hopkins Community Physicians’ (JHCP) Maryland suburbs regional medical director, and Karen Skochinski, JHCP operations director, had a few major goals for fiscal year 2020, but none more ambitious than to “ace” their quality metrics. And ace them, they did.

The region has seven adult sites with six quality measures each. Of those 42 metrics, 33 of them saw improvement. All seven adult primary care sites exceeded the quality target for well visits for patients age 65 and older, most of them by double digit margins. One site in particular, Annapolis, improved its score by 31% over the previous year.

Blakeman and Skochinski owe this remarkable success to a few factors. First, they encouraged their leaders to find ways to make quality improvement intrinsically motivating. A few examples are: look for small wins — starting with metrics they are close to meeting, so that changes can be felt; re-frame tasks to appeal to emotional motivations; and make the connection between providing great patient care and quality metrics — data that proves you are providing great care. One of Skochinski and Blakeman’s goals in fiscal year 2019 was to strengthen their practice administrator (PA) and office medical director dyads, an endeavor they believe carried over into FY 2020, as much site leadership became more proactive and creative in its pursuit of meeting metrics.

The regional leadership duo also emphasizes the importance of the entire care team achieving metrics — not just providers. Skochinski often sits down with PAs and staff members to discuss how they can break their data down so that it is manageable. For example: Instead of a medical office assistant trying to tackle a 10-page list of patients to call, starting with just one page yields better results. They also note that metrics regarding wellness visits are great to focus on, because they often lead to capture of other measures, like mammogram metrics. When the entire team is engaged, staff members can proactively change patient appointment types or length to accommodate the services reflected in quality metrics. This ensures that no one is falling through the cracks. Bridget Akinbobola, practice administrator at JHCP’s Glen Burnie site, says “providers work with their care team members to outreach to those patients who need gentle reminders. Ensuring patients complete their regular health maintenance is one of our top priorities.”

Skochinski and Blakeman also credit the JHCP Quality and Transformation team, and their practices’ Quality Improvement Officers (QIOs), for being major catalysts for improvement. The data that the Quality and Transformation team provides is indispensable, and according to Blakeman, the biggest benefit of QIOs is that “direction is not just top-down. Having another staff member who is focused on quality improvement helps to encourage and engage all staff in the process.” 

Finally, JHCP’s Tiger Team, a panel of experts with diverse knowledge who recommend solutions for improvement, was a tremendous help. Over the past few years, leadership and staff turnover has left a few practices in need of extra support. The multidisciplinary team showed up with new ideas and left the practices with renewed energy. Adds Skochinski, “The Tiger Team really knows how to drill down to specific issues that will help site leadership focus on key points and actionable items.” A testament to the team’s effectiveness, and to the focus and commitment of the practices, three sites in the Maryland suburbs region graduated from the services of the Tiger Team, and two more decreased their meeting frequency to bimonthly. 

But beyond support for leadership, engaging the entire team, and the roles of QIOs and the Tiger Team, the stark improvement in quality scores for the Maryland suburbs region comes down to the dedication of its leaders, staff members and providers. Blakeman and Skochinski are confident in their teams: “There are always bigger and better things coming up,” Blakeman says.