The Change Team is a multidisciplinary team of clinical staff in Dimock's Adult Medicine department working to transform the way we deliver primary care. Funded by the Harvard Medical School Primary Care Innovations Center, the Team consists of Dimock nurses, doctors, medical assistants, social workers, patient access coordinators, students and quality improvement staff.
The goal of the Team is to plan and test ways to redesign the Adult Medicine clinic into a patient-centered medical home. The primary focus of the first year of work is to improve the rates of cancer screening (pap smears, mammograms and colon cancer screenings), improve patient experience and improve staff satisfaction.
What is Patient-Centered Medical Home (PCMH)? It is a model of delivering health care in a coordinated way by a whole care team, driven by the needs of the patient. With a fully implemented PCMH model, adult medicine patients will experience:
Efficient visits in which staff offers preventive health maintenance alongside acute care needs;
Communications from hospitals and specialists available in Dimock's electronic medical record in a timely manner;
A focus on health goals set together by patients and clinical staff;
Care from an entire team of clinical staff: nurses, doctors, medical assistants, schedulers, social workers.
Beyond building the foundations of PCMH, the Change Team has begun to build a new approach to improving quality in the department. Using a "small tests of change" approach, the Team has practiced preparing for patient visits, employed interactive formats for staff meetings designed to spur new ideas and piloted a new urgent care phone line to get patients' requests to the right staff member.
The Team currently convenes weekly and is excited about the endless possibilities for Dimock patients.