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“We are here to make another world.” 

-Edwards Deming

How does a large institution go about preparing for a fundamental paradigm change, especially one for which there is no template?  In LCHC’s case, how might we best prepare for when our 18,000 patients with MassHealth switch to value-based payment on January 1st, 2023.

Over the summer, our leadership team spent hours on a survey tool recommended by both C3 and the National Association of Community Health Centers. The outcome of the survey has helped us to pinpoint areas of strengths, areas of greatest potential impact and areas of frank weakness.  Two insights emerged as I reflected on the results of the survey.  First, LCHC is well poised to meet the challenge that, if answered well, will deepen our ability to live our mission. Second, the changes required to be excellent in the new paradigm are deep, touching every aspect of the health center.

Adapting to value-based care is not about subtle shifts in response to optional new parameters.  It is a door through which we can reach a deeper communion with our mission, a better world for ourselves, for our patients and for the community we serve.  LCHC exists as a complex set of interlocking programs, some of which are crucial lifelines in our community. This means that the shift to a better model must be planned, and fundamental aspects need to be prioritized.

We will continue to build on the structure of our integrated primary care teams, and the roles that we hire to staff those teams.  We are rethinking our use of space, how we coordinate asynchronous patient care, and how daily professional life is structured for our staff.  Communication will take center stage as we work with our patients to identify social determinants that impact the lifestyle changes needed to bring about better health outcomes.

Because of the opportunities to meet with policy makers, with thought and industry leaders, leadership can have a broader vision of what is to come and can sometimes predict in a more informed way.  Yet, senior leaders do not typically have the feel of what it is like to be providing services, to be resolving problems day in and day out, to the enormous variety of patients in our community.  Neither can we intimately involve 600 staff members and 40,000 patients in the planning of the shift.  What better way than for frontline staff to help us in designing this new model of care?

We chose a core team approach for the first stage of our design exploration.  This is an integrated multidisciplinary team, whose challenge it is to determine how we design a model of care at LCHC to better serve our patients and attract new patients.  Unsurprisingly, the group’s title is the Ideal Care Model design (ICM) team. Through a series of daylong workshops facilitated by Alice Lee, a world renown thinker on patient-centered change and supported by the program managers, Alyssa Ruiz, Mia Wallach and Kim Eng, the ICM team has been learning about design thinking and lean principles, two methods of innovating which place the patient at the center.

To better understand the people we are designing for, more than 40 staff and patient interviews and observations were performed by the design team, elucidating the direct experience of those using our system.  The team was careful to choose staff and patients to interview that reflect the full spectrum of our healthcare system.  For instance, if you interviewed staff regarding training, you could choose a brand-new employee and one who has a decade under their belt, or a patient who has only used one of our service lines once, opposite a patient who has used 3 or more of our services repeatedly.  The ICM team also went to Gemba, the place where the work happens.  Going to gemba allows one to directly observe staff and patients at different points of the care delivery process, helping the team to gain a deeper understanding of the users within our current system.  From these conversations and observations, the ICM team worked to develop a storyboard for each, pulling out major points and key insights which helped us better understand what gets in the way of what patients and staff need​, understand patient preferences​ and how they see their care​.

Over the next few blogs, I will describe the process being used by the ICM team to answer the design challenge.

What patient or staff member would you choose to have a conversation with or observe to gain insight into how to design a model of care to better serve our patients and attract new patients?

Dr Kiame Mahaniah
Kiame Mahaniah


About Kiame

Inspired by a childhood divided between a war-affected third world country – the Congo – and a high performing first world one (Switzerland), as well as parents intimately involved in rural development NGOs, Dr. Kiame Mahaniah brings a deep passion for social justice and the fight against inequities to his work as CEO at the Lynn Community Health Center in Lynn, Massachusetts.

More About Kiame

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