Bertha Safford, MD
Medical Director of Quality Performance
Whatcom County, Washington
"My involvement in quality improvement started with a big bang, actually. I never sought it out; it just landed in my lap." (1:24)
I’m a family physician who practices in a little town in Whatcom County, Washington. I practice full-spectrum family medicine in a semi-rural area, with a hospital about 15 miles away. I’m also Medical Director of Quality Performance for our group of about 40 family physicians.
My involvement in quality improvement started with a big bang, actually. I never sought it out; it just landed in my lap. The state of Washington decided to improve care in patients with diabetes, so they got together a planning group, and one of the decisions they made early on was to send three practices, partnered with insurance companies, to IHI’s National Collaborative Breakthrough Series on Chronic Conditions. They planned to send the Army medical group in Washington State, and the Army group got deployed to Kosovo. So we got a last-minute phone call saying, “How would you like to go to the IHI Breakthrough Series?” Of course we said yes, but we were a brand new group, we had existed about three months, and so we had no clue what we were getting into. Absolutely no clue.
I told people later I felt like I fell upside down into a roller coaster. Because when we got there, they introduced to us this whole rapid-cycle change movement, and we were expected, in the first week we got home to have done five rapid-cycle changes. It’s been a whirlwind ever since.
"That was my first lesson in meeting the patient where they are, and listening, and not assuming." (1:17)
I was going to go home, and ask my next patient with diabetes what their goals were for that visit. I went in and dutifully asked my next patient, who happened to be a person I’ve known for many years, taking care of her, and her children, and delivered her grandchildren. So I went in the room and said hello — we knew each other well — and I said, “So what’s your goal for today’s visit?” I remember so well, because of the woman’s response. She didn’t even think, she just blurted out, “Get out of here alive!” Whoa, what’s so hard about coming here? What she said was, you always nag me about my smoking. This was a woman who has diabetes, her blood sugar was out of control, her blood pressure was out of control, her cholesterol was out of control, she smoked. I always think that I’m kind with people, but from her perspective, she felt she was being nagged about smoking. That was my first lesson in meeting the patient where they are, and listening, and not assuming. So I made a deal with her, right then and there, that I would never bring up smoking again, until she gave me permission. She is still my patient, her blood sugar is under control, her blood pressure is under control, her cholesterol is under control. Once, she let me bring up smoking, so we talked about quitting, she tried, did not succeed, and I haven’t said a word since.
"I’ve been radicalized, really." (1:05)
I’ve been radicalized, really. You know, I look at health care now so much from the patient’s perspective. And I’m always thinking, “What could we be doing that would make it better for the patient,” that you get real impatient with traditional modes. Interestingly, the hospital has radicalized its care, so that it’s very patient-centered. They have patients on all their committees and teams; they even have patients on their pharmacy and therapeutics committee, for example. They’ve redesigned some of their units to be more patient-centered, and really changed a lot of their policies. Our community as a whole has put together what we call a “Shared Care Plan,” which is both on a website and on a piece of paper, for patients that don’t have computers, that allows them to own and manage their own medical care, and choose who is on their health care team. Every member of the health care team has instant access to their personal goals, and steps they’re taking to better health. So, it has increased a whole new level of coordination and activation for patients. I think each of us in our private practices have looked at how we deliver care; we’ve invited patients in and partnered with them. We made a lot of changes in our practices based upon patient input.
"My mantra is, 'Change is only going to work if it makes the right care the easiest thing for all of us to do'.” (1:04)
In general, I’m a person who is interested in process. I never realized it until a couple years ago. Way back, a zillion years ago, I went to college and majored in sociology, and my honors thesis was on change within organizations. And then my life took a kind of 90-degree turn; I became a physician and never thought about it again. But I’m realizing that some of that innate interest that I had is coming out now, and really loving the processes of change, and how we help an organization change. I think perhaps the very earliest innovators of all had something unique about them, to make them sort of be on the edge, and willing to look at change. But it’s becoming so much more mainstream now, that I think most physicians are interested in it. Part of it is, what we’ve learned, is we can make our lives easier. My mantra is, “Change is only going to work if it makes the right care the easiest thing for all of us to do.” If it makes more work, and when push comes to shove, we just don’t have the time or the resources to do it. So I think as we are learning to make our lives easier, by improving the quality and the way we deliver care, more and more regular physicians just see this as a way to practice medicine.
06/14/2005
