Table 4.
Strategies Reported by Single Facilities
| Low Performing Facilities: No Clear Strategy Pattern | High Performing Facilities: Clear, Yet Locally Adapted Direction | ||||
|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | 6 |
| Attrition/layoffs Best practice sharing across facilities | Shared decision-making (with the patient) | Temporary, problem-specific committee | Strategy pattern: Coordinating and organizing information | Strategy pattern: Improving and maintaining the quality of verbal communication | Strategy pattern: Automation and introspection |
| Case manager | Designing strategic and/or action plans for policy and implementation | Centralized after-hours phone hotline | Encouragement from top to use computers | Empowering at the lowest possible level | |
| Centralized testing | Prioritizing based on population needs | Contract nurse program/care coordination | Expectation that reminders will be satisfied | Following the baldrige model | |
| Changing the manner in which data are monitored and utilized | Veterans Integrated Service Network-level committee | Empowering within scope of practice | Solicit provider input | Internal performance review (not necessarily charts) | |
| Changing the way patients are scheduled | Written dissemination (of the guideline) | Keeping the appointed schedule | Verbal feedback to provider | Plan Do Study Act process | |
| Clerical | Patient ed: education room/library | Clinical patient record coordinators, | Recruiting quality staff | ||
| Committee-based clinic | Communication patterns | Direct communication with decision makers | Restructuring the administration | ||
| Consolidation of equipment | Communications with VISN | Posters | Walk-in clinic | ||
| Consult with others about appropriateness of guideline | First come, first serve | Electronic medical record (historical) | Re-instituting primary care teams | ||
| Electronic medical record (partially implemented) | Physician decides | Central repository for process documentation | Routine procedure | ||
| Gaming? | Order sets | Open relationship with IRM | Standing orders Automated chart reviews | ||
| Grant money for special initiatives | Periodic clinical reminder review | ||||
| Have patient bring in their meds | Reference materials in CPRS | ||||
| Linking pin communication mechanism | |||||
| More time w/patient | |||||
| On-the-job training | |||||
| Patient ed: handouts/literature | |||||
| Patient ed: one on one demos | |||||
| Pdas for physicians | |||||
| Policy change | |||||
| Pretesting/test prioritizing | |||||
| Product line configuration | |||||
| Quality Manager as a CPG communication channel Quick turnaround equipment in the clinic | |||||
| Re-staffing | |||||
| Revised tracking and/or encounter forms | |||||
| Single point of contact for patient | |||||
| Staffing | |||||
| Standardized/quick/ computerized order sets | |||||
| Strategizing around workflow | |||||
| Threats | |||||
| Town hall meeting | |||||
CPRS: Computerized Patient Record System; CPG: Clinical Practice Guideline; OTJ: On-the-job; QM: Quality Manager; VISN: Veterans Integrated Service Network; PDSA: Plan Do Study Act.