Episode Details

Back at the beginning of this year, I was so sad when I had to edit out the clip that follows from the original and extremely popular episode 391 with Scott Conard, MD.

In the literally probably three minutes that follows in this clip with Dr. Conard after I finish my ramblings here, Dr. Conard introduces the impact that changing the practice model in a PCP practice in Queens, New York, had on the staff and patients alike. Spoiler alert: No way no how were they going back to the old way of doing things.

The "Before" here was a clinic where the waiting room was filled to overflowing out into the hall with patients waiting to be seen, and this included a mix of really sick people who really needed to be seen and also … others.

And thus they had, among a whole host of other bad things going on, the whole issue of suboptimal ER (emergency room) visits and urgent care usage. Anyone who couldn't wait just headed elsewhere.

Also, as it is so many places, care was pretty transactional. A patient who wasn't in clinic had an "out of sight, out of mind" relationship with their PCPs. There was no systemic way for the clinical teams to really think about the "in between spaces," as Amy Scanlan, MD, put it (EP402)—the spaces in between office visits. But then as a result, of course, we wind up dealing with uncontrolled chronic conditions and the failure to prevent preventable disease. We wind up with urgent needs for care and acute situations that had, frankly, no business getting to that stage in the first place.

So, Dr. Scott Conard and his team worked on practice transformation, including focusing on operational excellence. I say all that to say, here's Dr. Scott Conard:

DR. CONARD: We went and did one pilot clinic, which is, I think, the right way to do it. And then the practice manager was recruited by a competing group. They put another person in the clinic, another practice manager. And she immediately came in and thought that her job was to go back and put the old way of doing things in place, and within literally four or five days, they got together and sat down and said, "Look, we understand where you're coming from, but we will never go back. We are not going back to that old system. We are going to do things in this new way because it makes our lives—and we work together—so much better. And we enjoy being together, and we're seeing … we like not having 30 people waiting to get here at work. We like people getting … having a waiting room be close to empty as we just have one or two of the next people coming in. And we will never go back to that old system." And, to her credit, she's like, "Okay … cool. Let me understand this." And she's now one of the strongest leaders in that organization for this transformation.

STACEY: So, the PCPs … it was like mutiny on the bounty. They were like, "No way no how are we going back."

DR. CONARD: Oh, it was the entire team: their receptionist, the telephone operator, the MAs. They have a patient navigator, which is another part of the equation we haven't talked about that's really important. And so, the whole team said no.

Listen to the full episode 391 to learn more abou