Creating a Physician Practice Culture That Supports the Medical Home Model

Tuesday, February 5th, 2008
This post was written by Melanie Matthews

Dr. Lonnie Fuller
Fostering a practice environment in which staff are trusted to carry out standing orders and empowered to tell a physician when an error has been made can smooth the transition to the advanced medical home model, said Dr. Lonnie Fuller during our recent webinar on Building an Advanced Medical Home to Improve Chronic Care Outcomes. Dr. Fuller, medical director for the Pennsylvania Medicaid ACCESS Plus PCCM-DM Program, shared some of his thoughts:

In many cases, the physician is the boss. When I went into private practice, when I went into the hospital, sometimes the nurses stood up, and I thought, “What is this? I can’t believe they’re standing up just because I walked down the hall,” but the doctor was the expert, the doctor was right, no one could tell the doctor when they were wrong. So, when I made a mistake and the nurse saw, they might whisper to each other, but they didn’t say it to me. They weren’t comfortable pointing out things that I missed.

So part of this is, is your staff comfortable pointing out mistakes and problems? Can they tell the physician if the physician is wrong? “Doctor, that’s the wrong medication.” “But doctor, they really didn’t have the mammogram – can we order the mammogram?” Will the physicians let the staff determine how to do their job? As medical director, if I sat in an office and wrote out a policy and a protocol for how the medical assistants would draw blood, I would fail to do one that worked. They would try to follow it, knowing that it didn’t work. They would just get mad at me.

So we have to let people determine how best to do their job. Will physicians let the staff follow standing orders? Will we trust them to do the work? If we have measurement in place we can be sure they’re doing the work and follow up on it, but will we trust them as physicians?

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