A core principle of IPC is “all teach, all learn.” In these impact stories, IPC sites share their experiences and improvement journeys to help build our collective learning about changes they’re making to improve the Indian health system.
Forest County Potawatomi Health and Wellness Center: The Journey Home
When the opportunity arose to join the Improving Patient Care Collaborative, the health administrator and the staff of Forest County Potawatomi Health and Wellness Center saw it as just an isolated project to help improve certain aspects of care, especially for patients with chronic conditions. “Now, approaching 2012, we no longer look at IPC as a separate project. IPC is really the way we approach care. It has morphed into our own patient-centered care model,” explains Linda Helmick, health administrator. “We now approach every major decision and most moderate and minor decisions by asking what effect they will have on our patients.”
One of the clearest messages of the Improving Patient Care Collaborative is the value of centering care on patients. By listening to patients, understanding their challenges and their viewpoints, and then adjusting systems in response to that information, IPC sites can increase access to care and quality of care while boosting both patient and staff satisfaction. Truly a win-win combination. The staff at Red Lake Hospital in Minnesota have taken this lesson to heart. When asked what IPC has meant to its health care system, the first item on the list is “listening to patients and staff.” In fact, Red Lake’s slogan is “Our circle of excellence centers around you.”
Eastern Aleutian Tribes: Bold Vision for a Brave People
It takes a brave and determined people to settle on the Eastern Aleutian Islands, the archipelago that stretches northwest in an arc from the Alaskan peninsula. Bordered on one side by the Pacific Ocean and the other by the Bering Sea, the islands are accessible only by fishing boat, seasonal ferry, or small plane. Winter is long and harsh. Fog surrounds these volcanic islands more than 150 days a year, and gale force winds are not uncommon. In these conditions, trees don’t grow more than 10 feet high, but the Unangan (Aleut) people have lived here for thousands of years. About half of the permanent population of these islands claims Unangan descent.
Eastern Aleutian Tribes (EAT) was formed in 1991 by six Unangan tribes to serve the health care needs of residents in seven communities dotted among the islands: Adak, Akutan, Cold Bay, False Pass, King Cove, Nelson Lagoon, and Sand Point. An eighth community, Whittier, located on the western edge of Prince William Sound, joined the coalition in 1999. Designated health professional shortage and medically underserved areas, these communities lie hundreds of miles from most health facilities. Adak, the farthest community, is more than 1,200 miles from the closest hospital in Anchorage.
It takes an innovative health care organization to meet the needs of these remote communities. Luckily, EAT is just that. The organization’s determination is evidenced in the organization’s bold vision statement: “Eastern Aleutian Tribes have the healthiest people in the nation.”
South Dakota Urban Indian Health: Everyone Has a Voice of Change
The South Dakota Urban Indian Health (SDUIH) sites—Sioux Falls, Pierre, and Aberdeen—joined IPC in August 2008, full of enthusiasm and confidence. After all, chronic care—the focus of IPC—was one of their strong suits. And, they had been reporting regularly in compliance with the Government Performance and Results Act (GPRA). IPC was going to be a piece of cake.
By November, they were ready to quit. “We were completely drowning in a sea of overwhelming,” remembers Donna Keeler, SDUIH director and IPC sponsor.
Then, they attended their first in-person, national training in San Diego. They met the national team, heard the real-life success stories of other IPC sites, did hands-on exercises, and took time to focus on IPC methods as a team. All of the sudden the pieces fell into place.
There was a time when patients at Wewoka Indian Health Center routinely waited more than 2.5 hours for a 15-minute medical appointment. But that was before IPC changed the way the clinic does business.
Chinle Service Unit of the Indian Health Service provides health care to more than 35,000 members of the Navajo Nation. Chinle Comprehensive Health Care Facility is the health care hub for the region with in-patient facilities, a 24-hour emergency department and outpatient clinics with about 200,000 visits a year. Three satellite clinics in Tsaile, Rock Point, and Pinon provide primary care to patients in outlying areas. Even before joining the IPC Collaborative in 2007, Chinle had been experimenting with the IPC methods developed by the Institute for Healthcare Improvement (IHI). In fact, the Chinle Comprehensive Health Care Facility had started integrating IHI methods nearly a decade before the first round of IPC applications with slow but steady results.
With the support and structure of the IPC program, improvement efforts took wing and grew exponentially over the next four years. Chinle moved from one micro system in 2007 to three in 2009 and then increased tenfold to 30 in 2011. Now, IPC touches all primary care providers—and most of Chinle’s 35,000 patients—within the health system. By the end of IPC 3, Chinle expects to bring onboard the specialty practices and even nonclinical departments, such as human resources.
Eastern Band of Cherokee Nation: Macro Vision, Micro Changes
Cherokee Indian Hospital is the primary medical provider for the 14,000 members of the Eastern Band of Cherokee Indians who live in a five-county area of western North Carolina. With a 20-bed inpatient unit, an emergency department, and a variety of outpatient primary care and specialty care clinics at three locations, the hospital logs more than 22,000 primary care visits and approximately 20,000 emergency department visits each year.
When Cherokee Indian Hospital joined the IPC Collaborative, the organization’s strategic plan focused on hospital finances and operational indicators like volume and length of stay. While these statistics are important for the financial health of the institution, they may not have much to do with the health of the community.
At A-Mo Health Center in Salina, Oklahoma, the numbers are looking good. Screenings are up, comprehensive care is up, continuity of care is up. One number is down—way down. Average office visit cycle time—the time from registration to checkout, including a stop at the pharmacy—is down from a high of 150 minutes to just under an hour. For a visit that doesn’t require pharmacy, cycle time hovers around 45 minutes.
Kodiak Area Native Association: Many Tools for Change
Kodiak Island is part of a long archipelago in the Gulf of Alaska. The main settlement on the island is the City of Kodiak, located 250 miles south of Anchorage. The City has a population of about 13,000, of whom about 2,000 are members of federally recognized American Indian or Alaska Native Tribes. Another 1,500 people live in remote villages that can only be accessed by boat or small plane. Larsen Bay, for example, is 64 air miles from the City of Kodiak. The Alutiiq people have lived in Larsen Bay, population 96, for hundreds of years. For people who have lived here all their lives, leaving the village is difficult—logistically, financially, and emotionally.
Cass Lake Hospital may be one of the newer recruits to IPC, but this facility and its staff have jumped in feet first and accomplished much in just one year. While most IPC sites follow the recommendation to start with one micro system care team during the first year and gradually expand the ideas and concepts to other providers, Cass Lake involved all staff from the beginning and within six months had all providers on care teams and carrying out the IPC ideas.
