Thanks for your feedback!
Thanks - this is a nice job. A couple of small queries and then a bigger one. Small ones - do you want to create a position or do you want to create responsibility in an existing person? It seems like you are leaning toward the latter when you discuss the level of support for this activity that you will need- and it seems like it might not be full time. Second, if you want the places that "receive" positive fits to coordinate, it has to be clear which positive results at non-procedural facility map to the procedural facilities. Ok- here is the bigger question, and one that I don't know the answer to - in a managed environment like Kaiser, is the role of implementation science diminished compared to the role of management? Management is in my mind a particular strategy in the broad suite of practices that can count as implementation science (management for health to increase the use of evidence based practices). Obviously management only applies to certain organizational settings, but within those settings, can most forms of improvement be achieved with good management? or do you think the systems themselves need to be re-jiggered to improve care? In other words, is the existence of the node for coordinating follow up at the high performing facilities that way because there was an effective manager in those settings?
Hi Kevin, I totally agree with your approach of changing the work-flow for the follow-up of positive FITs. From my time working in an ambulatory care clinic I remember how hard it is as a primary care physician to keep track of all the results and to follow-up on patients, who are often hard to reach. I wonder whether you could not take more advantage of existing structures and personnel to implement your intervention, e.g. with electronic support such as automated notes or robocall as you mentioned, instead of hiring a new person at each facility, which might be challenging and a bit complicated due to high costs, the need of additional infrastructures such as desks, phones, computers, and the requirement to find the right persons with an adequate formation to fill this position? Maybe a cheaper intervention would also be more applicable to other settings outside the Kaiser system?
Looking forward to further discuss this in section!
Christine
Hi Kevin,
I think Elvin and Christine provided most of the relevant feedback. While creating a new position to do the navigation seems effective here, there might be other factors to think about. Will the person hired be working in collaboration with providers? If so, you might need to think about how adding a new staff member will require some changes in policies and procedures, and how those changes relate to the bigger organizational management (thinking about how challenging it could be to implement a change in health care).
You also mentioned focusing on external policies and incentives. I wonder what those policies would be and how the current staff will feel about that. I completely agree with incentives!
Kadi
Great Job! And really excellent name for your intervention, very catchy. I think this is a great start for your intervention though I definitely echo what Elvin, Christine and Kadi brought up. It may be interesting to look at other ways to address this work flow, instead or creating a totally separate role. I think if you had multiple people rotating through this role in each clinic there would be more impact on trying to get people scheduled for colonoscopy. For example if the MA's in each clinic (who mainly handle most scheduling to my knowledge) rotate through the positive FIT list throughout the week and are able to tackle this list when the flow is low then this would bring more attention to this issue by allowing more people to address it. Just a few thoughts but overall really nicely done.