ICSI 2016 ANNUAL REPORT | HANDS-ON PRACTICE TRANSFORMATION | 3
Hands-On Practice Transformation
Balancing Tensions and Creating New Systems to
Manage Chronic Conditions – Lessons from the Field
e Triple Aim of better care, better health, and lower cost challenges clinicians and care
systems to constantly improve. Pursuing these aims often uncovers underlying tensions:
seemingly opposing forces that complicate how best to accomplish these goals, too often
leaving care systems frustrated with their ability to improve outcomes and leaving
physicians and others feeling blamed for slowing progress.
ICSI has experienced firsthand how these tensions manifest themselves. In partnership
with HealthPartners Institute, Minnesota Department of Health, and Stratis Health,
we are working with 20 rural and metro area clinics in a multi-year Chronic Condition
Management Program funded through the Centers for Disease Control to improve
clinical care for patients with chronic disease. Hypertension was the initial focus,
with the ultimate goal being a sustainable management approach ("system") for
patients with any chronic condition.
As we partnered with these clinics, we identified five recurring tensions:
• Standardization vs. adaptation
• Single disease management vs. chronic disease management
• Quality improvement (transformation) vs. quality reporting (compliance)
• Commitment to innovation vs. capacity for change
• Leadership nimbleness vs. constancy of purpose
This Minnesota Physician article
describes these tensions, why they
exist, and what clinics can do
to manage them to make steady
progress in improving care.
Special thanks to HealthPartners'
Tom Kottke, MD, for his
leadership in this work.
SIM-Practice Facilitation
ICSI continued its partnership with Stratis Health to provide practice facilitation to eight Minnesota
organizations through funding from a State Innovation Model (SIM) grant. Participants have found
that practice facilitation provides structure to their improvement work and gave them permission
to set time aside for a project despite competing challenges, knowing that their coach would support
and hold them accountable. Participants trusted that the facilitator understood their challenges
and would take those into account as they worked together. We encouraged engagement by having
participants align their projects with other strategic goals and/or quality initiatives they were already
focused on so as not to create new work.
As a result, participants are more confident when conducting small tests of change. ey have a new comfort level with data,
including how to create and monitor trend charts. ey are learning from each other by sharing successes and challenges,
and plan to continue connecting beyond this project.
"This project has helped our staff see the full continuum
of change, specifically as it relates to clinical care.
Identifying the measure, documenting the workflow,
changing/modifying the workflow as needed, and then
measuring our success – this is a process we can
extend to multiple facets of patient care."
– Jill Smith, Clinic Administrator, Sartell Pediatrics
321
7
321 members
participated in
7 Triple Aim
improvement
projects
