The Massachusetts League of Community Health Centers partnered with GE Healthcare to launch the IMPACT initiative, which provides performance improvement training to community health center staff. The training includes modules on leadership, process improvement techniques, and implementing changes. Participating health centers have reported reductions in call wait times, patient discharge times, and improvements to appointment availability. The training aims to help health centers enhance the quality and affordability of care they provide.

1. GE Healthcare
Taking performance improvement training
and coaching to the next level
HOW THE MASSACHUSETTS LEAGUE OF
COMMUNITY HEALTH CENTERS IS COLLABORATING
TO DRIVE CHANGE
The first community health center in the United States was founded
in Massachusetts in 1965. Today, the state is home to a leading-edge
initiative that is helping community health centers transform their
operations to meet the quality and cost demands of providing
patient-centered care in the 21st century.
The IMPACT Initiative seeks to educate, energize, and challenge health
center leaders and staff in applying outcomes-based performance
improvement and change management methodologies aimed at building
capacity to improve access to high-quality, cost-effective primary care.
It was developed by the Massachusetts League of Community Health
Centers (the League), who partnered with GE Healthcare Performance
Solutions on the design and rollout of the IMPACT initiative, which was
underwritten by a grant from Partners HealthCare, the integrated health
system founded by Brigham and Women’s Hospital and Massachusetts
General Hospital.
C A SE S TUDY
Performance Solutions: Strategy and Leadership
THE ORGANIZATION
The Massachusetts League of Community
Health Centers is a statewide association
serving the needs of the state’s 49 community
health centers and their more than 280 primary
care practice sites.
RESULTS
To date, 15 community health centers
have participated in the IMPACT initiative.
Results include:
• Harbor Health established an organization-wide
virtual call center with decreased call wait times
and a double-digit drop in abandoned calls.
• North Shore Community Health designed
a new discharge process and reduced
the patient discharge time by 74%.
• South Boston Community Health Center improved
the accuracy of the patient-to-provider assignment
rate by more than 45%.
• Boston Health Care for the Homeless Program
achieved a 34% reduction in time for admission
to their respite facility.

2. Matt Fishman, vice president for Community Health, Partners HealthCare, describes the
need for the IMPACT program: “As we enter a new era of health reform, the demands on
health centers are growing. We want to support health centers in meeting these demands
and in providing excellent care to every patient every day. That’s why we’re committed to
investing in resources to further strengthen health centers—especially by providing
opportunities for front-line employees and caregivers to develop
new skills. For health centers to perform at the highest possible
level, they need vision, commitment, energy, and practical tools.
Health center leaders and staff and the Massachusetts League of
Community Health Centers are building the capacity health centers
need. The partnership we’ve built with GE Healthcare, and the
expertise and leadership the GE trainers have brought to this
hands-on learning experience, are outstanding. This performance
improvement effort is helping health centers make tremendous
gains: enabling patients to spend more time with their healthcare
providers, reducing wait times, improving safety, enhancing patient
and employee satisfaction, and removing avoidable costs.
The Performance Improvement Initiative has been an excellent
investment for all involved—especially for the health centers that
have committed caregivers, senior management, department-level
management, and staff time. In return, they have achieved real
progress on tough operations challenges, empowered workers,
and demonstrated the ability to use the Lean tool kit going forward.
We are excited and delighted about what we have all accomplished.”
WORKING TOWARD THE PATIENT-CENTERED
MEDICAL HOME MODEL
Community health centers in Massachusetts serve more than 820,000 residents. “They are
the safety net, providing services to some of the poorest and most vulnerable populations in
the state,” says Joan Pernice, clinical health affairs director for the League. In addition to
primary, preventive, dental, eye, and mental healthcare, the centers provide what Pernice
calls “wrap-around services” that extend to care coordination and social service activities
such as domestic violence and safe housing interventions.
“The Performance Improvement
Initiative has been an excellent
investment for all involved —
especially for the health
centers that have committed
caregivers, senior management,
department-level management,
and staff time. In return, they
have achieved real progress on
tough operations challenges,
empowered workers, and
demonstrated the ability to use
the Lean tool kit going forward.”
Matt Fishman
Vice President for Community Health
Partners HealthCare
Massachusetts
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3. Because community health centers are veterans at providing patient-centric care, they are
expected to play a key role in helping the U.S. healthcare system evolve as national health
reform initiatives — such as the development of patient-centered medical homes — take
greater hold. In Massachusetts, state leaders have set a goal of transforming all of the
Commonwealth’s primary care practices into patient-centered medical homes by 2015.
The medical home model places a formalized and systematic structure of reporting, staffing,
and technology requirements around how primary care providers coordinate patients’
health needs, from management of chronic conditions to preventive care. The state’s health
centers continue to be leaders both in developing and implementing these newly unified
standards at their practice sites throughout the state.
Over the years, the League has continued to assist Massachusetts health centers in meeting
the demands of state and federal health reforms. This has resulted in the development of
a full range of technical assistance resources to help them navigate those changes. As an
important piece of that ongoing effort, Pernice selected GE Healthcare Performance
Solutions in summer 2011 to collaboratively design and launch the IMPACT Initiative to
help the practices achieve and sustain the improvements critical to succeeding under the
patient-centered medical home model.
A PRACTICAL APPROACH TO PERFORMANCE IMPROVEMENT
The League’s IMPACT Initiative was designed for community health center personnel at all
levels, from senior leaders to front-line staff. To date, 179 staff members from 15 community
health centers have participated. IMPACT is composed of three components: Senior Leadership
Training, Essentials of Leadership Excellence, and Performance Improvement Practitioner
Development.™
These synergistic components are core GE Performance Solutions offerings
that have been customized for the League’s community health center leaders and staff.
“The GE Performance Improvement Practitioner Development program takes quality and
process improvement processes and combines them into one program,” says Antonia Blinn,
PIPD project manager for the Massachusetts League of Community Health Centers. “For our
health centers, it is a very practical, understandable approach to performance improvement.”
In addition, GE Healthcare helped increase the League’s internal capacity by training League
staff as master practitioners in Performance Improvement. This will ensure continued PIPD
training and team coaching for health centers well into the future.
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4. Essentials of Leadership Excellence (ELE) is a four-day course for midlevel managers with a
strong focus on arming community health center staff with essential leadership knowledge.
The ELE program provides tools and a framework for midlevel managers to use
performance improvement concepts in sponsoring process improvement initiatives,
creating individual growth plans, aligning programming, and enabling a culture of
continuous improvement.
Through ELE, center staff members learn to:
• Practice and deploy a personal communication model to maximize effective
interpersonal and team communications
• Practice coaching and feedback techniques to improve individual and team
performance and potential
• Develop practical skills to manage conflict and influence others
• Apply techniques for selecting top performers
• Learn a framework and utilize tools for implementing and sustaining critical
organizational change
• Use personal and team feedback to develop an individual leadership growth plan
Performance Improvement Practitioner Development (PIPD) training provides community
health center staff with instruction and hands-on practice over a four-month period.
Staff members learn how to analyze and resolve problems using process improvement
tools drawn from Lean, Six Sigma, and Change Acceleration Process (CAP), and Plan Do
Study Act (PDSA) methodologies.
Initially taught by a performance improvement specialist from GE Healthcare Performance
Solutions, and then taught directly by League staff, the sessions focus on helping
Community Health Centers:
• Learn how to identify waste in processes
• Utilize a common language around performance improvement and change management
• Complete a process improvement initiative, including solution testing and implementation
• Develop dashboards, metrics, and targets to sustain change
• Develop strategies for improving processes as part of daily work
4
Senior Leadership Training (SLT) is a two-day course attended by community health
center leaders (such as CEOs, medical directors, and IT directors) in order to understand
the goals of the Performance Improvement program, the process of change management,
and their role as leaders in providing resources, supporting change, and establishing an
organizational culture of performance improvement.
During Senior Leadership Training, leaders:
• Gain an executive-level understanding of the key principles of performance
improvement to guide and support staff members
• Learn how to structure a framework that links their organization’s strategic goals
(3- to 5-year plans) to annual performance goals while driving organizational strategy
down to the process improvement initiative and individual employee level
• Acquire the understanding and tools to mentor change and create a culture
of continuous improvement
• Become better able to lead and leverage the League’s investment in center staff

5. One of the practical facets of PIPD training is that the participating community health
center teams work on actual practice challenges during the sessions. Some examples
of process improvement initiatives that have been addressed since the inception of the
PIPD training
• Improving pediatric patient flows
• Increasing the accuracy of patient contact information
• Shortening patient admission times
• Improving the patient discharge process
• Creating same-day appointment slots
A COMMON LANGUAGE FOR PROBLEM SOLVING
One organization that participated in all levels of the training was Harbor Health Services,
Inc., which operates a network of community health centers in Boston and on Cape Cod.
“We were trying to align four health centers that had worked very differently for 25 years,
and we were evolving our practices to meet patient-centered medical home guidelines,”
says Paulette Shaw Querner, corporate vice president of Harbor Health Services.
The initial challenge that Querner selected for the Harbor Health team was to reduce
call wait and abandonment times. She wanted them to focus on a relatively simple
operational problem first in order to gain the skills and confidence necessary for tackling
more complex issues such as reducing variations in clinical care among the sites.
Process mapping and data collection at the sites revealed that lengthy hold times
resulted from front desk staff having too many responsibilities. Harbor Health decided
to split off phone duties and establish an organization-wide, virtual
call center. Piloting that approach has led to a significant reduction
in call wait times with a double-digit drop in abandoned calls,
according to Joanna Kreil, the League’s quality initiatives manager
and the coach who assisted the Harbor Health team.
Querner also had senior executives and midlevel managers from
Harbor Health undergo the GE training. “The CEOs and chief
medical officers who attended the sessions quickly laid out the
problems they were facing,” Querner says. “But more than that, I
was impressed with how effectively the GE trainers were able to
adapt their approach and tools to those healthcare challenges,
gaining immediate credibility with the group.”
“When I heard about the League
resources being offered, it was
clear that this could help us get
a common language, a common
set of tools, and a common
approach to problem solving.”
Paulette Shaw Querner
Corporate Vice President
Harbor Health Services
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6. TACKLING TOUGH ISSUES WITH CROSS-FUNCTIONAL TEAMS
From there, Querner decided to spread the skills deeper into the organization by inviting
approximately 45 site-director-level staff members to a two-day retreat in January 2013,
during which Kreil gave a presentation on Lean tools and concepts. Attendees were
divided into four teams, with each assigned a specific challenge related to transforming
into a patient-centered medical home: creating a high-risk registry; reducing variation
among the center’s different clinical teams; closing the loop on patient referrals; and
reducing variation in lead times for appointments. Eight of the middle managers who
had taken the PIPD course were assigned as facilitators, and Kreil was available for
consultation. Querner asked the teams to identify the root causes behind the problems
by March and propose solutions by May. When progress reports were given in March,
Querner asked the teams: “Was anybody energized by this process?” Every hand in the
room shot up, she reports.
According to Querner, the process has been invaluable for many reasons.
Querner “cross-pollinated” each team with staff from different sites, taking care
to avoid assigning the usual content experts to a problem area. She observed
that “the process made everyone equal in the work group, and they couldn’t rely
on their usual modes of communicating or thinking about problems.”
With the continuing changes in healthcare — including the recent communications
released by MassHealth on the plans to move its entire MassHealth population to a
global payment program — the focus on outcome measures, quality, efficiency, and cost
is only increasing. Querner says: “Strengthening our ability to analyze what is driving a
particular problem, such as variation in a process, and then quickly and effectively
implementing a sustainable improvement is critical to our future success.”
IMPACTING PATIENT CARE
Initially, the teams were skeptical about the upfront time required to effectively analyze the
cause of the problems. “But when they were able to look at real data, they discovered that
their initial assumptions were wrong in many cases,” Querner says. Closing the loop on
referrals was a case in point. That team assumed there was an established process by
which Harbor Health primary care physicians ordered a referral to a specialist: The order
was entered into the electronic medical record (EMR), the medical assistant made the
appointment, and, following the visit, the specialist’s findings were entered into the EMR.
What the team discovered was immense variation from site to site, with many referrals
never even making it into the EMR in the first place.
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7. According to Querner, there were many ramifications from this analysis. As a federally
qualified health center caring for underserved populations, Harbor Health’s pharmacy
is able to buy drugs at a substantial discount and pass those savings onto patients via
the 340B Drug Pricing Program. When Harbor Health patients are prescribed drugs by
specialists, they can return to the Harbor Health pharmacy to fill the prescription and
save money. But if that referral does not show up in the patient’s record when the
pharmacist queries the EMR, then the patient has to pay full retail price — which could
be significantly higher. Thus, any disruption in the administrative processes around
referral documentation can seriously erode the affordability of healthcare for patients
who are already stretched financially.
Another issue impacting patient care was the lead time for appointments. When a patient
wanted to schedule a physical, for example, the wait time at Harbor Health sites ranged
from 2 to 45 days, depending on the primary care provider. Initially, the team thought this
was due to individual appointment scheduling practices. In fact, the problem arose from the
high variation in the number of patients assigned to each provider, known as panel size.
Some providers had a panel size upward of 2,000 patients — 25 percent higher than the
average panel. Determining the optimum panel size and smoothing out variations will help
improve access to care for more patients, Querner says.
Querner does not expect her teams to find all the answers immediately. “These are very
complex problems that will require multiple approaches,” she says. “What’s important is that
the staff is learning new ways to approach problems and getting practice in using tools that
they can carry forward to address the next challenge. That is the real marker of success for me.”
What’s happening at Harbor Health and at other community health centers is that they are
building their own Quality Improvement infrastructure, Kreil says. “The training series is
giving them a framework for change, and they are making a real commitment and
investment in their staff to get the most out of what they have learned.”
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About GE Healthcare
GE Healthcare provides transformational medical
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for increased access, enhanced quality and more
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works on things that matter – great people and
technologies taking on tough challenges. From medical
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technologies and performance improvement solutions,
GE Healthcare helps medical professionals deliver
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For more information contact Chuck Taylor:
Chuck Taylor is a Director with Performance Solutions.
He has led multiple management and leadership
system transformations, and outcomes-based
performance improvement engagements, within
the healthcare industry.
He has 30 years of executive leadership and
change management experience across multiple
GE businesses and functions, and combines his
hands-on working knowledge of GE’s management
and leadership systems with strong expertise in
marketing, operations management, and total
cost productivity methodologies.
Chuck is also a graduate of GE’s Management
Development Course (MDC), taught at the
John F. Welch Leadership Center. Chuck can be
reached at chuck.taylor@ge.com or 704-682-5882.