In our experience, the single greatest predictor of success in attaining Patient Centered Medical Home (PCMH) recognition is whether you begin with the intention of transforming your practice, or simply of tweaking it.

Transforming or Tweaking. Which is Better?

Transforming involves changing the organizational culture, empowering staff and engaging patients. A lot of articles and consultant web sites suggest you begin with with this. When that’s done, then move on to PCMH.

On the other hand, if you begin by tweaking your practice, you’ll build the key processes for PCMH (population management, quality management, care management, etc.) and then:

• Run those processes for a few months,
• Collect data on costs and outcomes, and
• Look for the small tweaks in the processes and the practice that will ensure success.

It’s a lot like that age-old question: which comes first, the chicken or the egg? Wray, one of SigmaMed Solutions’s founders, raises laying hens. He buys the chicks, so the chicken always comes first.

Which should come first for PCMH – tweaking or transforming? Some might answer, “Who cares? If you start with one, you’ll always get the other, right?” Not necessarily. It’s possible to spend so much time on transformation activities that PCMH looks overwhelming and gets abandoned.

Successful PCMH happens when we get the chicken (Process Tweaking) first, and let the chicken lay the egg (Practice Transformation).

PCMH will, by definition, transform most practices through:

• New functions – Population and Care Management of chronically ill patients,
• Improved quality systems and management,
• New financial models,
• New roles for providers and staff,
• And more…

We like the tweaking approach because it generates great results faster.

One article on the subject is the Harvard Business Review piece titled “Successful Change Programs Begin with Results” by Robert H. Schaffer and Harvey A. Thomson  (may require a free registration or search the web).

Schaffer suggests that focusing on process measures and outcomes (what we like to call the hard stuff) is more likely to result in real improvement than starting with the soft stuff – empowerment, engagement and cultural change.

We believe in the soft stuff. Just let the soft stuff happen as a result of doing hard stuff. Let the process design and improvement drive transformation, not the other way around.

Your chances for a successful Patient Centered Medical Home will increase.