Table 4 Challenges requiring solutions during Microsystem Implementation

Lack of time and coverage for participation

“We are a busy clinic, we see a lot of patients. It’s hard to take on—don’t get me wrong, it’s not hard to take on new stuff, it’s nice to see the change, but it’s really hard to implement it if you don’t have the time to do it.”

“The other receptionists worried they would have to carry my load if I’m away from the phone. Most of the time, we have to have coverage for me…and I didn’t want them to think they had to carry my load if I’m not there.”

▪ Designated protected time during work hours for team meetings

▪ Float coverage provided for learning sessions

Need for Electronic Health Record technical support to implement certain interventions

“So we should be using this tool [the EHR], and we have this tool, and they started this microsystems process saying you absolutely may not use that tool. That’s nuts. That’s ludicrous. You do not want people thinking that way. You want people to be recognizing that that’s a tool to use.”

▪ 1.8 full-time equivalents of dedicated electronic health record consultation were hired for teams’ support

Lack of team member’s computer skills, technology and training

“I am really slow at compiling my notes. If I’m the recorder for the minutes, I’m really slow. So if I’m doing that, that’s a good half a day extra.”

▪ Provided teleconference, computer equipment and training

Improvement work not perceived as being valued

“Its research that’s rewarded, teaching is important, and how much, how many dollars you bring in. But there’s no reward or clout for administrative skills”

▪ Provided physician continuing medical education credits and medical assistant continuing education credits (American Association of Medical Assistants approved) for learning session participation

▪ Space made available within the clinic for team meetings and data displays

Dissemination to other teams difficult because of varied project focuses

“I can’t imagine learning anything from other clinics. Every clinic is so different”

▪ Teams directed to align projects to focus on access and efficiency

Opportunities to share improvement work

“So far it’s just been kind of osmosis, some of the things. The entire staff we send our minutes to and we have a bulletin board in the back. So we have it posted and we try to be transparent, but I think it’s ineffective.”

▪ Hosted an annual summit for improvement sharing and collaboration

▪ Created “Improvement Solutions” searchable web site for completed improvement projects from across organization