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System-level enablers Payment reform Practice facilitation Data use and aggregation More usable EHRs Practice-level tenets Build whole change together Focus on large-scale, long-term change to become the practice that you want to be for your patients and your staff Enlist everyone in the practice in the effort, including patients, families, and communities Use facilitators and facilitation strategies Change as a community, region, or system when possible Find the right financial payment model and structural support for long-lasting change Pace yourself Do not work too fast on too many things, but also do not work only on marginal changes that do not matter Sequence the change, starting with leadership, practice culture, and empanelment. Then move to other features of team-based care and coordination Build adaptive reserve and work on maintaining joy of practice Allow enough time to pass before passing judgment Focus on what matters most Explicitly target the most beneficial primary care outcomes or functions to for patients and communities, such as: Building long-term relationships Risk-stratified care management for high-need patients Key chronic diseases such as cardiovascular disease and diabetes mellitus Beneficial preventive measures (ie, immunizations, smoking cessation, colorectal cancer screening) Integrated behavioral health Social needs identification and resource connections Save the rest for another day—work on what matters most now Practice regular “quality improvement hygiene” Meet regularly as an entire team to review change Set targets and review progress toward those targets Use registries of electronic clinical quality measures (do not wait for old and often inaccurate claims quality data) Use an established quality improvement method—try changes and learn from them Involve patients and your community in the change upfront and throughout EHR = electronic health record.
