Table 1.

Operational Changes Implemented in University of Utah Community Clinics, 2000–2005

Phase of Change (Approximate Time)Examples of Changes
I: Draconian change (years 1–2)Restructure organization, governance, and leadership
Restructure financing
Achieve “right size”: match capacity to demand, close practices not suited to fee for service or for referrals to the university
II: Innovation and performance improvement (year 3 onward)Develop financial and management reports
Revise physician compensation and benefits to incentivize productivity and sustainable levels
Implement correct core principles of successful group practices

  • Focus on patient experience

  • Match the right person to the right job

  • Standardize procedures

  • Design facilities for efficiency and patient service

  • Exploit technology

  • Improve communication

Redesign ambulatory practice operations

  • Implement advanced access scheduling

  • Reengineer the ambulatory visit to be patient centered and physician efficient

  • Strive for lean design

Implement robust electronic medical record through all clinics
Establish an active clinical quality improvement program
Develop new services and new practice sites
III: Integration with the academic mission (year 4 onward)Teaching

  • Appoint physicians as adjunct faculty to the school of medicine

  • Standardize educational contracts with outside institutions

  • Allow elective rotations for students (medical, physician’s assistant, other) and residents

  • Offer a continuity clinic for pediatrics residents

  • Integrate outpatient family medicine residency/faculty clinics in to community clinics network

Research

  • Establish a research oversight committee: health sciences center faculty, community clinics physicians and staff

  • Develop principles and oversight for research: select research that enhances the practices without disrupting operations

  • Track projects and direct research expense using community clinics (total to date approximately $2.5 million)

  • Establish formal practice-based research networks: Utah Health Research Network, Utah Sports Research Network