Medical Homes are a culture change and could be a significant advance in the delivery of medical services. A medical home is named such because its stated purpose is to provide comprehensive patient-centered treatment for the life of a patient.
Community based, a medical home is defined by criterion.
A Medical Home must be:
- Geographically located within the community it serves.
- Every patient is assigned a personal physician.
- Most primary care is delivered by Advanced Nurse Practitioners or Physician Assistants- part of a team made up of at least one supervising physician.
- Must have active and reliable databases that can house medical history, provide a platform for continuous improvement, transfer records to associated hospitals, participate in evidence based medicine work and include a network of specialists.
- Provide opportunities for every patient to participate in health and wellness educational occasions at the site.
- Practice caregiver-patient collaborative medicine and create a culture of teamwork, compassion, and equality between all caregiver staff and between staff and patient.
- Create a culture that is committed to safety and quality.
Falling Short of a Culture Change:
With the integration of non-profit medical centers, acquisitions of physician practices and hospitals, it might appear that the presence of a true medical home would permeate almost any community within the next few years.
Community based patient care delivery is inevitable but a community based care location does not ensure the establishment of a medical home. With today’s medical services integrations and information technology, there is a good chance of implementing the transactional (criterion 1-4) while setting aside the difficult (transformational) criterion 5-7.
I have used a medical home that’s an extension of a medical school for years and am very satisfied with my health care. I use Mychart, my doctor holds an endowed teaching chair and each visit with a specialist usually includes several interns and residents. I enjoy the new Doc’s greatly.
In spite of the competence of the care, no visible cultural change has happened the years in which I’ve gone. The clinic began calling itself a medical home around 2009, yet it still practices a degree-based hierarchy, does not hold team meetings, does not offer public education sessions for common diseases and addictions and does not offer prevention counseling except by the physician during a consult.
Leading a Culture Change
A culture change and Transformational Leadership will become a requirement if medical homes are to live up to their promise.
Even though quality processes and lean techniques have adapted to the patient care environment and proven useful, the magic bullet for a big leap in collaboration, clinical treatment equivalence for APN’s and PA’s, true patient centered collaboration and a new possibility for patient care –all would benefit from a transformational catalyst if medical homes are to realize their mission.
The transformational must gain equal standing with the transactional.