The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery works with, and within, Mayo Clinic's medical practice to identify, test, and implement innovations to improve health and the experience of health care.

Recently the center has been collaborating with Mayo Clinic's Outpatient Practice to develop new ways of caring for patients. A multidisciplinary team examined the outpatient practice and developed an agile framework upon which practices can customize the use of skill sets, tools and collaborations to provide excellent in-person and non-visit patient care.

With this foundation for innovation and practice customization in place, Mayo Clinic will be able to meet the needs of patients today and in the future, all-the-while improving team satisfaction and joy through a collaborative care model that capitalizes on the skills and capabilities of each team member.

One innovative development of this project team called "Mature the Message" is currently being implemented across Mayo Clinic.

Mature the Message is program designed to help improve the care team experience when working in In Basket and improve efficiencies for all team members. (In Basket is a secure messaging system for patients and care team members that is linked to a patient's electronic medical record). The Mature the Message concept encourages and empowers everyone to do as much as they can with a message before passing it on to another care team member. Opportunities for improvement with Mature the Message resources include:

• No more after hours or lunch break In Basket management.
• Zero In Basket at the end of every day.
• Return from time away from work to an empty In Basket.
• More things can be done with a single action.
• Care team culture improves as each team member knows what to do that makes sense for the patient.
• Patient needs and staff capabilities control workflows, not In Basket.
• Improves response times to patients and colleagues.

Teams that were trained to Mature the Message have seen:

• A 27% improvement in staff feeling they were adequately trained and ready to work in In Basket.
• Overall satisfaction with In Basket increase 15%.
• Staff members were 19% more likely to feel In Basket messages from other team members provided enough information.
• Health care providers saw a 22% decrease in In Basket volume.

Joseph Furst, M.D., family medicine physician at Mayo Clinic's Southeast Clinic in Rochester, Minn., participated in Mature the Message training a couple of years ago and says it is invaluable to team based care. “Our care team at the Southeast clinic continues to meet monthly even two and a half years later,” says Dr. Furst. “In our efforts to mature the message, the providers understand that efficient care starts with a good note. “There are fewer questions downstream when we are specific and concise with the plan.”

Dr. Furst adds the nurses and desk operations staff feel empowered to pend orders, and "a pended order with a brief SBAR is fabulous." (A pended order is an order for patient tests, medications or other care needs, developed by another team member for review and signature by the physician. The process allows all team members to work to the top of their licensure. SBAR is an acronym referring to a succinct communication of the Situation, Background, Assessment, and Recommendation.)

“The providers have all wrenched their communication activity task bars so that pended orders can be easily seen without opening the message to help us know what messages can likely be dealt with quickly between patients,” he says. “We also talk about metrics in our monthly meetings so everyone understands that good metrics result from everyone pitching in. So although maturing the message is the centerpiece of our meeting, it leads to maturing the care team, which leads to great staff and patient satisfaction.”

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Tags: Center for the Science of Health Care Delivery, Joseph Furst, medical innovation, News, patient experience, physician burnout, practice improvement