Activities and experiences

to prepare us to embark on this journey. There are many trails we are exploring at the same time. All areas are essential and need leadership and attention. They aren't linear tasks.

Governance/The Federated Model: We took several years to build the collaboration we have. Trust is key. We built it through taking risks together and focused it directly through the Quality Culture Series I wish I knew more about how other cooperatives have worked. And how to keep it working given that the glue is good will and an understanding of the common good. The health centers are becoming much more interdependent with each other and with the network.

A culture of quality and managing change: A culture of quality means the norm is improving processes -- aka changing how we do things around here. EHR changes the guts of a clinic because it becomes the guts. We underestimated the work involved. Just like everyone else.

Product development/Managing the vendor: Did we ever underestimate this! We picked eCW because the docs loved it --- and still do. We knew that the challenges would be the reliability of service and support from a company stretched thin, and with no experience with CA Medi-Cal billing. But now we are living it.

Network and health center team building: Since the network is taking on responsibility for key functionality in each health center, a decision about who does what where is always on the table. The preparation for this was/is the technical assistance our QI staff gives our health centers.

Engaging staff/Training: Here is where our QI understanding has helped us a lot...on all levels. From front office staff doing "as is" workflow analysis to prepare them for improving the workflow --- to the clinical leaders learning the system enough to build alerts templates into it. We've built in a QI context to the product training, and network staff rather than vendor staff are increasingly doing the trainings.

We get frustrated. But, overall, we are excited. Our health centers are/will be so much more able to provide medical homes for their patients. A cornorstone of a reformed health delivery system.

These are my random thoughts.