In the complex setting of a medical practice, the idea of providing exceptional quality to every facet of every person's job may seem difficult to digest. This is why using your EMR as a functional, quality tool to transmit necessary information to your staff members in a convenient and efficient way will help patient interactions and overall care. Marcy Shimada, CEO/administrator at Puget Sound Family Physicians in Edmonds, WA, compares her practice's former processes to "moving dirt with a teaspoon." But when she saw that using an EMR could improve this area, the practice decided it could be "moving the dirt with a bulldozer instead."

Physician practices do not always realize the level of change necessary to successfully implement and use a P4P program. “It is a new model of clinical care that changes the way you think and structure your processes and the way you operate your business,” says Marilyn J. Orr, MBA, CMPE, executive director at Beacon Orthopaedics & Sports Medicine in Sharonville, OH.

It is vital to remember that managers are only as good as the staff members reporting to them. The quantity of the medical staff does not matter if the quality is inferior. A practice manager must train staff members with appropriate tools and written policies in order to see individuals successfully providing quality to the practice. Too often in this industry, there are holes in practice processes that are plugged by hiring inexperienced staff members. This can create more problems than it solves.

When patients enter your practice, every doorknob, countertop, or writing device they come in contact with is a path to infection. This is one reason why you need to maintain a safe environment for your staff members and patients, especially since agencies such as OSHA are tightening their scrutiny of the physician's office environment. The most important responsibility of any practice is to decrease the spread of infection, says Gwen Rogers, RN, BS, MS, CIC, manager of epidemiology and infection prevention at Maine Medical Center in Portland.

You can't open a professional publication or attend a meeting without hearing about patient-centered care. But settling on a working definition is difficult. Part of the problem is that the term has been diluted, says John Wasson, MD, a physician and professor at Dartmouth Medical School in Hanover, NH, and a faculty member of the Institute for Healthcare Improvement. Too often, he says, it refers to hitting certain process-related targets rather than focusing on what the patient needs.

Residents and practicing physicians, even experienced ones, often struggle with effective clinical caregiving. They may not know how to handle a bad patient interaction or a poor clinical outcome, but with the right problem-solving techniques and emotional support, it can get better. Balint groups can help resolve these issues. Michael and Enid Balint are psychoanalysts who formed the movement by speaking at seminars for family physicians in London during the 1950s.