The state stopped by to see us the other day.
Wow, that sounds ominous.
No, really, I mean it felt like the entire Empire State: multiple people from multiple offices of New York state government, department of health, office of compliance this, oversight that, all with a vested interest in how things have been going (i.e., how we have been spending their money) in our patient-centered medical home resident pilot program.
A few days earlier we had received an email from one of our hospital leaders, telling us that we were going to be one stop on the tour for these folks, for them to see what we’ve accomplished thus far during the first year of the grant.
Time for a dog and pony show.
They were going to spend the bulk of their morning at the uptown campus, and then join us for about 40 minutes for a lunch meeting to hear about all of our projects.
Wait, 40 minutes, all of our projects? Internal medicine and pediatrics?
Does that sound doable?
Here is what happened: First, we went around room and introduced ourselves; the names, offices, branches, divisions, committees went flying by. I don’t know what each of them did, and I’m not sure they knew what we did. But now, at least, we had titles and we knew (if we had any doubts), that they were all there to check us out.
Our medical director gave a brief introduction, the curriculum director went through the patient-centered medical home curriculum that our junior residents had received, and then several of our residents presented two representative practice improvement projects that we have done through several PDSA cycles and implementation cycles.
A few of the visitors asked relevant and insightful questions, to which we had pretty good answers. They seemed impressed with what the residents had created and completed. No one seemed to imply that we had wasted their time and money.
Lastly, we went through our transitions and emergency department discharge project, and by now we were talking really fast.
Hard to keep on track (get us talking, and it’s hard to get us to stop).
We internists burned 35 minutes, then it was the pediatricians’ turn.
They did a yeoman’s job of rushing through their presentations, and it was really interesting to see the diversity and range of projects they have implemented literally right upstairs from us without us ever really knowing what they were doing.
And I think they were surprised about what we have done.
Our visitors seemed very positive, and everyone left happy. We got an email later in the day saying they had found our work “very exciting.” Our leadership team seemed very relieved, very pleased with how the day had gone.
Now we wait, maybe for the other shoe to drop.
We are supposed to be getting a letter from them in the next few days, telling us in a more formal fashion what they thought of how we have been doing with our progress with the program’s development.
The issue now is the aftertaste: our aftertaste.
Overall it had made us feel sort of inadequate, like, shouldn’t we have done more with all that they’ve given us? Shouldn’t we be farther along at this point? Shouldn’t we have a fully functioning, lean, mean, patient-centered fighting machine up and running at this point?
All of the parties that are in this hope that the grant will continue, that the funding will not dry up, that yet another innovative intervention will not wither on the vine. We’re trying to make change here, and we know that we’re responsible for showing them how we spent their money. But we also recognize that this takes time.
Forty minutes just isn’t enough.
Neither, it would seem, is a year.
Fred N. Pelzman is an associate professor of medicine, New York Presbyterian Hospital and associate director, Weill Cornell Internal Medicine Associates, New York City, NY. He blogs at Building the Patient-Centered Medical Home.
