Rationale / Objectives
When Bellin acquired 20 sites across Wisconsin in the late 90s, they struggled with physicians who were frustrated by the disjointed nature of the system. There was so much lack of coordination and such significant financial loss that it was imperative for Bellin to undertake improvement efforts if it wanted to be a sustainable entity.  
Project/Program Description & Major Achievements
Bellin made the transition to a team structure with strong leadership and a culture of improvement in which physician participation was expected rather than held as an unattainable ideal. The focused excellence teams identified and consistently used a 10-step road map for improvement. By involving physicians in the improvement initiatives, the excellence teams were able to make significant achievements in the financial, clinical, operational and customer satisfaction arenas, including increased operating margins and visit volume. Accounts receivable turnaround time was reduced by nearly half. Operating margins increased in 77% of their clinics and visit volume increased by 10% to 13% yearly.  
Achieving sustainability requires constant improvement efforts. Bellin’s transformation began with a two-day planning retreat that involved not only the administrators who had hitherto run the group, but also the physicians. Priorities were set. Four excellence teams were created, each focusing on improvements in one of the following areas: operational, clinical, service, and business. Each of the teams had specific aims, with defined roles and responsibilities. They reported to the executive governance committee. Any protocols decided on by a group had to meet the approval of the committee. For the most part, each site had a physician leader and an administrative leader. An internal listserv was used as a means of generating feedback. Improvement decisions were communicated via letters, listserv, internal publications, and word-of-mouth. Because the expectation of physician involvement in improvement initiatives was both part of the organization’s culture and a stipulation for recruitment, physician team participation was high. It was important to spend the time (it took between 6 and 8 months) to obtain consensus on these expectations. Rather than reinvent the wheel, the excellence teams made use of resources such as IHI’s IMPACT Network, and the Chronic Care Model. The Business Excellence Team Leader prepared monthly reports which managers discussed at staff meetings. Substantial physician involvement and training were seen as important factors to the success of improvement initiatives. Also, limiting the number of concurrent initiatives created focus. Sustained system-level redesign was credited with improving Bellin’s overall performance. 
|Accounts Receivable turnaround time||Decreased from 120 days to 64 days|||
|Operating margins||Increased in 77% of clinics||The increase ranged from 5% to 50%|
|Visit volume||Increased by 10-13%||Per year |
|PDSA used for improvement||100%||Implemented in all clinics |
|Care team redesign work done||86%||Accomplished in 86% of clinics |
|Electronic Disease Management Registry implemented||100%||Implemented in all clinics |
|Patient Satisfaction||Improved||For 5 consecutive quarters |
One of Bellin’s major achievements in their efforts to improve was the identification of a 10-step roadmap, which is reproduced below. Ten Steps to Sustainable Improvement:
- Describe where you are today.
- Describe the environmental forces impacting your business.
- Define where and what you want to be in the future.
- Determine how you are performing today.
- Identify what you will focus your time, energy and resources on.
- Determine how you will organize yourself
- Utilize a standard process for improvement.
- Remain on track.
- Review progress and adjust if necessary.
- Maintain momentum over time.