Redesign of quality improvement work methods in the community in the health care organization in Israel

Background Comprehensive and coordinated management of chronic disease is a major challenge for healthcare systems. Clalit Health Services, a non-profit health fund, insures 4 million people in Israel, and provides comprehensive care through 1,300 primary and secondary clinics and 14 hospitals. The base of the health care is 1150 multi-professional primary care health centers. Clalit has a computerized database that tracks all services used by the members of the health fund. The data is linked to performance measurements by 52 indicators of care. This study describes the introduction and implementation of an innovative work model and assesses its influence on quality improvement, patient satisfaction, and waiting times, without the need for additional resources. Redesign of the quality improvement actions in the clinic using the unique features of each profession to improve clinical quality and performance with emphasis on team work and use of the computerized indicators’ data for initiation of proactive interventions in patients’ care. Interventions included structured work process from population level to single patient level and computerized tools supporting the identification of patients for recall and active intervention during the visit. The only resources were reserved time for primary care providers to concentrate on clinical quality promotion. The adoption of the program was promoted by widespread publishing of the results in the organization and continuous follow up of the results.