Alaska Native Medical Center
Improvement initiative meant greater CMA role
WHEN PATIENTS WALK into Alaska Native Medical Center (ANMC), they are treated to a lobby distinguished by natural light, high, soaring ceilings, plants, and a plentiful array of Native artifacts and crafts. Visitors may also notice what they don’t notice-the lack of anything medical within view. Instead, they encounter a large, comfortable community area where they’re free to sit, talk, and just relax. Nearby, a large Health Information Center (with a fulltime staff member) beckons with a variety of services, including exhibits, videos, touchscreens, web searches, and other educational features. Visitors may also enjoy the nearby coffee shop, information desk, and Internet cafe.
The ANMC design is inspired by the Idealized Design of Clinical Office Practices (IDCOP) model. The emphasis of the IDCOP model is on relationships. In its design, ANMC strives to provide both visitors and staff with a humane, caring environment, one naturally conducive to healing and reflective of the culture of those it serves.
Alaska Native Medical Center (ANMC) in Anchorage is the main hospital and primary care center serving the Alaska Native population in south central Alaska. In 1998 a large portion of ANMC’s management transferred from the federally run Indian Health Service to the Southcentral Foundation (SCF), an Alaska Native owned health corporation working under the tribal authority of Cook Inlet Region, Inc. (CIRI). This transition created an opportunity for the health care organization to take a fresh look at its values, practice and design. One result was an enhanced role for Certified Medical Assistants (CMAs) in the ANMC system.
Core values defined
The SCF solicited feedback from a cross section of the local Native community, including patients, local tribal leaders, front-line staff and others. What they heard was the community’s clear desire for an active, engaged partnership with its health care providers, led by tribal leadership and based on tribal values.
“People said things like, ‘I want to see my same doctor, nurses, my same health care team, every time I come in/” remarks Douglas Eby, MD, MPH, SCF’s vice president for medical services. “? want more information and more education so I can be more of a partner. I want to get into issues of wellness, not just illness treatment. T don’t want to wait, or have to tell my health story over and over again. Most importantly, I want to be treated with honor, dignity, and respect.”‘
“The Native leadership and the community’s message was not necessarily earth-shattering,” adds Eby. “But for us to be able to stand on it and say, ‘here is what people said, these are now the operational parameters that will drive our entire system,’ has been a very powerful tool for us.”
Serving nearly 40,000 patients, SCF’s primary care system at ANMC has evolved into a nationally recognized model of innovative quality care and customer service. The system is modeled on open access which guarantees same-day access to the patient’s chosen primary care team.
The role of CMAs expand
The medical center sought ways to expand its utilization of CAlAs. “Historically, ANMC had always had a very RN-centric nursing approach,” says Eby. “When we began our redesign, there was initially a significant amount oi resistance on the campus to using CMAs, because they’re not nurses. It was a struggle just to get medical assistants accepted as part of the system. Now, the clinic floor staff, who are the primary people interacting with patients when they arrive for an appointment, are overwhelmingly CMAs.”
Pauline Stubberud, RN, SCF/ANMC’s primary care nurse executive places a high value on the versatility of CMAs. Stubberud explains, “Our CMAs process patients through the clinic, in addition they administer medication/ immunizations, assist with procedures, and obtain EKGs. What I think is unique is their active involvement in patient education. Using standardized materials, they are relied upon to teach patients on a wide variety of subjects (the materials are standardized).”
“The SCF/ANMC’s CMAs also act as coordinators,” says Stubberud. “We have CMAs who are involved in coordinating projects, such as orientation of new staff, coordination of our Point of Care Testing programs, scheduling, JCAHO [Joint Commission on Accreditation of Healthcare Organizations] compliance, and safety activities. Our CMAs participate in administrative teams in each department that organize and implement programs and projects for the department, as well as provide oversight. The most unique development is our CAIA team leadersthey are active participants/members of the management teams for each clinic. They come to the table with an equal voice with the physicians, nurses and administrative staff. They are involved in establishing clinic procedures and processes, and in providing oversight and leadership to the clinic.”
Admittedly, ANMC also had practical reasons for promoting a greater role for CMAs. Locally, 2 colleges had begun to provide training in medical assisting, while the area’s one nursing school was filling only a small number of available RN positions. Hiring more CMAs made sense from a practical standpoint, but it also furthered the medical center’s other major mission: to promote Native hiring and development.
Says Stubberud, “Our Native CMAs understand the cultural aspects of health care and arc better able to communicate with our patients using terms and examples that they are familiar with.”
CMAs strengthen the team
Today, ANMC promotes a health care philosophy that puts a premium on long-term relationships. That means promoting a team model in primary care, based on a physician, RN case manager, and CMA, working together in partnership with patients and their families. In the system design, other aspects of the care system are layered in around this core group.
“The really unique thing I see in the organization now is that the CMAs are a very strong part of the team,” says Stubberud. “They work closely with the physicians, RN case managers or LPNs, and together help to plan and manage care for a whole panel of patients. Our CMAs get an opportunity to do more than just get the patient in a room and take vital signs. They can develop and grow as team members and in team building. Many of our physicians love to teach and to educate, and many of the CMAs take advantage of it.”
Stubberud adds, “One of our “drum beats” is that people do only what they are uniquely qualified to do. The CMA is the best qualified person in our system for their role on the primary care team.”
Mark Harris is a Chicago-area journalist and medical writer. he is a former senior editor for the joint Commission on Accreditation of Healthcare Organizations.
Copyright American Association of Medical Assistants Sep/Oct 2003
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