The 10 Building Blocks of Primary Care
Share the Care™: Mrs. Chen and the Building
Blocks
Background and Description
We present the principles shared by high performing practices in the building blocks of
Share the Care™. As clinics work on the building blocks of Share the Care, the answers to
questions about access, continuity, and teamwork may change. In turn, the patient
experience changes. In this activity, we see Mrs. Chen experience in four different practices,
each with different standards of practice.
Instructions
Review the steps Mrs. Chen takes as she navigates through each clinic. Determine which
building block the steps address and if the clinic has achieved that building block. You may list
more than one building block for each step. Discuss Mrs. Chen’s experience at each clinic from
the patient, provider, MA and RN’s point of view.
UCSF Center for Excellence in Primary Care
The Center for Excellence in Primary Care (CEPC) identifies, develops, tests, and disseminates
promising innovations in primary care to improve the patient experience, enhance population
health and health equity, reduce the cost of care, and restore joy and satisfaction in the
practice of primary care.
Acknowledgments
The UCSF Center for Excellence in Primary Care would like to acknowledge Amireh Ghorob,
MPH for her contribution to this work.
Copyright 2014, The Regents of the University of California
Created by UCSF Center for Excellence in Primary Care.
All rights reserved. Individuals may photocopy these materials for educational, not-for-profit uses,
provided that the contents are not altered and that attribution is given to the UCSF Center for
Excellence in Primary Care. These materials may not be used for commercial purposes without the
written permission of the Center for Excellence in Primary Care.
Unblock Patient Care
Meet Mrs. Chen, a
65-year-old female
with diabetes. She
walks into the clinic
without an
appointment
complaining of a
burning on urination.
Will she receive care
that day? Who will
treat Mrs. Chen?
Mrs. Chen’s experience depends on the clinic’s
practices. High-performing primary care clinics
- and clinics working towards improvement implement practices that:
Common practices at these sites include stable
teams, expanded roles of MA’s and RN’s using
standing orders, and population management –
health coaching, panel management and
complex care management.
We present the principles shared by high
performing practices in the building blocks of
Share the Care. As clinics work on the building
blocks of Share the Care., the answers to
questions about access, continuity, and
teamwork may change. In turn, the patient
experience changes.
Let’s see what happens to Mrs. Chen in four
different clinics, each with its own standard of
practice.
• Improve health outcomes
• Increase patient satisfaction
• Increase provider and staff satisfaction
©2012, The Regents of the University of California. Created by UCSF Center for Excellence in Primary Care.
Clinic A
Step 1
• Mrs. Chen's PCP has no open
slots
• RN triages Mrs. Chen
Step 2
Step 3
Step 4
• PCP agrees to overbook
• Like on most days, her PCP
doesn't leave clinic until 7:00 PM
Which block?
Identify the building block
represented by each step.
You may list more than one
block for each step.
Step 1
Step 2
Step 3
Step 4
©2012, The Regents of the University of California. Created by UCSF Center for Excellence in Primary Care.
Has the clinic
achieved the
block?
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
Clinic B
Step 1
Step 2
Step 3
• Mrs. Chen's PCP has no open slots
• RN triages Mrs. Chen
Which block?
Identify the building block
represented by each step.
You may list more than one
block for each step.
• Drop-in Doc treats Mrs. Chen for her UTI
• Doc notes non-adherence to meds and
HbA1c of 10.4 but has no time to address it
Step4
• Clerk gives F/U appointment with assigned
PCP in 1 week for diabetes care
Step 5
• Mrs. Chen no shows for her scheduled
appointment as her UTI is resolved
Step 6
Step 1
Step 2
Step 3
Step 4
Step 5
Step 6
©2012, The Regents of the University of California. Created by UCSF Center for Excellence in Primary Care.
Has the clinic
achieved the
block?
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
Clinic C
Step 1
Step 2
Step 3
• Mrs. Chen's PCP has no open slots
• Drop-in Doc sees Mrs. Chen
• MA rooms Mrs. Chen and through med-rec
discovers she has no refills left for Metformin
• MA schedules patient a diabetes visit with
her RN for self-management coaching and
Step 4
med refills using standing orders
• Drop-in Doc treats the UTI and schedules Mrs.
Step 5 Chen to see her own PCP in a week for follow up
Which block?
Identify the building block
represented by each step.
You may list more than one
block for each step.
Step 1
Step 2
Step 3
Step 4
Step 5
©2012, The Regents of the University of California. Created by UCSF Center for Excellence in Primary Care.
Has the clinic
achieved the
block?
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
Clinic D
Step 1
• Front desk gives Mrs.Chen same-day appointment with her
PCP -- an RN who cares for a sub-panel of patients with
diabetes
Step 2
• MA rooms Mrs. Chen and notices she is overdue for
colorectal cancer screening
• MA offers FIT test and coaches about why and how to do it
Step 3
• MA notices that Mrs. Chen is overdue for her third
Hep B shot and administers using standing orders
Step 4
• Finding no red flags, RN treats Mrs. Chen for UTI
using standing orders
Step 5
• RN notes HbA1c = 10.4 and does med-rec. Using standing
orders, RN intensifies Mrs. Chen's diabetes medications
and works with Mrs. Chen on an action plan to lower A1c.
Step 6
• The next day, the RN reviews Mrs. Chen's care plan
during the A.M. team huddle
Which block?
Identify the building block
represented by each step.
You may list more than one
block for each step.
Step 1
Step 2
Step 3
Step 4
Step 5
Step 6
©2012, The Regents of the University of California. Created by UCSF Center for Excellence in Primary Care.
Has the clinic
achieved the
block?
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
Discussion
How would you describe Mrs. Chen’s
experience at the clinic?
How would you describe the MA’s experience?
How would you describe the RN’s experience?
How would you describe the clinician’s
experience?
Where are you now?
Put a check mark by the Steps (Clinic A, B, C, &
D) that represent your clinic now.
Where are you going?
Draw a star next to the steps (Clinic A, B, and C)
that represent where you want your clinic to
go. How do we get there?
©2012, The Regents of the University of California. Created by UCSF Center for Excellence in Primary Care.