How A Clinic Seized Upon A Slow Period to Vastly Improve Community Health

Flip the ClinicBy

December is low season when you run a health clinic. People are traveling or otherwise occupied, which means they’re putting off appointments. Keith Seidel, the medical director of Southeast Health Center in the Bayview neighborhood of San Francisco, saw the holidays as an opportunity. First, fewer patients meant he could give all the health center’s employees as much time off as they wanted. Second, it would give Seidel the opening to bring his team together and make some changes to his clinic. He’d mobilize everyone working in the clinic—behavioral specialists, nurses, dentists, physicians, data scientists, everyone—to tackle a number of public health challenges facing his patient population.

To do it, they’d use data. In preparation for the holiday, one of Southeast’s administrators with an interest in public health dove into the clinic’s electronic medical records. Querying the database, she pulled out patients who hadn’t yet received a flu shot, patients who were behind on scheduling a prenatal appointment, and others who were overdue for a blood test or thyroid assessment. The lists represented the potential for better-sustained health in the community–contact everyone on them and people get immunized, get their medications adjusted, and know where they stand as they take care of themselves at home.

Before diving in, Seidel made some temporary but dramatic tweaks to the way the clinic was run. During the holidays, when patients would rather be with family than submit to a regular check up, Seidel temporarily switched Southeast to a no-appointment zone. The clinic would take drop in or same-day appointments only. For the clinic staff, no appointments meant showing up for the day and taking patients when patients came in, but being otherwise available for the center-wide big public health push.

In whatever spare time they had, everyone on staff—regardless of title—worked their way down a daily list supplied by the clinic’s resident data analyst. So as not to waste any time asking people to come in who no longer lived in the area or who had switched insurers, clinicians verified a patient’s insurance information before calling. Then they hit the phones, setting up appointments for as many people as they could. For the group needing flu shots, Seidel set up a special holiday flu shot session, which drew in 75 community members on a single designated day.

The initiative was a striking success. “All 30 lists in the clinic were cleaned up,” says Seidel. For a few weeks, the clinic operated under the radical idea that if everyone on staff let go of their job descriptions and worked together to solve an important problem their community would benefit. “I thought they’d be more hesitant,” says Seidel. “Oddly enough, the staff—the whole staff—really liked working with the lists. They thought it was really nice to have vision and defined goal. The staff has requested that we have providers come down to bare minimum once a quarter.” In April, Seidel plans to run the same program again.

That’s not all Seidel is up to at Southeast. A doctor with many years of public health experience working in London, Seidel has made dramatic changes to his San Francisco health center since moving there 18 months ago. To learn how he’s improving the patient experience by incorporating Apple Store qualities into the clinic, check out his Flip, which he developed at the inaugural Flip the Clinic Lab in San Francisco.

Image by Maggie Osterberg.