I can’t wait to find out what this clinic will do next!

We can achieve so much through great collaboration

by Kristin Chatfield, 2016

One of the things I loved most about being a Healthy Hearts Northwest practice facilitator was working with practices as they came up with new ideas and helping them with implementation.

A perfect example was the “BP call-back card” developed by a group in one of my clinics in the relatively isolated community of Klamath Falls, Ore.  This organization includes five primary care clinics varying in size, as well as specialty care clinics. The call-back card’s purpose is two-fold: to implement a standard protocol for patients who have a high BP to come in for their follow-up appointment and, more importantly, to help them begin to understand and manage their BP.

All of these primary care and specialty clinics began using the card, and the story of how the card was created highlights the great things that can happen when practices get inspired by quality improvement.

Forward thinking: One good idea leads to another
There are a lot of things that made this practice special to me. For one, their patient demographic perfectly represents the community they serve—which is something we discovered thanks to a Healthy Hearts Northwest practice survey.

Secondly, their QI work is both broad and deep. In addition to Healthy Hearts Northwest, they were involved in several other initiatives, including Quality by Design and Comprehensive Primary Care (CPC+).

And third—from managers to clinicians to IT staff—the people who work here are creative forward thinkers.

The forward thinking that led to the BP call-back card began after we identified blood pressure control as an area for improvement. The first step was a system-wide training for all MAs on proper protocol for taking BP measurements. The training launched in January 2016 for primary care as well as specialty departments—like dermatology, where it is less common for staff to be familiar with the protocol if a patient has an elevated blood pressure.

By all accounts, the training was a huge success. It was clinically technical, but also funny and engaging. Instead of relying solely on tables and data, it fostered really open conversations with frontline staff sharing their challenges and what they’ve seen. In the process of developing the training, however, staff immediately realized that it would not be as effective without a next step. So they started asking, “Now what?”

And then, at a regular Healthy Hearts Northwest check-in with their leadership team, someone suggested a little workflow adjustment that could help ensure patients received proper follow up after a high BP reading. The idea of the BP call-back card was born.

Collaboration brings the BP call-back to life
This organization’s leadership team includes people with a diverse range of expertise and rolls, including clinic managers, doctors, nurses, MAs, and people from IT. This group is egalitarian and came together in a really honest collaboration to bring the call-back card to life. The clinic operations manager first came up with the idea, but the brainstorming that followed was so open and dynamic that the concept really belongs to the entire team. The front of the card includes tips for getting accurate BP readings and important facts about risks related to high BP. On the back, patients have space to write in pulse and BP measurements they take at home or at a drugstore so they can share these with their doctor. They can also keep track of their target BP and the date of their next appointment. And thanks to a suggestion from their IT lead, the card is paired with a smartphrase in the EHR. That means, in addition to tracking overall BP numbers, they’ll be able to know who is using the card and when.

More ideas and collaboration on the horizon
In their overall push for good BP protocol and high-quality care, this group of clinics began thinking about developing a poster on proper BP positioning to hang in clinic exam rooms. The idea was developed in response to an important issue that came up organically during their work on high blood pressure: It’s not always easy for MAs to tell patients to be quiet during a BP reading. Having a poster showing proper BP technique would give MAs a gentle way to remind patients of what they need to do to get an accurate BP measurement.

Projects like these serve as poignant reminders of how much we can achieve through great collaboration that brings people together across primary care. I can’t wait to see what these providers will achieve next.


Kristin Chatfield, MPP is a researcher and economist who loves using data to create social good. She believes that with a little help, rural communities have a boundless ability to innovate and create healthy, vibrant places. Kristin served as a Practice Enhancement Research Coordinator on the Healthy Hearts NW project.  She received her master’s degree in public policy from Oregon State University.