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Transformational change, or reengineering, is a tough assignment for any organization. The pay-off, however, can be huge: happier patients, reenergized staff, and increased productivity. This article describes the team-based Apollo 11 project at Southeast Health Center in Indianapolis. Although this redesign effort took 7 months of extraordinary team effort, it resulted in a 54% reduction in patient encounter time, a decrease of more than 40% in per-visit cost, and improved patient and staff satisfaction. This article summarizes the background and dynamics of Apollo 11, shares some initial project results, and summarizes the lessons learned, so that other healthcare organizations can successfully tackle the reengineering challenge.

While electronic medical records (EMRs) have long held the promise of improved efficiency and quality, they have not yet made significant inroads into ambulatory care. One reason may be attempted EMR implementation in "old paradigm" clinic models. Southeast Health Center (SEHC) in Indianapolis, Indiana, began by reengineering its clinic procedures; only then did staff look for a computerized record. Because the new clinic model meshed nicely with the design of a relatively new EMR, a joint project was undertaken to test this EMR in SEHC's unique environment. This article details the reengineering, EMR implementation, project dynamics, results, and lessons learned.

When asked to produce convincing evidence of quality, 281 ambulatory healthcare professionals suggested 98 different components of an ambulatory program. Obviously no overwhelming majority exists, nor is there a clear focus on what constitutes quality in the ambulatory setting. This demonstrates and highlights both the diversity of ambulatory care and the difficulty of defining quality in the ambulatory environment. We all feel that we know what quality is and that we provide quality care in our organizations. Quality is high priority, yet when asked for the most important demonstrator of quality, ambulatory care professionals gave 98 different answers. Based upon the Pareto diagram's top five categories as shown in Figure One, we can put together a composite definition. This composite would present the combined judgment of nearly 80% of the 281 seminar attendees. Quality ambulatory health care--meets the expectations (pleases) the patients, is enhanced and demonstrated by an effective quality assurance program, is the achievement of desired outcomes for patients, is dependent upon the excellence of the provider staff, and is enabled by an accurate, timely, and complete medical record system. The message for those of us in ambulatory care is that the process of working toward the definition of quality may be just as important as the actual definition of quality. A consensus on a definition of quality in the ambulatory setting is unlikely as there is too much diversity. It is important that each of our ambulatory centers should set out to determine its own definition of quality. The process itself is useful because it will help us to focus on the dimensions of quality. (ABSTRACT TRUNCATED AT 250 WORDS)