When it comes to changing behavior, something as simple and inexpensive as a sign on an exam room door can be effective.

“It creates new habits,” said Deborah Hani, the department administrator at the Hill Road Medical Office in Ventura, in Southern California. .

Hani is the management co-lead for the Internal Medicine department-based team (which is how the facility refers to its unit-based teams).

Bright yellow reminder

When the team wanted to improve its performance on helping patients control hypertension, they came up with a simple—but effective—bright yellow sign reminding physicians and staff to repeat blood pressure tests on patients who require them.

In just one month, the department’s score on giving second blood pressure tests was 100%.  Hill Road was controlling high blood pressure (bringing it down to 140/90 or lower) among 79.8% of patients with hypertension in May 2009, up from 76% in August 2008, just a hair below the regional goal of 80.1%.

A patient whose initial blood pressure reading is elevated needs to have a second test at some point before the end of the office visit—but it has to be at least two minutes after the first test. The second test is an important element in accurately diagnosing hypertension. The trouble was, patients often left the medical office before the staff could the get second test done.

Repeat tests were missed

In fact, in March 2008, the Internal Medicine staff at Hill Road, which is part of the Woodland Hills Medical Center, was doing needed second blood pressure checks only 26 percent of the time.

When they put their heads together, the team members came up with the idea of a super-bright yellow paper reading, “Caution: Second blood pressure reading is required on this patient.” When a patient has a first high reading, employees hang the sign on the exam room door so that the doctor or other staff would see it and make sure the second test got done.

“The DBTs come up with good ideas about workflow because these are the folks in the trenches and they see the headaches. They share ideas and work out processes that help,” said Prakash Patel, MD. “This was a ‘try-out mode,’ and now the results are much better.”

Doctors part of team

Lydia Rodriguez, a medical assistant at medical offices and the labor co-lead for the team, agrees.

“We’re the frontline workers. We see this,” said Rodriguez, a UHW-West member. “When we talk about problems and solutions, we work together and get things done.”

“The doctors were participating,” Hani said.  “They became part of the team.”

Bringing down high blood pressure means decreasing a patient’s risk of heart disease, stroke, kidney disease and blindness. When hypertension is properly diagnosed, doctors can recommend patients make lifestyle changes—such as exercising, quitting smoking, and eating a more healthful diet—and might prescribe medication.

The staff got a Distinguished Accomplishment team award from the Southern California region. It is helping the Woodland Hills Medical Center meet the region’s clinical goal of controlling high blood pressure.