Overview

There is significant debate in the scientific community whether the second law of thermodynamics—that energy tends to disperse rather than remain concentrated in a contained space—applies to the humanities. This paper will not answer that debate here, but will use the second law's underlying principles to illustrate the challenges of achieving and sustaining transformational change in health centers and clinics that serve the poor, the uninsured, and the underinsured in New York City, organizations with which Primary Care Development Corporation (PCDC) works.

Over the past six years, PCDC has worked with more than 70 teams from 21 New York City organizations to create patient-focused health care centers where a visit to the doctor takes no more than an hour and patients can get an appointment with their own primary care provider within 24 hours. Building on the Institute for Healthcare Improvement's (IHI) Breakthrough Series Model to achieve change, PCDC has created a unique set of learning collaboratives, two of which address the twin issues of delays in access to care and long visit cycle time. The results of these two initiatives are the focus of this paper.

Citation