High-functioning teaching clinics are one way to address the problems facing primary care. At their best, they provide excellent clinical care experiences while simultaneously providing inspiring training experiences for students and residents. Establishing these high-functioning teaching clinics, however, requires a little guidance.
Between 2010-2011, the UCSF Center for Excellence in Primary Care (CEPC) visited dozens of high functioning primary care clinics of varying size, staffing, and patient populations. They discovered that despite these differences, these clinics shared several similarities in the ways they deliver high quality, patient-centered healthcare.
The CEPC has summarized these similarities in the 10 Building Blocks of High Performing Primary Care. They have since identified an additional 3 Building Blocks that are critical for resident teaching clinics.
Template of the
FutureResident schedules may
include telephone call and
e-visits, video visits,
group visits, and co-visits
with other team members.
to CareThe clinic provides prompt
access for new-patient,
routine follow-up, and
day access is arranged
with the resident primary
provider or team.
and Care CoordinationReliable systems exist
for coverage of EMR
in-boxes and urgent
patient issues when
residents are away from
clinic or on a busy
PartnershipResidents learn and
support skills and
ManagementResidents have dedicated
time to work with team
members on panel
coaching, and care
management of patients
with complex health care
Continuity of CareScheduling algorithms
patients with their
primary resident provider
or team continuity
provider if the resident
is not in clinic.
Engaged LeadershipClinic and residency
leaders work closely
together and prioritize
missions of both
patient care and education.
ImprovementPerformance data on
patient, resident, and
staff experience are
available and transparent
across clinic, team, and
EmpanelmentEach patient chooses
or is assigned to
a faculty member
Team-Based CareProviders and staff,
always work on
their team to provide
continuity when residents
are not in clinic.
Resident SchedulingResidents are scheduled in clinic
regularly, predictably, and far in advance
in order to main stable teams and
provide patient continuity.
Resident EngagementResidents learn about practice
transformation through engagement in,
and leadership of, clinic-improvement
projects based on clinic priorities.
Resident Work-LifeResident experience and burnout is
assessed, and structures exist for
actively responding to
The CEPC’s 10+3 Building Blocks of High Performing Primary Care identify shared qualities of high performing primary care clinics that deliver high quality, patient-centered healthcare.
The UCSF Double Helix Curriculum uses the CEPC’s 10+3 Building Blocks of High Performing Primary Care model to teach residents, faculty, and clinics how to identify and remove some of the barriers that interfere with the delivery of high quality, patient-centered healthcare.
* While we use the 10+3 Building Blocks of High Performing Primary Care model in this curriculum, the goal is not merely to promote implementation of this model. Instead, our goal is to teach the next generation of primary care leaders the way to think about system structures and system change so that they can build and guide us towards the model of tomorrow.
Bodenheimer et al, The 10 Building Blocks of High-Performing Primary Care
Bodenheimer et al, High-Functioning Primary Care Residency Clinics