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  • St. Luke's Dr. Waj Nasser on Adaptation in Health Care: '... if we don't do it, somebody else will.'
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St. Luke's Dr. Waj Nasser on Adaptation in Health Care: '... if we don't do it, somebody else will.'

By Dr. David C. Pate, News and Community
November 25, 2014

Providing patient-centered care is part of St. Luke’s vision statement, and we are making significant progress. 

Patient-centeredness is more than just meeting patients’ needs; it is also addressing their wants. Among those leading the charge at St. Luke’s are Dr. Waj Nasser and the team at St. Luke’s Clinic – Capital City Family Medicine on State Street in Boise. 

Not only are their efforts better satisfying patients, but they are reducing healthcare costs as patients receive prompt care without the added costs of an emergency room visit. Roya Camp, my blog editor, writes here about successes of the clinic under Dr. Nasser’s leadership.

St. Luke’s Clinic – Capital City Family Medicine is pioneering new ways to deliver health care within St. Luke’s Health System, and the clinic’s founding physician is rediscovering the excitement of his profession in the process.

Sign of the times.

Dr. Waj Nasser’s clinic on State Street in Boise and St. Luke’s Clinic – Family Medicine on Parkcenter, also in Boise, started offering extended hours in September as a St. Luke’s Health System pilot project. Both clinics are now open seven days a week, 8 a.m. to 8 p.m., and most holidays, and welcome people who have not been St. Luke’s patients.

Dr. Nasser’s clinic has been offering extended hours since he started it in 1998 with Dr. Bill Jonakin, before joining up with St. Luke’s in 2011. This latest chapter is a chance to test a blended clinic that features urgent care, a traditional appointment schedule, and hours that make “visiting the doctor” no big deal.

That’s as it should be, Dr. Nasser believes. He recalls his own childhood appointments as half-day affairs, a tedious drive followed by more tedium in the waiting room.

“Unacceptable,” he says flatly.

Dr. Nasser’s strongly held convictions around patient-centered access to health services match those of St. Luke’s Health System, which is testing many new clinics and approaches to find the best ways to help residents of the region.

The location of his clinic, on one of Boise’s main thoroughfares in proximity to well-regarded pharmacists, and his keen interest make Capital City Family Medicine a good test site for the best ways to take care forward.

“At the end of the day, it’s for our patients,” he said. “It’s what is best for the patient, what is best for the patient’s schedule. We’ll see any patient, any time, for any problem.”

The team is still working out how the various functions of the clinic work alongside each other, and while additional access is now possible, that same access can confuse patients long accustomed to one way of doing things. Dr. Nasser has observed, for example, that patients don’t necessarily differentiate among urgent care, the walk-in access, and the traditional scheduling process.

“If patients don’t have a clear sense of the full array of what we offer, we’re not able to serve them as well,” he said.

The changes his clinic is making, Dr. Nasser believes, are the right and necessary next evolution of care. And St. Luke’s Health System has made many of the changes possible.

“There’s no question that I enjoyed immensely being independent and growing a practice, but the reality is, the ground is shifting,” he said. “We know that in an increasingly complex environment, we have better communication among doctors, we have electronic records, and we have a greater capacity to improve the community’s health.”

Dozens of patients have found their way to the clinic during the extended hours and expressed their appreciation. Dr. Nasser also has appreciated the access – in a different way.

Medical Assistant Jade Ramsey works with patient Toni Ansotegui on the first Saturday of St. Luke's Clinic - Capital City Family Medicine's extended hours. The State Street clinic previously was open Saturdays but went from six hours to 12 on those days starting in September.

The pace, the variety, and the teamwork required to attend to the varied needs is meaningful in ways that the regular schedule doesn’t call forth, and the mix of scheduled and walk-in patients compound the variables.

“It’s more chaotic, it’s more hectic, it’s unpredictable. It adds another element to what’s going on in the day.

“I enjoyed it immensely,” he said, after working the Friday night, Saturday, and Sunday of the second weekend that the clinic was open the longer hours, during which he saw 80 patients for everything from a collection of assorted fractures to an upper GI bleed to an unusual nervous system reaction.

“Family medicine is about continuing narratives that never end, and it’s an artificial construct when we close,” Dr. Nasser said. “You have things that just happen, and we can address those things every day of the week. These are the sorts of things that you don’t typically see on an appointment basis.”

Building a blended-service clinic is professional satisfaction of a different sort, and Dr. Nasser can see the potential in new approaches. He’s also interested in optimizing how patients move in and out of clinic settings and in what telemedicine can do.

“We like to be efficient,” he said, “and I consider us still highly inefficient.

“Saving patients time and money is a competitive strategy and leads to patient satisfaction. Less time out of their day, to me, that’s a very rewarding thing as well.”

Dr. Nasser understands those physicians who’d rather not change how they approach their practice. He’s just not one of them. And he thinks that health care is going to change whether others like the idea or not.

“My enjoyment of what I do is as great, if not greater, than when I started,” he said. “What attracted me to medicine was that it was a field that promised to continue to change. It’s about how you deliver the health care. It’s about how you deliver the access. And that’s changing, and I think people should welcome that.

“The reality is, if we don’t do it, somebody else will. This is what patients want. They want this kind of access. Increased joy comes out of this sort of thing, patient satisfaction,” Dr. Nasser said. “There’s no question that I’m a better doctor than I would be otherwise.”

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.