[Redesign of community-based health services: the solution for decreasing the quality gap]

The quality gap is defined as the gap between the observed and the expected, evidence-based, quality indicators. Experts agree that significant reduction of the quality gap requires transformation of the current system of health care provision. Maccabi Healthcare Services has formulated a "change package" in order to redesign its community-based healthcare services. This is based on a proactive approach in primary care, which manages all aspects of health for a defined community of members. This is built on multidisciplinary team-work, led by a physician and a nurse; planned visits for the management of patients with chronic diseases; one-stop-shopping for efficient health promotion; and encouraging patient-centeredness, which ensures that patient values will guide all clinical decisions and patients will be provided with support to enable self-management. The following conditions and infrastructure were required to allow for the redesign: 1) Redesign became a focus of the organizational strategy; 2) Building a comparative performance measurement for presentation at all managerial levels; 3) Agreement on the incentives to primary care clinics, which voluntarily joined the process of change; training of "quality leaders" who will use common terms and methodology to improve the quality of care. Starting in 2005 as a "pilot project", the change process has gradually evolved to include about 50 primary care clinics towards the end of the year 2007.