Many practices begin by focusing on one group of patients. Patient groups may be selected by condition or by other characteristics.  For example, a cystic fibrosis clinic at an academic teaching hospital chose to begin their SMS work with those patients whose lung function was in the lower 50^th percentile for the patients in their practice.   For the initial phase of their improvement work, the organization freed up 20% FTE for the clinic’s  nurse manager, and two hours per week for a physician, a social worker, and the office manager.  They also scheduled a monthly check-in with the chief medical officer for the practice.  Learn more about setting up teams for practice redesign at the Institute for Healthcare Improvement.

It is not surprising that many groups get started down this path with the help of a foundation or government grant. Funding tends to be devoted to:

• Administrative coordination, (perhaps part time of one physician and part time of one nurse or care manager),
• Additional staffing (E.g. additional MA time, health coaches and/or paid patient advocates), and
• Funds to support staff and patient training. And
• Program evaluation

Some efforts end once funding runs out. In order to sustain SMS improvements it is important to consider the business case / value proposition from the early stages of the work. If possible, ensure that SMS projects help you achieve and important organizational strategy for quality or reputation. Also visit, Reimbursement Strategies for tips on realizing revenue from SMS activities.

Trying to undertake significant SMS redesign without adequate resources may impede a team’s efforts to make improvement and risks demoralizing staff.  Pay particular attention to allocating sufficient time in staff’s work day to meet, test changes, and measure results.