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2018 TBC Learning Collaborative Session 1, May 09 2018

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2018 TBC Learning Collaborative Session 1, May 09 2018

  1. 1. Welcome! Implementing Team Based Care (TBC) Learning Collaborative National Cooperative Agreement and Community Health Center, Inc. Session One May 9, 2018 3:00 - 4:30 EST
  2. 2. TBC Faculty, Collaborative Design, and Facilitation AnnMarie R Hess NP, MS  Consultant  ahess@maine.rr.com National Cooperative Agreement Amanda Schiessl, MPP  Project Director, NCA  Schiesa@chc1.com Nashwa Khalid, MA  Project Coordinator, NCA  khalidn@chc1.com Kerry Bamrick, MBA  PI, NCA & Program Director, Postgraduate Residency Training Programs  Kerry@chc1.com Margaret Flinter, APRN, PhD, FAAN  PI, NCA & Senior Vice President/Clinical Director  Margaret@chc1.com 3:35 Mentors, Coaching Faculty Deborah Ward, RN  Senior Quality Improvement Manager  WardD@chc1.com Kasey Harding, MPH  Director of the Center for Key Populations  HardinK@chc1.com Evaluation Faculty Kathleen Thies, PhD, RN  Consultant, Researcher  ThiesK@chc1.com Improvement Science Faculty Patti Feeney, MS  Manager of Quality Improvement Education  HardinK@chc1.com Mark Splaine, MD, MS  Director of Education  SplainM@chc1.com
  3. 3. Get the Most Out of Your Zoom Experience • Use the Q&A Button to submit questions! • Please use chat button to tell us the name of your health center and how many people from your organization have joined the meeting • Recording and slides are available after the presentation on Moodle within one week Q&A Chat
  4. 4. The Community Health Center, Inc. and its Weitzman Institute will provide education, information, and training to interested health centers in Transforming Teams and Training the Next Generation • National Webinars on advancing team based care, implementing post-graduate residency programs, and health professions students in FQHCs. • Invited participation in Learning Collaboratives to advance team based care or implement a post-graduate residency program at your health center. Access the NCA resources at www.chc1.com/nca CHC’s NCA on Clinical Workforce Development The National Training and Technical Assistance Cooperative Agreements (NCAs) provide free training and technical assistance that is data driven, cutting edge and focused on quality and operational improvement to support health centers and look-alikes.
  5. 5. 2018 LC Participants
  6. 6. WELCOME to Implementing Team-Based Care Learning Collaborative  A 10-month participatory learning experience offered by the National Cooperative Agreement (NCA) to support Clinical Workforce Development  Funded by the Health Resources and Services Administration (HRSA)  Hosted by Community Health Center, Inc. (CHCI) in Middletown, CT.  Our goal is to help primary care practices in Federally Qualified Health Centers (FQHCs) implement a more advanced model of team-based care
  7. 7. TBC Learning Collaborative 2016- 2017Name of FQHC City State Avenal Community Health Center Lemoore CA Carolina Family Health Centers , Inc. Wilson NC Community Health Initiatives Brooklyn NY Daughters of Charity New Orleans LA Educational Health Center of Wyoming Cheyenne WY El Rio Tucson AZ Family Practice and Counseling Network (FPCN) Philadelphia PA Healthcare for the Homeless Houston TX Holyoke Health Center Holyoke MA Johnson City Community Health Center Johnson City TN Peach Tree Healthcare Marysville CA Pecos Valley Medical Center Pecos NM Sumter Family Health Center Sumter SC Syracuse Community Health Center, Inc. Syracuse NY The Children’s Clinic Long Beach CA Tyler Family Circle of Care Tyler TX Via Care Community Health Center Los Angeles CA
  8. 8. Your Goals • Access to mentors and coaches, and other FQHCs will help motivate us to keep our TBC initiative as our top priority for 2018 • Learning from other CHCs will help us gain insight into how to build and sustain organizational energy around the transformation. • The structured time , training, and networking will help us advance our model of care and improve outcomes. • Access to ideas from other centers that we can adopt will help us strengthen our current team based care foundation. *Interviews, 2018
  9. 9. Some of Your Challenges  Turnover impact team structure, roles, workflow adherence, and training  Little or no experience with coaching model  Lots of recent growth and change  EHR satisfaction : data, documentation workflows, duplication, quality  Getting to the ‘next level’ of TBC, lots of staff trepidation  Resistance to expanding TBC model to all sites  Competing priorities (too many) and limited resources  Struggling to provide access to care, meet the demands  ‘Fitting’ quality improvement work into busy schedules
  10. 10. Name of FQHC Coach Central Virginia Health Services, Inc. Lisa Dunkum HealthRIGHT 360 Alan Hernandez Gutierrez Lancaster Health Center Julie Hoffer Western Maryland Healthcare (Mountain Laurel) Erica Healy, Autumn Rush New Horizons Healthcare Angela Martin Northwest Michigan Health Services Gwen Williams OPTIMUS HEALTHCARE Nelly Angah San Vicente Family Health Center Cara Johnson Thunder Bay Community Health Service, Inc. Kayla Berry Tri-Cities Community Health Whitney Garcia Fraga Wellspace Health Jeremy Meis Family Health Center of Worcester Anne Reeder Thank You Coaches!
  11. 11. Practice Overview  PCMH+ o 11 Practices Certified o 3 Practices Level 3  Total number of patients served o Range is from 4,759 to 49,521 patients  Number of practices within organization o Range is from 2 to 17  Number of Providers in health system o Range is from 9 – 130 (MD, DO, PA, NP)  Electronic Health Records (EHR) o Include ECW, Athena, NextGen, Greenway *Uniform Data System (UDS), HRSA
  12. 12. Number of Teams Reporting Level A Team Practice Assessment Category Number Teams Level A Behavioral Health Integration 8 Enhancing Access 7 Clinic-Community Connections 6 MA Role 4 Medication Management 4 Communication Management 3 Care Management 4 Layperson (CHW, Navigator) 3 Pharmacist 3 Referral Management 2 RN Role 2 Self Management Support 1 Population Management 1
  13. 13. Opportunity for Sharing Best Practices UDS Data 2016
  14. 14. https://www.weitzmaninstitute.org/NCA Advancing TBC Core Concept Resources 2016 TBC Webinars Webinar #1: Advancing Team Based Care : Building Your Primary Care Team to Transform Your Practice Webinar #2: Enhancing the Role of the Medical Assistant Webinar #3: The Emerging Role of Nurses in Primary Care Webinar #4: Data Driven Dashboards to Support Team Based Care Webinar #5: A Team Approach to Prevention and Chronic Illness Management Webinar #6: Complex Care Management in Primary Care Webinar #7: Achieving Full Integration of Behavioral Health and Primary Care Webinar #8: Dissolving the Walls: Clinic Community Connections 2018 TBC Webinars Webinar #1: Taking Team Based Care to the Next Level Webinar #2: Advancing the Practice of RNs and Behavioral Health Providers Webinar #3: Beyond the Walls: Effectively Utilizing Community Health Workers and Clinical Home Visitors as Part of the Team Webinar #4: Caring for Patients with Pain is a Team Sport *LEAP Project Improvingprimarycare.org
  15. 15. Objectives Session #1 1. Introduce participants and opportunities for learning from each other. 2. Review the learning collaborative structure and expectations. 3. Provide an overview of a nationally recognized team based care model, and resources for learning. 4. Help you ‘get started’ using tools to assess roles and efficiency. 5. Discuss Action Period 1 Assignments, skills and tools you will need.
  16. 16. Session 1 Pre Work  Post Application Interviews  Organizing , Communication Planning  Complete Coach Skills Assessment  2 Day Coach Bootcamp (April 17-18)  1 Team Meeting  Review Effective Meeting Skills  Review Practice Team Assessment Data  Complete Team Skills Assessment  TBC Webinars  Prepare 2 minute Introduction
  17. 17. Time LS 1 Agenda Lead 3:00 Introductions Welcome and Background Amanda Schiessl Margaret Flinter 3:10 Objectives and Agenda Ann Marie Hess 3:15 2 min Participant Introductions (6) Teams 3:27 Collaborative Structure: Expectations and Assessment Data | Concepts in TBC: TBC Model Ann Marie Hess 3:42 2 min Participant Introductions (7) Teams 3:58 Concepts in TBC: Assessment Tools : Role Activity, Cycle Time Ann Marie Hess 4:05 Action Period 1 Assignments QI Utilization: Toolkit Overview, meetings and the role of the coach Kasey Harding 4:15 Guest Your Next Team Meeting Deb Ward 4: 25 Wrap Up Amanda Schiessl
  18. 18. 2 Minute Introductions by Team Order of Introductions 1 Lancaster Health Center 2 WellSpace Health 3 Optimus Health Care 4 Tri-Cities Community Health 5 Central Virginia Health Services, Inc.  Name of Your Practice and Size  Names, FTE, and Positions of participating Core and Extended Team Members  Something your team has done recently to improve care that you are most proud of..  One or two things you want to learn from other teams. 3:15
  19. 19. Lancaster Health Center 22,000 patients 6 locations in urban Lancaster, PA 65 exam rooms 37 clinicians (26 FTE)
  20. 20. OUR CARE IMPROVEMENT: EMPOWERING OUR MA’S TO INITIATE ORDERING PREVENTIVE CARE SERVICES FOR PATIENTS (I.E. MAMMOGRAMS, COLON CANCER AND CERVICAL CANCER SCREENING) Extended Team Members Alex Pineda, LCSW- Behavioral Health Georgia Clack- LPN, Care Coordinator Megan Hess- Care Coordinator for Gateway insurance Dorie Rodriguez- Care Coordinator for Amerihealth Caritas insurance Lin Hoang, PharmD- Gateway imbedded pharmacist TBC Core Team Mark Sprunger- call center manager Julie Hoffer- CMA, EHR team Virginia Rodriguez- LPN Matthew Weitzel, MD- family doc
  21. 21. • Sacramento, CA and Surrounding Areas • 14 health centers (more on the way) • 75,000 patient population • NextGen EHR • Fully incorporated Dental (pediatric only) and behavioral health
  22. 22. • Recent Success: • Pap smear rates • Hoping to Learn? • Scalability • Team Dynamics
  23. 23. Optimus Health Care
  24. 24. Tri-Cities Community Health  Multispecialty FQHC located in Southeastern Washington  9 Locations  Service Lines - Family Practice - Internal Medicine - Obstetrics and Gynecology - Pediatrics - Endocrinology - Dental - Behavioral Health - Optometry - WIC - MSS - Walk-In Primary Care - Pharmacy 2017 UDS Medical Patients – 27,858 Dental Patients – 8,974 Behavioral Health – 2,777 Migrant/Seasonal – 8,411
  25. 25. Meet Our Core Team Members Whitney Garcia (Coach) – Quality & Accreditation Coordinator Sara Dusky (Co-Coach) – Clinical Pharmacist Krisinda Wolfe, ARNP – Provider Otilia Villa – Medical Assistant Increased Access to Care  Fall of 2016 our Urgent Care facility was transitioned to a Walk-In Primary Care to treat both acute and chronic conditions on a same daily/no appointment needed basis. Efforts to establish wi th a PCP are then encouraged for follow-up of chronic conditions. Goals… 1. Strategies to effectively identify Provider strengths and promote leadership in individual care teams. 1. Effectively communication skills/strategies from front line staff to cl inical teams, support staff, and clinic leadership.
  26. 26. Tri-Cities Community Health Locations
  27. 27. Central Virginia Health Services, Inc. • 17 practice sites located throughout Central Virginia • Current Practice size for the collaborative has: 2 MDs: 1 OB/GYN (PT) 1 Pediatrician ( PT) 1 DO (FT) 2 NP-both (PT) Nurses , 2 LPNs (FT) MA, 2 (FT) 1 LCSW (FT) 1 Dentist (FT)) 2 Dental Assistants (FT) 1 Dental Assistant (PT) • Electronic Health Record: E Clinical Works (ECW) Core Team Members Position/Role FTE Lisa Dunkum, RN Quality Coordinator/Coach FT Michael Richmond Medical Provider/time keeper FT Carrie Gladden, LPN Practice Manager/facilitator FT Shelly Bunn MA/Recorder FT Mary Linn Wolf FNP PT Extended Team Members Vernita Williams, PSR (FT) Amber Payne, PSR (FT) Seirra Clark, PSR (FT) Lisa Clark-Long, PSR (PT) Joi Smith, LPN, (FT) Anita Walker, LPN (FT) Jennifer Davis, MA (FT) Kristin Kelly, DA (FT) Sarah Green, DA (FT) Kim Gimour, DA (FT) Keri Wakefield, DDS (FT) Erin Kirshowitz, NP (PT) starts June Liz Crotty, NP (PT) leaves June
  28. 28. Central Virginia Health Services, Inc. What did the team recently do to improve care that we are most proud of? Worked on our UDS Measures in the area of Colorectal Cancer Screenings: • fit test were made a standing order • used grant money from HQI to purchase postage to return FIT cards • Identified a nurse to call patients and remind them to return the cards. • We are currently at 8% and our goal was to improve the percentage to 36.9% at the end of March, Our goal was a compliance rate of over 30% by 12/31/18. Items we want to learn: 1. To improve the efficiency of our quality meetings 2. To increase compliance of UDS measures, specifically Cervical Cancer Screenings.
  29. 29. Time LS 1 Agenda Lead 3:00 Introductions Welcome and Background Amanda Schiessl Margaret Flinter 3:10 Objectives and Agenda Ann Marie Hess 3:15 2 min Participant Introductions (6) Teams 3:27 Collaborative Structure: Expectations and Assessment Data | Concepts in TBC: TBC Model Ann Marie Hess 3:42 2 min Participant Introductions (7) Teams 3:58 Concepts in TBC: Assessment Tools : Role Activity, Cycle Time Ann Marie Hess 4:05 Action Period 1 Assignments QI Utilization: Toolkit Overview, meetings and the role of the coach Kasey Harding 4:15 Guest Your Next Team Meeting Deb Ward 4: 25 Wrap Up Amanda Schiessl
  30. 30. Collaborative Structure And Expectations
  31. 31.  Define Core and Extended Team (structure, roles)  Achieve multiple TBC specific aims, data driven PDSAs  Standardize (SDSAs) roles and key processes (Playbook, Spread Plan- another team)  Improve team and coach skills (improvement science, team work, coaching)  Move Practice Assessment Data toward Level A  Develop a post collaborative team Improvement Plan Collaborative Structure and Expectations Seven 90 min Zoom Learning Sessions ( 3:00-4:30 EST) Between Session Action Periods (6 weeks) Meet Weekly as A Team , Conduct Daily Huddles Complete Assignments Upload Work to Moodle Folders Use Online Moodle Learning Network (Share Your Work , Resources) Between Session Coaches Meet with Mentors Weekly Faculty Support Discussion Board 7 Session 1 May 9 Session 2 June 20 Pre Work Session 3 Aug 1 Session 4 Sept 12 Session 5 Oct 24 Session 6 Dec 5 Session 7 Jan 16
  32. 32. Conditions of Success (NCA 1)  Attendance at collaborative learning sessions and engagement in weekly coach/mentor calls  Engagement in work between sessions that included protected time to meet as a team, trust and respect.  Commitment of trained coaches to improving their skills and helping teams achieve results  Support of practice leadership for time, resources, spread and sustainability
  33. 33. Team & Roles Defined Assessment And Baseline Data Global Aim Problem Statement Specific Aims And Measures Change Idea Solution- Storming PDSA SDSA Spread Measure and Monitor Learning Session 2 Learning Session 3-5 Learning Session 6-7 Powered by Weitzman Institute Core Concepts in Team Based Care Teamwork On-Going Data Collection & Review Learning Session 1 May 9
  34. 34. Team Skills Assessment Summary (2018)
  35. 35. Team & Roles Defined Assessment And Baseline Data Global Aim Problem Statement Specific Aims And Measures Change Idea Solution- Storming PDSA SDSA Spread Measure and Monitor The Stages of Improvement Powered by Weitzman Institute  1. TEAM AND ROLES DEFINED Coach Assigned, Identify Core and Extended Team Members, Define Roles, Schedule Team Meetings, TOOLS/SKILLS/PROCESS: Effective Meeting Tools Daily Huddles Communication Plan  2. ASSESSMENT AND BASELINE DATA What is our current state? Describe population of interest, Identify data sources, Drill down to specific areas of focus. Related to other projects? TOOLS/SKILLS/PROCESS: Tick & Tally & other data collection Process Mapping Role Assessment Team Practice Assessment  3. GLOBAL AIM What is our overall goal for advancing TBC Model? Theme, Name process, location, Start/End of Process, Benefits/Imperatives TOOLS/SKILLS/PROCESS: Build Consensus Fishbone Diagram (cause & effect diagram) Core Concepts in Team Based Care Teamwork On-Going Data Collection & Review
  36. 36. Team Coach Role and Training (April Bootcamp)  Help and support teams working together to use new skills , achieve their aims, document their work.  Help teams complete assessments and action period assignments to stay on track.  Help teams run effective weekly team meetings and facilitate teamwork .
  37. 37. Coaching Skills Self-Assessment
  38. 38. Weekly Coach Mentor Meetings Tuesday 3:00 - 4:00 pm EST Kasey Harding (CHCI Mentor) Wednesday 1:00 - 2:00 pm EST Deb Ward (CHCI Mentor) 1 Lancaster Health Center 1 Thunder Bay Community Health Service Inc. 2 WellSpace Health 2 HealthRight 360 3 Optimus Health Care 3 Family Health Center of Worcester 4 Tri-Cities Community Health 4 Centro San Vicente 5 Central Virginia Health Services, Inc. 5 Mt. Laurel Medical Center. 6 Northwest Michigan Health Services, Inc. 7 New Horizons Healthcare CHCI Mentor Role  Provide support and resources for developing coaching and improvement skills  Assess progress and addressing challenges, help teams stay on track  Provide individual support as needed
  39. 39. NCA Online Learning Network Find material for download, TBC webinars, and team folders for sharing your work... Improvingprimarycare.org Discussion Board Ask questions or make requests of teams, faculty….
  40. 40. Using Your Practice Team Assessment Data
  41. 41. Team Practice Assessment: How Do We Shift Levels Toward A?
  42. 42. Team Practice Assessment: How Do We Shift Levels Toward A?
  43. 43. What is Team Based Care? Team-based care is a strategic redistribution of work among members of a core and extended team. In the model, all members of the team work together for a common purpose, respect and trust each other, and strive for the highest quality of patient and family care. Improvingprimarycare.org
  44. 44. Implementing Team Based Care (gradual approach) (2016 webinar 1-3, 2018 session 1) → Defining your Core and Extended Team Structure → Strategically redistributing work among team members (reduce waste, protocols) → Increasing communication among the team, practice and patients. → Creating new responsibilities and provide training → Improving efficiencies (wait times, start times) → Standardizing processes to reflect new model (making hundreds available) → Using a plan for optimizing the model → Meeting Regularly, Huddle Daily
  45. 45. Team Structure and Role Descriptions www.Improvingprimarycare.org Patients want to receive their care from smaller teams (PODS), know them personally
  46. 46. CHC|NCA TBC Webinars, www.improvingprimarycare.org
  47. 47. Questions
  48. 48. Time LS 1 Agenda Lead 3:00 Introductions Welcome and Background Amanda Schiessl Margaret Flinter 3:10 Objectives and Agenda Ann Marie Hess 3:15 2 min Participant Introductions (6) Teams 3:27 Collaborative Structure: Expectations and Assessment Data | Concepts in TBC: TBC Model Ann Marie Hess 3:42 2 min Participant Introductions (7) Teams 3:58 Concepts in TBC: Assessment Tools : Role Activity, Cycle Time Ann Marie Hess 4:05 Action Period 1 Assignments QI Utilization: Toolkit Overview, meetings and the role of the coach Kasey Harding 4:15 Guest Your Next Team Meeting Deb Ward 4: 25 Wrap Up Amanda Schiessl
  49. 49. 2 Minute Introductions by Team Order of Introductions 1 Thunder Bay Community Health Service Inc. 2 HealthRight 360 3 Family Health Center of Worcester 4 Centro San Vicente 5 Mt. Laurel Medical Center. 6 Northwest Michigan Health Services, Inc. 7 New Horizons Healthcare  Name of Your Practice and Size  Names, FTE, and Positions of participating Core and Extended Team Members  Something your team has done recently to improve care that you are most proud of..  One or two things you want to learn from other teams. 3:42
  50. 50. Thunder Bay Community Health Service Inc.
  51. 51. HealthRIGHT 360  How many sites? 5 clinics across the Bay Area, multiple residential and behavioral health facilities across the state. Staff Role Leticia Gonzalez Primary Care Provider, Adam Corona Registered Nurse Daniela Sanchez Medical Assistant/Phlebotomist Alan Hernandez Clinic Operations Manager  How many patients served? 6,870 patients, 39,394 visits  Specialties  Infectious Disease  Addiction  Trans Healthcare
  52. 52. What have we done to improve patient care? We have had successful PDSAs, our most successful being the decrease in third next available appointments. We are also a well integrated primary and psychiatry team that collaborates daily. What do we hope to achieve? We hove to improve the quality of life for patients, expand into new much needed services, and model successful team dynamics. HealthRIGHT 360
  53. 53. Family Health Center of Worcester, Inc. • Serves approximately 25,000 patients • 15 sites – Primary Care, Dental, WIC, and School-Based Health Centers • Project Team → Name Role at FHCW Anne Reeder (Coach) Quality Improvement Nurse Coordinator Karen Hutchinson Clinical Director Rola Saab Provider, Associate Director for Quality Improvement Beverly Benoit Team Lead Nurse Yamilex De La Cruz Medical Assistant Suheily Maldonado Medical Assistant Karen Puca-Pinho Patient Services Manager Lydia Santiago Unit Clerk
  54. 54. Accomplishments and Looking Forward What is one thing you have done to improve patient care that you are proud of? FHCW implemented team huddles for each of its primary care teams. These huddles meet every morning and allow for the team to connect prior to the day. They also allow providers and medical assistants to review the pre-visit planning tool prior to patient visits. What is one thing you hope to learn from others? We would like to learn about how others conduct pre-visit planning at their health centers and incorporate best practices into our care at FHCW.
  55. 55. Centro San Vicente
  56. 56. FTE in Oakland, Md. Core Team  Administration: 7  Providers: 7  Registered Nurse: 4  NCC: 3  BHC: 3  MA: 8  PAS: 4  QI: 1  IT: 1  Outreach: 3  HIM: 3  Referrals: 3  Billing: 3 6.398 individual patients seen past 12 months  Providers: 2 Shawn Long, MD., Michelle Dixon CRNP  MA: 2 Kari Bernard, Jeremiah Broadwater  RN: 1 Erica Healy  NCC: 1 Stacy Barr  Pt Access Supervisor: 1 Autumn Rush  Electronic Prior Authorization
  57. 57. 4 Clinics serving 6,519 in 2017 Core Team Members, all full-time:  Bree Myers, QI / Data Coordinator, Coach  Marisa Herrera, FNP  Flor Garcia, CMA  Socorro Martinez, Front Desk  Alicia Harmon, CHW Extended Team Members:  Gwen Williams, Senior Leader Support  Kim Corliss, Clinical Services Manager  Helen Gerig, Care Coordinator  Jen James-Witteveen, LMSW
  58. 58.  Recent Success we’re Most Proud of:  Worked together to increase breast and cervical cancer screening rates  Developed clinical protocols for order and result entry  Developed standing orders for mammogram order  What we Want to Learn from Other Teams:  How to work most effectively as a team  How to use the team at the top of their licenses to address preventive care needs in all visits
  59. 59. New Horizons Healthcare • New Horizons Healthcare-serving 9360 patients annually • Team Based Collaborative Care Team (Yellow Pod) – Ruthie Peevey, NP Kelsey Kingery, PAR – Sani Widner, NP – Vicky Robinson, LPN Coaches-Angie Martin – Melissa Taylor, MA Missy Stevens We recently achieved PCMH level 3 with a “perfect score” We hope to learn best practices and share innovative ideas for team based care with other centers
  60. 60. Quality is our Game
  61. 61. Time LS 1 Agenda Lead 3:00 Introductions Welcome and Background Amanda Schiessl Margaret Flinter 3:10 Objectives and Agenda Ann Marie Hess 3:15 2 min Participant Introductions (6) Teams 3:27 Collaborative Structure: Expectations and Assessment Data | Concepts in TBC: TBC Model Ann Marie Hess 3:42 2 min Participant Introductions (7) Teams 3:58 Concepts in TBC: Assessment Tools : Role Activity, Cycle Time Ann Marie Hess 4:05 Action Period 1 Assignments QI Utilization: Toolkit Overview, meetings and the role of the coach Kasey Harding 4:15 Guest Your Next Team Meeting Deb Ward 4: 25 Wrap Up Amanda Schiessl
  62. 62. “Transformation to team based care requires that primary care physicians and other health professionals envision new roles for themselves and that practices incorporate new paradigms of how best to care for patients”. Both of these challenges are more difficult than anyone had imagined.
  63. 63. Polling Question On a scale of 1-5 How challenging or difficult has it been for your practice to implement new roles and new ways of caring for your patients? 1 2 3 54 Extremely Difficult (evidence we are not doing much of this) Not Difficult At All (evidence we are doing this well)
  64. 64. Action Period One Assessment Tools 4:08 Cycle Time (Efficiency) Role Activity Analysis Key Points : Team Based Care Model → Strategically redistribute work among team members (reduce waste, duplication, variation) → Increase communication among the team, practice and patients (meetings, huddles, messaging) → Improve efficiencies (role duplication, variation, interruptions, wait times)
  65. 65. Assignment: Assess Cycle Time to Improve Efficiency Electronic or Manual
  66. 66. 15 Patients (1-2 weeks) Use Clipboard with Clock Select One Appointment Type Random Selection Patients AM and PM Target 1.5 X Appt Time 15 min Appt = 23 min cycle time 20 min Appt = 35 min cycle time 30 min Appt = 45 min cycle time 45 min Appt = 68 min cycle time SampleData.Hess.2009 Worksheet.clinicalmicrosystem.org Note: scheduled appoint time Subtract Early Arrival Time
  67. 67. Data Collection Worksheet
  68. 68. Hess.CPM.2010 Problem: Assessment data shows long cycle time. Root causes identified using Fishbone Diagram. Process map current state pre visit planning, rooming workflow. Informs Next Session : aims and small tests of change. High Leverage Change Ideas: Possible Quick Wins
  69. 69. Role Assessment and Processes : Webinars 1-8
  70. 70. Role Activity Assessment (customizable)
  71. 71. Process Source of Complaint, Impact on Quality and Goals , Role Variation and Duplication, Healthcare for the Homeless NCA 2016
  72. 72. Role Tracking Worksheet Consider Tracking Interruptions Role Activity Analysis Position: Tic Marks (each time activity done, may add AM, PM) Total Tic Marks Estimated Time per Activity in minutes Total Time Access and Communication Processes Activity 1. Schedules patients with a personal clinician for continuity of care ||||| ||||| ||||| 15 4 min 60 min 2. Coordinates visits with multiple clinicians and/or diagnostic tests and procedures 3. Triages how soon a patient needs to be seen including a process for after-hours care 4. Monitors access to appointment, backlog and wait time using telephone and email requests 5. Monitors and triages secure patient portal messages 6. Provides advice on clinical issues via telephone or portal messaging 7. Identifies and arranges for language services 8. Collects patient demographic and insurance information, including preferred method of communication 9. Helps patients activate their Personal Health Record by signing up during office visit 10. Identifies and refers patients who might benefit from care management support, other practice resources, community services Population Health Management Activity 1. Uses population registries and clinical quality reports to monitor a panel of patient’s health and risk status and close care gaps. 2. Communicates with many patients at once via bulk outreach letters and portal messaging (e.g. reminders for preventive care visits ,testing, screening gaps) 3. Provides outreach services to patients overdue for visit to follow up management of chronic
  73. 73. 76 33% 67% Non-Physician Tasks Physician Tasks Non-Physician Tasks -immunizations -obtaining consults -obtaining MR -setting up room -filling out clerical fms -finding interpreter -bringing pt to room -data entry -finding information
  74. 74. SampleData.Hess.2009 Worksheet.clinicalmicrosystem.org IHI.org Poster 25% 75% RN Activity [planned care registry, triage level 2, nurse visits, self management support] Sampling of a Typical Day RN Role Ticks and Tally
  75. 75. Time LS 1 Agenda Lead 3:00 Introductions Welcome and Background Amanda Schiessl Margaret Flinter 3:10 Objectives and Agenda Ann Marie Hess 3:15 2 min Participant Introductions (6) Teams 3:27 Collaborative Structure: Expectations and Assessment Data | Concepts in TBC: TBC Model Ann Marie Hess 3:42 2 min Participant Introductions (7) Teams 3:58 Concepts in TBC: Assessment Tools : Role Activity, Cycle Time Ann Marie Hess 4:05 Action Period 1 Assignments QI Utilization: Toolkit Overview, meetings and the role of the coach Kasey Harding 4:15 Guest Your Next Team Meeting Deb Ward 4: 25 Wrap Up Amanda Schiessl
  76. 76. Action Period 1 Assignments (May 9th to June 20th) 1. Meet weekly (50 min) as a Core Team  Practice effective meeting skills and use tools with coaching support Next Team Meeting  Establish Core and Extended Team Structure and Roles  Use Practice Team Assessment Data to Identify Priorities for Improvement  Draft Your Global Aim Statement 2. Continue or Test Daily Huddle 3. Complete Role Activity Analysis 4. Complete cycle time assessment, or use system reports 5. Use assessment and other practice data to state a problem 6. Complete a fishbone diagram – identify drivers of a problem 7. Map a process 8. Submit readiness survey (ORIC) by June 11th .
  77. 77. Tools for Running Effective Meetings
  78. 78. Tool for Assignment: Writing Global Aim Statement
  79. 79. Assignment: Improve Daily Huddles Carolina Family Health Center, NCA 2016
  80. 80. Assignment: Complete a Fishbone Diagram and Process Map to Understand Problem and Opportunities
  81. 81. Resources can be found in the following places on the main Moodle page.
  82. 82. This was a memorable and valuable experience to be a part of. I really enjoyed getting to know what other health organizations are doing and how we can relate and also learn from those experiences. The mentor calls were very helpful and empowering. This is a learning experience that provides growth both for your organization and yourself. Great experience! I hope the 2018 Teams take advantage of all of these amazing opportunities! Good Luck! TEAM COACH Karla Rodriguez, RN, BSN, PHN Nurse Educator, The Children’s Clinic Long Beach, California NCA 1 Team Coach Reflection
  83. 83. Time LS 1 Agenda Lead 3:00 Introductions Welcome and Background Amanda Schiessl Margaret Flinter 3:10 Objectives and Agenda Ann Marie Hess 3:15 2 min Participant Introductions (6) Teams 3:27 Collaborative Structure: Expectations and Assessment Data | Concepts in TBC: TBC Model Ann Marie Hess 3:42 2 min Participant Introductions (7) Teams 3:58 Concepts in TBC: Assessment Tools : Role Activity, Cycle Time Ann Marie Hess 4:05 Action Period 1 Assignments QI Utilization: Toolkit Overview, meetings and the role of the coach Kasey Harding 4:15 Guest Your Next Team Meeting Deb Ward 4: 25 Wrap Up Amanda Schiessl
  84. 84. Guest Dr. Rajiv Modak El Rio Health, Arizona
  85. 85. 5 MINUTE TEAM DEBRIEF- NEXT MEETING 1. Meet weekly (50 min) as a Core Team  Practice effective meeting skills and use tools with coaching support Next Team Meeting  Establish Core and Extended Team Structure and Roles  Use Practice Team Assessment Data to Identify Priorities for Improvement  Draft Your Global Aim Statement 2. Continue or Test Daily Huddle 3. Complete Role Activity Analysis 4. Complete cycle time assessment, or use system reports 5. Use assessment and other practice data to state a problem 6. Complete a fishbone diagram – identify drivers of a problem 7. Map a process 8. Submit readiness survey (ORIC) by June 11th .
  86. 86. NCA Contact Information Amanda Schiessl Project Director (860) 266-8665 (860) 347-6971 ext. 3650 Schiesa@chc1.com Nashwa Khalid Project Coordinator (860) 852-0806 (860) 347-6971 ext. 3699 Khalidn@chc1.com Next Team Based Care Learning Collaborative Session #2 is scheduled for Wednesday, June 20th at 3:00pm EST
  87. 87. Thank Your Colleagues!

Editor's Notes

  • Kerry
    Anna: Kerry & Margaret done by 3:05
  • Kerry – overview of NCA
  • During our interviews, this was the model we used to help you identify the core team members for collaborative participation.

    Core team can be 1-3 provider and MA dyads. At a minimum , your core team is a dyad.
  • 3:55

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