Here are some questions teams have about core and extended teams, pre-visit planning/huddles, self-management goal setting workflows, and the coaching role:
Core and Extended Teams:
- How are you identifying your patient care teams (PODS) so staff and patients know their team?
- What specific roles have you seen change on teams and how?
- How are you training staff on team-based care?
- How do you maintain team integrity with turnover/MAs covering multiple teams?
- Are managers/leaders part of your core and extended team model?
Pre-Visit Planning and Huddles:
- How do you manage prep time for huddles? Are
If you want to learn more about how and why Saskatchewan is using Lean in health care, join us for this introductory session. During the Quality Summit, you will hear about various Lean tools, concepts and principles, and this session will serve as a quick primer for you, covering some “lean essentials” to enhance your Summit experience!
If you want to learn more about how and why Saskatchewan is using Lean in health care, join us for this introductory session. During the Quality Summit, you will hear about various Lean tools, concepts and principles, and this session will serve as a quick primer for you, covering some “lean essentials” to enhance your Summit experience!
A huddle is a brief meeting held each shift/day to enable teams to be informed, review work, make plans, and move ahead rapidly with the daily work. Conducted standing up, preferably around the data dashboard/patient board, the whole team meet for just 10 minutes to make plans for the day and ‘quick fire’ ideas to trouble shoot any potential issues.
Tips to engage stakeholders in 7 day servicesNHS England
NHS England’s Sustainable Improvement team are hosting a series of free sharing and learning webinars to support organisations implement seven day services (7DS).
The next in the series focuses on stakeholder engagement, as feedback from the service has indicated that good stakeholder engagement is a key factor in successfully implementing 7DS.
This webinar will showcase practical tried and tested approaches supported by Trust examples. There will be opportunities for peer to peer connections, learning and for participants to share their own practice.
During this session you will hear about examples from:
University Hospital Southampton NHS Foundation Trust: Whole System: Engaging commissioners, clinicians and Patients for 7DS with Dr Juliane Kause, Care Group Lead Emergency Care, Lead Consultant Out of Hours Care and Seven Day Services.
Oxford University Hospitals NHS Foundation Trust: Spreading the word and resources to help clinicians: Portal for Oxford 7DS Guide with Belinda Boulton, Director of Transformation and Ruth McNamara, Integrated Care Projects Lead.
Maidstone and Tunbridge Wells NHS Trust: Getting it right from the start: engaging internal stakeholders for 7DS clinical leadership and planning with Lynne Sheridan, Head of Delivery Development
Accreditation for Postgraduate Residency Programs (Nurse Practitioner and Cli...CHC Connecticut
This webinar explored the accreditation process for postgraduate residency programs within health centers. Avenues for accreditation were discussed specifically for postgraduate nurse practitioner and psychology residency programs. Speakers discussed their experiences in the accreditation process.
The webinar was presented April 27, 2016 3:00 PM Eastern Time as part of the CHC Clinical Workforce Development National Cooperative Agreement.
Risk analysis and control
FMEA: Failure Mode and Effects Analysis (FMEA) is often the first step of a system reliability study. It involves reviewing as many components, assemblies, processes and subsystems as possible to identify failure modes, and their causes and effects. For each component, the failure modes and their resulting effects on the rest of the system are recorded in a specific FMEA worksheet. - more at http://www.nhsiq.nhs.uk/improvement-programmes/patient-safety/learning-and-resources.aspx
A3 Thinking:
A3 thinking is a structured technique of working through problems or opportunities for improvement. The ‘A3’ itself is literally just that: a piece of A3 paper summarising the logical thought processes that have been agreed by the team in defining the opportunity for improvement or solving the problem they face.
Implementing Post-Graduate Nurse Practitioner and Clinical Psychology Residen...CHC Connecticut
This webinar discussed the importance of research and evaluation in measuring successes and failures in the implementing of postgraduate residency programs within health centers. Different evaluative methods were explored in this webinar including self-assessment, standardized tools and journaling.
This webinar took place April 13, 2016 3:00 PM Eastern Time as part of the CHC Clinical Workforce Development National Cooperative Agreement.
A huddle is a brief meeting held each shift/day to enable teams to be informed, review work, make plans, and move ahead rapidly with the daily work. Conducted standing up, preferably around the data dashboard/patient board, the whole team meet for just 10 minutes to make plans for the day and ‘quick fire’ ideas to trouble shoot any potential issues.
Tips to engage stakeholders in 7 day servicesNHS England
NHS England’s Sustainable Improvement team are hosting a series of free sharing and learning webinars to support organisations implement seven day services (7DS).
The next in the series focuses on stakeholder engagement, as feedback from the service has indicated that good stakeholder engagement is a key factor in successfully implementing 7DS.
This webinar will showcase practical tried and tested approaches supported by Trust examples. There will be opportunities for peer to peer connections, learning and for participants to share their own practice.
During this session you will hear about examples from:
University Hospital Southampton NHS Foundation Trust: Whole System: Engaging commissioners, clinicians and Patients for 7DS with Dr Juliane Kause, Care Group Lead Emergency Care, Lead Consultant Out of Hours Care and Seven Day Services.
Oxford University Hospitals NHS Foundation Trust: Spreading the word and resources to help clinicians: Portal for Oxford 7DS Guide with Belinda Boulton, Director of Transformation and Ruth McNamara, Integrated Care Projects Lead.
Maidstone and Tunbridge Wells NHS Trust: Getting it right from the start: engaging internal stakeholders for 7DS clinical leadership and planning with Lynne Sheridan, Head of Delivery Development
Accreditation for Postgraduate Residency Programs (Nurse Practitioner and Cli...CHC Connecticut
This webinar explored the accreditation process for postgraduate residency programs within health centers. Avenues for accreditation were discussed specifically for postgraduate nurse practitioner and psychology residency programs. Speakers discussed their experiences in the accreditation process.
The webinar was presented April 27, 2016 3:00 PM Eastern Time as part of the CHC Clinical Workforce Development National Cooperative Agreement.
Risk analysis and control
FMEA: Failure Mode and Effects Analysis (FMEA) is often the first step of a system reliability study. It involves reviewing as many components, assemblies, processes and subsystems as possible to identify failure modes, and their causes and effects. For each component, the failure modes and their resulting effects on the rest of the system are recorded in a specific FMEA worksheet. - more at http://www.nhsiq.nhs.uk/improvement-programmes/patient-safety/learning-and-resources.aspx
A3 Thinking:
A3 thinking is a structured technique of working through problems or opportunities for improvement. The ‘A3’ itself is literally just that: a piece of A3 paper summarising the logical thought processes that have been agreed by the team in defining the opportunity for improvement or solving the problem they face.
Implementing Post-Graduate Nurse Practitioner and Clinical Psychology Residen...CHC Connecticut
This webinar discussed the importance of research and evaluation in measuring successes and failures in the implementing of postgraduate residency programs within health centers. Different evaluative methods were explored in this webinar including self-assessment, standardized tools and journaling.
This webinar took place April 13, 2016 3:00 PM Eastern Time as part of the CHC Clinical Workforce Development National Cooperative Agreement.
NHS Improving Quality held a webinar about basic service improvement tools and techniques for strategic clinical network and mental health teams with little or no service improvement experience. The aim was to raise awareness and gauge future training needs.
The COVID-19 pandemic has created several challenges for our country’s health care infrastructure, and the community health center workforce is no exception. Join us as we describe strategies to get patients back into dental care. Along with these strategies, participants will learn how to recognize challenges in dental practices, as well as how to engage the interdisciplinary care team through role redesign and integration to increase access to comprehensive care.
NTTAP Webinar Series - June 7, 2023: Integrating HIV Care into Training and E...CHC Connecticut
In order for health centers to provide compassionate and respectful HIV prevention, care, and treatment in comprehensive primary care settings, the clinical workforce must be knowledgeable, confident, and competent in their ability to do so.
We’ll explore the need to integrate HIV care into training and education for the clinical care team, as well as educational models to train the next generation. Using Community Health Center Inc.’s Center for Key Populations Fellowship for Nurse Practitioners (NPs) as a framework for best practices, experts will discuss how to implement specialty care for key populations in your training programs. Additionally, participants will gain awareness of the importance of training the clinical workforce on key population competencies in HIV programs (e.g. HCV, MOUD, LGBTQI+ health, homelessness, and harm reduction).
Utilizing the Readiness to Train Assessment Tool (RTAT™) To Assess Your Capac...CHC Connecticut
Improve educational training experiences at your health center by assessing your capacity and infrastructure to host health professions students.
Join the upcoming hands-on interactive activity session to learn how to utilize the Readiness to Train Assessment Tool (RTAT™). This tool was developed by HRSA-funded National Training and Technical Assistance Partners (NTTAP) at Community Health Center, Inc. (CHC) to understand organizational readiness to host health professions student training programs.
NTTAP Webinar Series - May 18, 2023: The Changing Landscape of Behavioral Hea...CHC Connecticut
The COVID-19 pandemic has resulted in significant shifts in the mode of care from face-to-face to virtual interactions. Join us as we discuss the challenges currently facing behavioral health care and at least one strategy for each. Along with these strategies, panelists will go over what integrated behavioral health care was and is before and following COVID-19, as well as what actions should be taken going forward to increase access to comprehensive care.
Panelists:
• Dr. Tim Kearney, PhD, Chief Behavioral Health Officer, Community Health Center, Inc.
• Melinda Gladden, LCSW, PMHC, Behavioral Health Clinician, Community Health Center, Inc.
• Jodi Anderson, LMFT, Virtual Telehealth Group Coordinator, Community Health Center, Inc.
NTTAP Webinar Series - April 13, 2023: Quality Improvement Strategies in a Te...CHC Connecticut
Join us for a webinar on quality improvement in team-based care!
Building a quality improvement (QI) infrastructure within team-based care is an organizational strategy that will establish a culture of continuous improvement across departments and improve quality in all domains of performance.
Participants will learn about:
• QI infrastructure
• Facilitating QI committees
• Coach training within health centers
Faculty will also provide an example of how trained coaches use QI tools to test and implement changes within an organization.
Implementation of Timely and Effective Transitional Care Management ProcessesCHC Connecticut
Join us to discuss best practices for integrating daily follow-ups for patients recently hospitalized for health emergencies. Effectively following up with patients is a critical responsibility for integrated care teams.
Experts will share how their teams respond to patients to identify care gaps and support the transition of care. Workflow descriptions will provide participants with the tools to support their work to adapt specific steps into their model of team-based care.
Panelists:
• Mary Blankson, DNP, APRN, FNP-C, FAAN, Chief Nursing Officer, Community Health Center, Inc.
• Veena Channamsetty, MD, FAAFP, Chief Medical Officer, Community Health Center, Inc.
• Bibian Ladino-Davis, Behavioral Health Coordinator, Weitzman Institute
Implement Behavioral Health Training Programs to Address a Crucial National S...CHC Connecticut
Health centers are uniquely positioned to address the unprecedented need for behavioral health services but are challenged by the workforce shortage. Participants will gain the knowledge needed to begin conceptualization of a training pathway.
Join us to discuss the considerations of sponsoring an in-house training program across all educational levels, including the benefits, program structure, design, curriculum, supervisors' role, and required resources.
Experts will provide participants with examples from practicum and postdoctoral level training programs to help them gain confidence in developing a behavioral health training pathway.
HIV Prevention: Combating PrEP Implementation ChallengesCHC Connecticut
Expert faculty present case-based scenarios illustrating common challenges to integrating HIV PrEP in primary care. As part of improving clinical workforce development, this session will delve into a variety of specific PrEP implementation challenges. Participants will leave with strategies to overcome these obstacles to establish or strengthen their PrEP program.
Panelists:
• Marwan Haddad, MD, MPH, AAHIVS, Medical Director, Center for Key Populations, Community Health Center, Inc.,
• Jeannie McIntosh, APRN, FNP-C, AAHIVS, Family Nurse Practitioner, Center for Key Populations, Community Health Center, Inc.
NTTAP Webinar Series - December 7, 2022: Advancing Team-Based Care: Enhancing...CHC Connecticut
Join us as expert faculty outline the differences between case management, care coordination and complex care management to frame up a discussion on strategies to leverage effective models for both in-person and remote services.
Expert faculty will discuss the role of the medical assistant and the nurse in care management, as well as how standing orders and delegated orders support this work. This session will discuss how telehealth and remote patient monitoring enhancements can support complex care management for patients with chronic conditions.
Participants will leave this session with the knowledge and tools to begin or enhance implementation of chronic care management by enhancing the role of the medical assistant, nurse and the technology that supports the clinical care.
Panelists:
• Mary Blankson, DNP, APRN, FNP-C, Chief Nursing Officer, Community Health Center, Inc.
• Tierney Giannotti, MPA, Senior Program Manager, Population Health, Community Health Center Inc.
NTTAP Webinar: Postgraduate NP/PA Residency: Discussing your Key Program Staf...CHC Connecticut
Expert faculty will discuss the drivers, benefits, and processes of implementing a postgraduate residency training program at your health center. This session will dive deeper into a discussion on the responsibilities of key program staff, preceptors, mentors, and faculty for successful implementation. This webinar will equip participants with a road map to go from planning to implementation and offer an opportunity for coaching support.
Panelists:
• Program Director of the Nurse Practitioner Residency Program, Charise Corsino, MA
• Clinical Program Director of the Nurse Practitioner Residency Program, Nicole Seagriff, DNP, APRN, FNP-BC
Training the Next Generation within Primary CareCHC Connecticut
This webinar discussed the various avenues of workforce development including:
• training non-clinical roles
• the value of an administrative fellowship
• the key questions to ask before establishing a fellowship at your agency
The discussion referenced CHC Chief Operating Officer Meredith Johnson and CHC Project Manager Megan Coffinbargar’s publication “Establishing an Administrative Fellowship Program: A Practical Toolkit to Support and Develop Future Community Health Center Leaders” for the National Association of Community Health Centers (NACHC).
Panelists:
• April Joy Damian, PhD, MSc, CHPM, PMP, Vice President and Director of the Weitzman Institute, Community Health Center, Inc.
• Megan Coffinbargar, MHA, Project Manager, Optimizing Virtual Care Initiative, Community Health Center, Inc.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
2. Using Zoom
Turn your webcam on!
Please remember to mute
yourself during the presentations.
If you have a question, you may
un-mute yourself and ask after
each presentation, OR use the
Q&A button
3. Advanced Team Based Care (TBC)
Learning Collaborative
Welcome to Session 6
April 26, 2017
3:00 - 4:30 EST
Developing core and extended team capabilities for implementing an advanced team based care model.
4. Introductions
TBC Collaborative Design, Facilitation, Faculty
Ann Marie R Hess ANP, MS
National Cooperative Agreement
Anna Rogers, Director
Reema Mistry, Program Coordinator
Mentors , Coaching Faculty
Deborah Ward, RN
Kasey Harding
Evaluation Faculty
Kathleen Thies, PhD, RN
Improvement Science Faculty
Patti Feeney
Mark Splaine, MD
5.
6. Objectives Session 5
Summarize Action Period 5 Milestones (6 weeks)
Provide a team example of a playbook that documents improvement work
Learn from questions you have for other teams
Discuss how to develop a post collaborative improvement plan
Provide a path forward | assignments for Action Period 6
7. Agenda
3:00 5 min Welcome and Introductions
Improvement Road Map
3:05 15 min Action Period 5 Milestones and Challenges
3:20 15 min Playbooks | Standards (10 min, 3 min questions)
Educational Health Center of Wyoming | Prescription Refills
3:35 15 min How are we doing? Core and Extended Team Structure and Roles
3:50 15 min Discussion Questions : What do you want to learn from other teams?
4:05 10 min Post Collaborative Improvement Plans Using Progress Check List
4:15 10 min Action Period 6 Assignments
8. Action Period 5 Assignments
1. Improve ‘effectiveness’ of your weekly meetings
2. Improve ‘quality’ of daily huddles , measure impact
3. Achieve Specific Aims by implementing multiple PDSAs
4. Collect and Track Data (daily|weekly, small tests of change)
5. Implement SDSAs (standards) – draft playbook(s)
6. Spread a standard to another POD, track how it is working
7. Complete progress check list (9)
8. Post all work on TBC website (moodle)
9. Improve leadership communication and engagement
10. Define Core and
Extended Team
(structure, roles)
Achieve multiple TBC
specific aims, data
driven (PDSAs)
Standardize (SDSAs)
roles and key processes
(Playbook, Spread Plan)
Improve team and coach
skills (improvement
science, team work,
coaching)
Move Practice
Assessment Data toward
Level A
Develop a post
collaborative team
action plan
TBC Learning Collaborative
90 min
Learning
Sessions
Between Session Action Periods (6 weeks)
Complete Assignments
Weekly Team Meetings , Daily Huddles
Monthly Reporting
Share Your Work – TBC Website (Moodle)
Developing Effective Meeting and Improvement Skills
Implementing Team Based Care – Small Tests of Change
Learning from Each Other
Action Period 5
Core (POD) and
Extended Team
Roles, Spread
Achieving Aims,
Using Data
Playbook
Documentation
Weekly Team
Meetings and Daily
Huddles (92%)
Progress Check List
(9)
New Aims Between Session
Coach Mentoring (weekly – attend 2-4/mo)
Faculty Support
Moodle Resources and Discussion Board
7
Sept 21 Dec 14 Jan 25 Mar 15 Apr 26 June 14Nov 2
11. Improvement Science Theory Bursts (10 min)
Session 1 : Sept 21st
o Running effective team meetings using tools
o Developing and using a cause and effect diagram to inform PDSAs
o Writing a global and specific aim statement
Session 2 : Nov 2nd
o Developing a process map or current state workflow
o Applying PDSA methodology for improvement
Session 3 : Dec 14th
o Using data for improvement (run charts, bar graphs, sampling)
Session 4 : Jan 25th
o Standardizing (SDSAs) and Process Reliability
Session 5 : March 15th
o Spreading Change
Session 6 : April 26th
o Improve Plan Post Collaborative : 3-6 month Core Team (progress check list)
Session 7 : June 14th
o Resources for Refreshing and Learning Improvement Skills
14. 24 Specific Aims and Measures, Small Tests of Change (PDSAs)
Behavioral Health
Behavioral Health Integration Huddles
Care Coordination |Management
Lab Result Tracking and Follow Up
Referral Process
Prevention screening and closing gaps, MA protocols
Population Management
Complex care management
• Clinical Documentation
Eliminate Paper and Duplication Role Activity |Documentation
Rooming Standards – health maintenance, accurate BP
Planned Care
Pre Visit Planning
Daily Huddles
Pre Registration Phone Call
Medication Management
Prescription Refills Process
Access and Communication
Appointment Scheduling Guidelines
Patient Portal Activation
15. FQHA Possible Playbooks
Educational Health
Center of Wyoming
Prescription Refills
Healthcare for the
Homeless
Core and Extended Team
El Rio Well Child Checks
Peach Tree MA Rooming |Documentation
Via Care MA Led Huddles
Holyoke Health
Center
Behavioral Health Huddle
Integration
The Children's Clinic Colon Cancer Screening
How are teams getting your
improvement work
documented….
not only to stay on track,
but to :
share with others,
train teams,
spread,
optimize EHR workflows ?
Documentation :PDSAs, SDSAs, Data Over Time, Processes and Protocols, Playbooks
16. Sustaining and Holding the Gains: Team Meetings
We have a team leader who keeps us engaged and motivated,
this is not our meeting leader.
Our coach has transitioned effective meeting and improvement
skills to our team. We meet without our coach when not
available.
We invite leaders and managers to our meetings as needed
based on our work and challenges.
Our team members ‘onboard’ new staff to our TBC model
(turnover, staffing issues)
Meeting as a team improves care for our patients and families.
17.
18. 30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Nov 09 Dec 09 Jan 10 Feb 10 March 10 April 10 May 10 June 10 July 10 Aug 10 Sept 10 Oct 10
% Pts w/ Up-to-Date A1C Testing
UW Health Trained Microsystem Team Pilot Teams
Registry management and
standardized lab ordering per
protocol
UW.hess.2011Ihi.org
Higher Performing PODS : Building Organization Capacity
Top Down Projects
Business as usual
High Performing POD
20. Agenda
3:00 5 min Welcome and Introductions
Improvement Road Map
3:05 15 min Action Period 5 Milestones and Challenges
3:20 15 min Playbooks | Standards (10 min, 3 min questions)
Educational Health Center of Wyoming | Prescription Refills
3:35 15 min How are we doing? Core and Extended Team Structure and Roles
3:50 15 min Discussion Questions : What do you want to learn from other teams?
4:05 10 min Post Collaborative Improvement Plans Using Progress Check List
4:15 10 min Action Period 6 Assignments
29. What is the problem we attempting to remedy?
• Based on comments received from our patient satisfaction
survey
• There were a significant number of patient complaints
regarding our telephone system
o Patients expressed concern over
o Phone calls not answered promptly by the nursing
staff/provider
o Patients often left multiple messages
• Q: For the team – is it possible that the telephone problems
may not be system itself, but rather our internal processes?
Family Medicine Residency Program at Cheyenne 820 East 17th Street Cheyenne WY
30. Purpose for Patient Phone Calls to Our Practice?
• Data collection occurred over a two week period
to identify the reason(s) for incoming phone calls
(i.e. scheduling, RX refill) and the frequency of
the calls.
• All staff who receive in-coming calls participated
in the phone call tracking process.
• Phone call tracking occurred from 02/06/17-
02/24/17
Family Medicine Residency Program at Cheyenne 820 East 17th Street Cheyenne WY
32. What did the data tell us?
• Our clinic experiences a highly daily call
volume
• We spend a great deal of day answering
and responding to the phone.
• RX and scheduling accounted for about
8% of our total phone calls.
Family Medicine Residency Program at Cheyenne 820 East 17th Street Cheyenne WY
33. PDSA #1
Specific AIM: To decrease the number of phone
calls related to prescription refills.
• Our goal is to identify individual providers who
are prescribing patients sufficient medication
and refills until their next follow up visit.
Family Medicine Residency Program at Cheyenne 820 East 17th Street Cheyenne WY
40. Lisinopril Prescribing Pattern – Sept 1, 2016 – 3-31-2017
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
Number of Day Supply
Percent of Day Supply Prescribed
41. Next Steps
• Continue to monitor all providers to ensure that a
majority of patients prescribed Lisinopril receive a 6
month – 1 year refill
– Provided the patient’s labs are within range and their
current health status allows this
• As necessary offer ongoing education to providers
regarding the benefits of long term vs. short term
Lisinopril scripts
Family Medicine Residency Program at
Cheyenne 820 East 17th Street Cheyenne
WY
42. What is the problem we attempting to remedy?
• Evaluate that purpose(s) for patient phone calls to our practice
• Process
– UW FM conducted a patient satisfaction survey
• Observations
– There were a significant number of patient complaints regarding our
telephone system
o Patients expressed concern over phone calls not answered promptly by the
nursing staff/provider
o Patients often left multiple messages without a response
The UW FM process improvement team discussed the possibility that
telephone problems may not be the system itself or the patients, but rather
our internal processes?
Family Medicine Residency Program at Cheyenne 820 East 17th Street Cheyenne WY
43. Family Medicine Residency Program at Cheyenne 820 East 17th Street Cheyenne WY
0
50
100
150
200
250
300
350
400
450
2/6/2017 2/8/2017 2/10/2017 2/20/2017 2/22/2017 2/23/2017 2/24/2017
Date Date Date Date Date Date Date
UW FM Phone Calls -
Feb 2017
RX Refill Scheduling Other Total
44. Lisinopril Prescribing Pattern – Sept 1, 2016 – 3-31-2017
0
10
20
30
40
50
60
70
80
90
100
45
60
90
120
150
180
210
240
270
360
390
420
450
540
630
# of Scripts
Days
Family Medicine Residency Program at Cheyenne 820
East 17th Street Cheyenne WY
New Lisinopril scripts accounted for
16% of the total Lisinopril scripts or 53
out of 332 scripts
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
NewPescription
30
45
60
90
120
150
180
210
240
270
300
330
360
390
420
450
480
510
540
570
600
630
Number of Day Supply
Percent of Day Supply Prescribed
45. Agenda
3:00 5 min Welcome and Introductions
Improvement Road Map
3:05 15 min Action Period 5 Milestones and Challenges
3:20 15 min Playbooks | Standards (10 min, 3 min questions)
Educational Health Center of Wyoming | Prescription Refills
3:35 15 min How are we doing? Core and Extended Team Structure and Roles
3:50 15 min Discussion Questions : What do you want to learn from other teams?
4:05 10 min Post Collaborative Improvement Plans Using Progress Check List
4:15 10 min Action Period 6 Assignments
46. Blue Pod
(Core Teams)
Dr. Etheridge
Jackie, MA
MA
Dr. Brant
Joe, MA
Porcelyn, MA
Richie Hall, NP
Vicky, LPN
MA
47. RN and MA Roles
What do you want to learn from other teams?
51. Level D: Just Getting Started
Level C: Early Stages of Change
Level B: Implemented Basic Changes
Level A: Achieved Most or All of the Important Change Required
52. Primary Care Team Guide Assessment Data (n=16 Teams)
0
2
4
6
8
10
Level A Level B Level C Level D
Medical Assistant (MA)
0
2
4
6
8
Level A Level B Level C Level D
Registered Nurse (RN)
0
5
10
Level A Level B Level C Level D
Medication Management
0
5
10
Level A Level B Level C Level D
Planned Care
0
5
10
Level A Level B Level C Level D
Population Management
53. What new MA roles have you
been implementing?
Any lessons learned?
What do you want to learn from other teams?
54. Level D: Just Getting Started
Level C: Early Stages of Change
Level B: Implemented Basic Changes
Level A: Achieved Most or All of the Important Change Required
55. Agenda
3:00 5 min Welcome and Introductions
Improvement Road Map
3:05 15 min Action Period 5 Milestones and Challenges
3:20 15 min Playbooks | Standards (10 min, 3 min questions)
Educational Health Center of Wyoming | Prescription Refills
3:35 15 min How are we doing? Core and Extended Team Structure and Roles
3:50 15 min Discussion Questions : What do you want to learn from other teams?
4:05 10 min Post Collaborative Improvement Plans Using Progress Check List
4:15 10 min Action Period 6 Assignments
56. What do you want to learn from other teams?
Core and Extended Team Model
How are you identifying your PODS in your health center so that know
their team ? *Scrub colors, wall colors, door colors, badges, business cards,
pictures?
What specific roles on your team have you seen change, and how?
How are you training and educating staff about team based care?
How do you maintain the integrity of your CORE team with turnover and
/or MAs covering multiple teams/PODS.
Are manager and leaders part of your core and extended team model?
57. Pre Visit Planning and Huddles
How do you manage the prep time for huddles? Are you using EHR in real time to reduce
prep time?
Is anyone allowing patient to give verbal consent for records release new patient visit?
Future Aims:
What is your self management goal setting workflow – forms, who , when , and follow
up?
Coaching Role:
We are dependent on the coach to prepare and help us run weekly meetings. We have
difficulty getting work done between meetings. How are teams managing these
challenges? Who is stepping up as your improvement leader ?
How are teams managing the challenge of documenting their work using the tools
(Specific Aims, PDSAs, SDSAs, Data Over Time, Playbooks)?
What do you want to learn from other teams?
58. Agenda
3:00 5 min Welcome and Introductions
Improvement Road Map
3:05 15 min Action Period 5 Milestones and Challenges
3:20 15 min Playbooks | Standards (10 min, 3 min questions)
Educational Health Center of Wyoming | Prescription Refills
3:35 15 min How are we doing? Core and Extended Team Structure and Roles
3:50 15 min Discussion Questions : What do you want to learn from other teams?
4:05 10 min Post Collaborative Improvement Plans Using Progress Check List
4:15 10 min Action Period 6 Assignments
63. Action Period 6 Assignments
1. Work on specific aims (PDSAs, SDSAs). Use Data.
2. Draft Playbook(s )| Documentation of Your Work
Define Core and Extended Team (benchmark CHA)
Huddles
Specific Aim You Have Achieved (e.g. prescription refill)
3. Spread a standard to another POD
4. Improve ‘effectiveness’ of your team meetings and
daily huddles
64. Action Period 6 Assignments
5. Schedule a team meeting with Leaders. Share your work, discuss
organizational implications TBC model.
6. Complete progress check list. Upload for conversion to draft
post collaborative improvement plan.
7. Complete Post Assessments – May 29 – June 9
Team Improvement Skills Assessment
Coach Skills Assessment
Primary Care Team Guide Assessment
8. Post your work on Moodle Learning Network site
https://moodle.weitzmaninstitute.org/login/index.php
65. Next and Final Session June 14
Celebration of Your Work Together
oPresent what you team accomplished that they are most proud of ?
Approach as if your audience were other teams in your practice and leaders. Be creative.
oHow has your collaborative participation helped your team?
oWhat were some of your lessons learned?
oDo you have your draft post collaborative improvement plan?
66. Thank You All
Survey Post Session
Thank you for your participation today and your feedback : Session Evaluation
67. Mentor Name of FQHC State Coach Team Members Team
Kasey Avenal Community Health Center CA John Kalfayan
Frances Silva, Behavioral Health
Vivian Stafford, Physician
Khuong Phui, Medical director
Betty Mora, MA
Christina Castaneda, Receptionist
1 BH, 1 Physician, 1 MA, 1 Medical
Director, 1 Front Desk
Deb
Carolina Family Health Centers ,
Inc.
NC Mary Williams
Amparito Fiallo, MD
Al Abaya, NP
Lisa Vinson, LPN
Bernadette Mangum, LPN
Cheyenne Robbins, Care Coordinator
Betty Lucas, Front Desk
Zenaida Aguilar, Interpreter
Raquel Milbourne, CNA
Sandra Botello, Referral Specialist
1 MD, 1 NP, 2 LPN, 1 Care
Coordinator, 1 Front Desk, 1
Interpretor, 1 CAN, 1 Referral
Sepcialist
Deb
Educational Health Center of
Wyoming
WY Pamela Oiler
Donna Romain, RN
LaDonna Whittaker, Radiologic Tech
Liz Bravo-Alcon, Executive Assistant
Stephanie Schneider, MA
Patrick Monahan, Clinical Manager
Marianne Ploucha, Business Office Manager
Kimberly Broomfield, Faculty Physician
Jennifer Walsh, MA
Christie Novy, MA
Evan Norby, Clinical Team Lead
Monette McKee, RN
Thanh-Nga Nguyen, Faculty Pharm D.
Pamela Oiler, Faculty LCSW
1 Provider, 2 RN, 1 Radiologic
Technologist, 1 EMR Manager, 3 MA, 1
Clinical Manager, 1 Pharmacist, 1
LCSW
68. Mentor Name of FQHC State Coach Team Members Team
Kasey El Rio Santa Cruz AZ Josh Carzoli
Crystal Chavira, MA
Yomaira Preciado, RN
Jennifer Stivers, LPN
Rajiv Modak, Physician
Stephanie Pinedo, Reception
Linda Beauchesne, Medical Informatics Supervisor
Sonia Reidy, Physician
1 MA, 1 RN, 1 BH, 1 Chief Clinical
Officer, 1 LPN, 2 Physician, 1 Front
Desk, 1 COO, 3 RN Clinic Manager, 1 IT
Deb Healthcare for the Homeless TX Carlie Brown
The core team:
Henry Siem, MD
Luis Huerta, MA
Krissy Joubert, MA – Intake/Registration
Unfilled RN Position
Extended team:
Cidney Aae, Case Manager
Joseph Benson, Community Health Worker
Need new team
Kasey Holyoke Health Center MA
Megan T.
Wechsler, Rosie
Romero
Core Team:
Dr. Kefah Al-Ramahi, Internal Medicine, MD
Karen Horgan, RN
Natalie Alicea, MA
Juan Acevedo-Behavioral Health Integration
Program Manager
Mariluz Vargas, Front Desk
Extended Team:
Dr. Alejandro Esparza, CMO
Martha Fisk, Director of Quality and Compliance
1 Director of Quality and Compliance,
1 Physician, 3 RN, 1 MA, 1 Front Desk
Deb
Johnson City Community Health
Center
TN Flo Weierbach
Martiza Ramirez, Front Desk
Rebecca Morrison, PNP
Amy Mclaughlin, LCSW
Mae Crestinger, RN
Laura Gentles Gonzales, Interpreter
1 Dfront Desk, 1 PNP, 1 LCSW, 1 RN, 1
Interpreter
69. Mentor Name of FQHC State Coach Team Members Team
Kasey Peach Tree Healthcare CA Ruben Ruiz
Core Team:
Margarita Cuevas, MA
Rene Minnaar, NP
Jose Alvarado, MA
Kathleen Hawes, Site Manager
Alex Castro, Customer Service Specialist
Tang Yang, Operations Specialist
Tameka Frank, Quality Coordinator
Hakeem Adeniyi, Chief Medical Officer
Ruben Ruiz, Quality Coordinator
Sheila Arnold, Clinical Support Services Manager
Other Team Members in Monthly Meetings:
Michelle Woodard, Director of Operations
Mary Renner, Director of HR
Dalip Rai, Data Analyst
1 Chief Quality Officer, 1 Quality
Coordinator, 1 Director of
Operations, 1 Site Manager, 1
Director of HR, 1 NP, 3 MA, 1
Data Analyst, 1 Operations
Specialist, 1 Clinical Support
Services Manager
Deb Sumter Family Health Center SC Sandra Sturkie
Core Team:
Linda Brice, Adult Health Clinical Manger
Dr. Etheridge, Adult Health MD
Porcelyn Scarborough, MA
Ebony Singleton, Call Center/Registration
Sondra Richardson, Referrals Manager
Extended Team:
Kitty Kulungowski, RN Behavioral Health
Wendy Bonds- Chapman, Case Management
Mary Byrd, Case Management
Tina Thompson, Behav Health RN
Jolie Costello, Dental Services Coordinator
Joyce Bair, Patient Financial Coordinator
Marti Martin, Clinical IT/EMR
Melvina Chappell, Pharmacist
1 Director of Patient Services, 1
Clinical Manager, 1 BH Clinical
Manager, 1 BH RN, 1 Physician,
2 Case Managers, 1 MA, 1
Dental Services Coordinator, 1
Patient Financial Coordinator, 1
Clinical IT, 1 Pharmacist, 1 Call
Center Rep, 1 Referrals
Manager
70. Mentor Name of FQHC State Coach Team Members Team
Deb
Syracuse Community Health
Center, Inc.
NY Cathy Brigden
Dr. Roy Smith, Physician
Ms. Zarina Smith, FNP
Ms. Stephanie Green, LPN
Ms. Rebecca Wright, RN
Ms. Shanieka Smith, MA
Ms. Tania Guntin-Bernal, MA
Ms. Tiffany Senke, MA
Ms. Stephanie Montgomery, Office Manager
Ms. Verna Griffith Payne, RN
1 Physician, 1 FNP, 1 LPN, 2 RN, 3 MA,
1 Office Manager
Kasey The Children’s Clinic CA Karla Rodriguez
Dr. Shea Suskin, Provider
Joana Rios, MA
Elizabeth Castruita, LVN
Angela Moreno, Clinic Manager
1 Provider, 1 MA, 1 Care Team Rep
Deb Tyler Family Circle of Care TX Sherri Gould
Carolyn Risinger, CMO
Linda Isabell, COO
Nadra Miller, Lead LVN
Juana Crespin, OA
Robin Hogue, PNP
Vanessa Vela, Process Improvement Manager
1 CMO, 1 COO, 1 LVN, 1 OA, 1 PNP, 1
Process Improvement Manager
Kasey
Via Care Community Health
Center
CA Lourdes Olivares
Agustin Jaime Lara, CMO
Anamaria Lopez-Chavelas, MSW
Ema Hernandez, LVN
Laura Andrade, MA
Julio Arellano, Enroller
Maria Valdez, Director of Operations
Maricela Romero, MA/Front Desk lead
Victoria Moreno, RN
1 FNP, 1 MA, 1 Outreach & Enrollment
Specialist, 1 MSW, 1 Front Office Lead
MA
Editor's Notes
Our agenda after more introductions…
We will be referring to this ramp throughout the collaborative as a road map, or the structure to a proven approach to change.
As shown by the skills assessments, there is opportunity to close some gaps by building improvement science into the sessions over time. What you need, when you need it – to be successful.
For example -
Outcomes have been attributed to higher levels of team based care competencies
Our agenda after more introductions…
YOU HAVE THE Skills and Core Team to run some tests of change within your control.
Our agenda after more introductions…
YOU HAVE THE Skills and Core Team to run some tests of change within your control.
We also have some preliminary information from the primary care assessment from each 11 teams to date, not individuals.
We also have some preliminary information from the primary care assessment from each 11 teams to date, not individuals.