Making Teamwork Work in the Residency­Based Patient­ Centered Medical Home Tziporah Rosenberg, PhD Stephen Schultz, MD Colleen Fogarty, MD University of.

Slides:



Advertisements
Similar presentations
2012 EXAMINER TRAINING Examples of NERD Comment Formatting
Advertisements

Medical Education Outcomes Research Frederick Chen, MD, MPH Center for Primary Care Research Agency for Healthcare Research and Quality June 26, 2003.
Safety Net Medical Home Initiative Ed Wagner, MD, MPH, MACP MacColl Center for Health Care Innovation Group Health Research Institute Safety Net Medical.
Team Structure The ratio of We’s to I’s is the best indicator of the development of a team. –Lewis B. Ergen NEXT: ®
Patient Centered Care Model The model which was drawn from NMH’s Henderson Framework for Nursing Practice proposes to provide a healing environment centered.
C3 Goals Students will: 1.acquire teamwork competencies 2.acquire knowledge, values and beliefs of health professions different from their own profession.
1 Interprofessional Education (IPE) “.. Occurs when two or more professions learn with, from, and about each other to improve collaboration and the quality.
Tad P. Fisher Executive Vice President Florida Academy of Family Physicians Patient Centered Medical Home A Medicaid Managed Care Alternative.
An Embedded Quality Improvement Curriculum : Lessons learned from Family Medicine Residency Program Directors’ Retreat September 25, 2014.
Team Structure NEXT:. T EAM STEPPS 05.2 Mod Page 2 Team Structure 2 Objectives Discuss benefits of teamwork and team structure Define a “team” Identify.
1 Actively Engaging Physicians in the Planetree Philosophy Robert Devermann, M.D. Aurora System Planetree Physician Champion Cindy Pfaff, Director, Employee.
GME Lunch n Learn Series Cuc Mai September Common Program Requirements: Competency-based goals and objectives for each assignment at each educational.
Teamness Ron Stock MD MA Associate Professor of Family Medicine OHSU April 12, 2013.
Hollis Day, MD, MS Susan Meyer, PhD.  Four domains for effective practice outlined in the Interprofessional Education Collaborative’s “Core Competencies.
Triple C Competency-based Curriculum: Implications for Family Medicine Residency Programs.
Using Outreach & Enabling Services to Support the Goals of a Patient-Centered Medical Home Oscar C. Gomez, CEO Health Outreach Partners Health Resources.
Leadership and Management Training for physicians Maria V. Gibson, MD, PhD Trident / MUSC Family Medicine Residency Program Background Practice Problem.
Shared Decision Making: Moving Forward Together
ACGME OUTCOME PROJECT : THE PROGRAM COORDINATOR’S ROLE Jim Kerwin, MD University of Arizona.
Presented by Vicki M. Young, PhD October 19,
Dual interviews: Moving Beyond Didactics to Train Primary Care Providers in the Biopsychosocial Model James Anderson, PhD Fellow in Primary Care Psychology.
Webinar: Leadership Teams October 2013: Idaho RTI.
Creating Sustainable Organizations The Baldrige Performance Excellence Program Sherry Martin HIV Quality of Care Advisory Committee September 13, 2012.
1. 2 Why is the Core important? To set high expectations –for all students –for educators To attend to the learning needs of students To break through.
Integration in Practice; Tracking the Transformation Perry Dickinson, MD Stephanie Kirchner, MSPH, RD Kyle Knierim, MD Collaborative Family Healthcare.
Implementing Team Training at Duke Karen Frush, BSN, MD Chief Patient Safety Officer Duke Medicine.
Sustaining Change in a Changing World Jay Ford, PhD Assistant Scientist.
PCMH Health Workforce- in Montana Community Health Centers Paula Block, RN Montana Primary Care Association, /
Team Training in EM Residency Education CORD Academic Assembly 2012 Ryan Fringer, MD Christopher McDowell, MD MEd.
THE ROLE OF STAFF IN A PATIENT CENTERED MEDICAL HOME.
Terry McGeeney, MD, MBA, President and CEO, TransforMED Nathan Bieck, Marketing Communications Manager, TransforMED.
Abu Raihan, MD, MPH Director of Program, Asia IAPB 9th GA, Hyderabad, September 2012 Symposium 6: Challenges in Monitoring.
C OACHING : G OAL -S ETTING Coaching Meeting Carrie Rassbach, MD August 12, 2013.
M ODULE 1: Getting Started Coach Medical Home Strategies & tools to support patient-centered medical home transformation.
Education & Training Curriculum on Multiple Chronic Conditions (MCC) Strategies & tools to support health professionals caring for people living with MCC.
Implementing QI Projects Title I HIV Quality Management Program Case Management Providers Meeting May 26, 2005 Presented by Lynda A. O’Hanlon Title I HIV.
UK Deans’ Interprofessional Honors Colloquium Andrea Pfeifle, EdD, PT Center for Interprofessional HealthCare Education, Research & Practice James C. Norton,
The Patient-Centered Medical Home & Health 2.0 AHRQ Annual Conference September 15, 2009 Michael S. Barr, MD, MBA, FACP Vice President, Practice Advocacy.
Principles & Values Partnership Expertise Teamwork Leadership Goals & Strategies Vision/Mission.
Outcomes Tier 2 – PI-LDP Course Tier 3 – ATP or mini-ATP Tier 1 – ACT Program Three Tiers of QI TrainingAbstract DEVELOPMENT OF FACULTY MENTORS IN QUALITY.
Setting a Culture for Innovation Penn Medicine Center for Health Care Innovation Shivan Mehta, MD, MBA Assistant Professor of Medicine, Division.
Becoming a Skilled Mentor: Tools, Tips, and Training Vignettes Rebecca Pauly, M.D. Cecilia Lansang, M.D. Gwen Lombard, PhD. Gwen Lombard, PhD. *Luanne.
AN INTRODUCTION Managing Change in Healthcare IT Implementations Sherrilynne Fuller, Center for Public Health Informatics School of Public Health, University.
AHRQ Safety Program For Long-Term Care: HAIs/CAUTI Module 1: Using the Comprehensive Long-Term Care Safety Toolkit: Applying Safety Principles.
Literature Review Individual Faculty Development Plans (IDP) Faculty Development-Division Directors SIG Workshop May 2, 2010 Juan M. Parra, MD, MPH.
Pharmacists’ Patient Care Process
بسم الله الرحمن الرحیم.
1 Insert Title Here. Coaching for Practice Transformation 2 Elaine M. Skoch, RN, MN, NEA-BC Director, Systems Transformation HealthTeamWorks.
Implementation and Sustainability in the US National EBP Project Gary R. Bond Dartmouth Psychiatric Research Center Lebanon, NH, USA May 27, 2014 CORE.
New Community, New Practice: Redesign of Physical Space to Support the New Model David B. Graham, MD University of Colorado Denver STFM Practice Improvement.
Join the conversation! Our Twitter hashtag is #CPI2011. Fostering Shared Leadership in the Patient-centered Medical Home: From Taking Orders to Driving.
A Multidisciplinary Leadership Model in a Community Health Center Greg Thesing, MD November 2014.
All for One, One for All: Value of Small Teams in Residency Family Medicine Clinics Robert Kraft, MD and Alice Brown, RN Salina Family Healthcare Center,
Developing Global Family Medicine Faculty “de Novo” John G Halvorsen, MD, MS Professor Emeritus of Family and Community Medicine University of Illinois.
Curriculum Development: an Overview of 6 Steps MAJ Heather O’Mara, DO, FAAFP Faculty Development Fellow.
1 Transforming Our Practices Transformed Our Teaching: Meeting ACGME Competencies with New Models of Care Katherine Miller, M.D. John Nagle, MPA U. Of.
Context and Problem Effects of Changes Strategy for Change Aim: To reduce the length of handover by standardising the quality of information transmitted.
The AIC journey to engineering a more reliable and coordinated approach to health care delivery Presentation to the MA Coalition April 11, 2016 Sara J.
Using the Practice Huddle to Teach Systems-based Practice & Teamwork University of California, Davis Henderson, Balsbaugh, Eidson-Ton, & Marshall STFM.
Unit 5a. Managerial activities and administrative controls: exercise TB Infection Control Training for Managers at National and Subnational level.
Innovations in Primary Care: Implementing Clinical Care Management in Primary Care Practices Judith Steinberg, MD, MPH Deputy Chief Medical Officer Jeanne.
Team Leader It’s more than a title Swedish Family Medicine Residency Mary Onysko, PharmD, BCPS Morgan Campbell, DO Kerry Salter, MS, CN, LPN Bradford Winslow,
Building Your Primary Care Team To Improve Patient Care and Outcomes: Learning from Effective Ambulatory Practices MacColl Center for Healthcare Innovation.
Clinical Learning Environment Review GMEC January 8, 2013
FMIG Advisor Summit 2016 Inter Professional Experiences
Practice Re-design in Residency Training
Best Practice Strategies for Maximizing Clinic Efficiency: Part 1
Interprofessional learning and teaching in evidence-based practice
Implementing Care Teams
By: Andi Indahwaty Sidin A Critical Review of The Role of Clinical Governance in Health Care and its Potential Application in Indonesia.
Presentation transcript:

Making Teamwork Work in the Residency­Based Patient­ Centered Medical Home Tziporah Rosenberg, PhD Stephen Schultz, MD Colleen Fogarty, MD University of Rochester School of Medicine and Dentistry Family Medicine Residency Program

Objectives 1. Identify the “key ingredients”/roles/personnel of the PCMH team in a residency training program. 2. Enumerate the barriers to creating an effective team as well as strategies to overcome them. 3. Generate methods of measuring team effectiveness in a residency program. 4. Appreciate the difference between the process skills and content expertise requisite to run an effective team in a residency training program.

What does the National Demonstration Project (NDP) tell us about teamwork? 36 practices around USA Followed for 2 years Half facilitated, half not Quantitative & qualitative analysis For teamwork: Practice Environment Checklist (PEC) Qualitative analysis of interactions with practices -from Evaluation of the AAFP Patient-Centered Medical Home National Demonstration Project ( Annals of Family Medicine Vol. 8, Supplement 1, 2010)

“Practices often had trouble implementing team-based care. Many took initial steps by creating stable physician-medical assistant teams and locating physicians and MAs in same work area; however, these actions were viewed only as important intermediate steps and did not constitute team care.” Nutting PA, et al. Effect of facilitation on practice outcomes in the NDP model of the patient-centered medical home. Ann Fam Med. 2010;8(Suppl 1):s33-44

Practice-based Care Teams The components of this domain: Provider leadership Shared mission and vision Effective communication Task designation by skill set

What Helps Form Functional Teams? 1.Developing shared visions of how care teams affect the patient experience 2.Frequent front-back office meetings and retreats 3.Reconfiguring office work flow and patient flow across front-back functions 4.SUBSTANTIAL effort in cross-training, systematically having ongoing training

What Helps Form Functional Teams? 5.Establishing standing orders for routine lab ordering, and refilling prescriptions 6.Daily team huddles (NOT to be confused with MD- MA dyad!) 7.“Transformation required substantial shifts in individual roles and personal identities.”

The State of the Team in Primary Care The IOM’s call for change in our healthcare delivery system clearly identifies the need for creating practices (and training) built around interdisciplinary teams. Little offered (or published since!) regarding how to apply models that work to the outpatient setting (especially ones in which residents are trained).

The State of the Team in Primary Care Grunbach & Bodenheimer authored a 2004 manuscript in JAMA describing the phenomenon of primary care teams, including focus on membership and how each members sees their role and responsibilities identifying key elements of team building: clear goals with measurable outcomes clinical and administrative systems that support teams division of labor training continuous communication.

The State of the Team in Primary Care Not too big, not too small, but JUST right. Team cohesiveness appears to correlate with effectiveness, though “effectiveness” is not the same as productivity. So what about outcomes? Not much to say for outpatient care teams Improved learning opportunities, quality of teaching, job satisfaction, staff attitudes toward residents reported by Wayne State’s Markova, Mateo, and Roth (2012; JABFM).

Our Context p4 residency program focused on team based care, quality improvement, and merging education and clinical practice Thursday afternoon (weekly) team/teaching time Team Collaboratives (monthly) Interdisciplinary teams (staff, residents, faculty, behaviorists) Additional methods we’ve used to develop teams (retreats, relationship-building, Difficult/Crucial Conversations) Team meetings (incl roles, agenda, structure)

What Makes Teams So Danged Hard? Small group process Reflect for a moment individually on your own programs and what barriers have gotten in the way Work with your group to prioritize the top 3-4 barriers in terms of importance, desire for feedback, or general PITA factor Try on a strategy we’ve used with much success

Breaking Down Barriers Some strategies we’ve tried have worked! Examples: red dot/green dot, meeting roles, huddles Some haven’t. Or can’t. Examples: multiple sites, staff turnover, meeting roles And how do we know? Issues related to measurement of teamness and effectiveness Relevance in the day to day clinical setting vs “Research”

Resources for Change Core functions Adaptive reserve – a practice’s capacity for organizational learning and development 3 components to adaptive reserve: relationship infrastructure facilitated leadership aligned management model “Teamwork…arises when adaptive reserve features are present and operating well.”

How Can You Transform Teams in your Program? What We’ve Learned May Help Change ain’t easy. Really, it isn’t. Evolution is key to surviving, and thriving. Change is impossible without investment of time and heart.