1. Bonnie T. Jortberg MS, RD, CDE And Caitlin O’Neill, MS, RD

2.  Overview of the differences in leadership styles/skills for the PCMH; small group discussion  Stages of the Change Process ; group discussion  Leading Teams Through Change  Group Facilitation Skills and Running Effective Meetings  Questions/Next Steps

3.  Questions for Discussion:  Based off the differences listed above, what are leadership styles/qualities that are needed for a practice to be a successful PCMH?  Have you observed these leadership styles/qualities in the SFMR practice? If so, list out these leadership styles/qualities.  Have you observed other leadership styles/qualities in the SMFR practice?  Have you observed leadership styles/qualities in your residency program that you think impede becoming a PCMH? If so, list out these leadership styles/qualities.

4.  “People don’t mind change, they just don’t like being changed.”  Why do some people welcome change?  Why do some people resist change?

6. See Handout:  Shock  Defensive Retreat  Acknowledgment/Acceptance  Adoption

7.  Shock: educate and communicate  Defensive retreat: educate, communicate, and sell (“burn the boats”)  Acknowledgment/Acceptance: sell and train  Adoption: reinforce and recognize

8. Confidence Time “I’m not sure I know what’s going on” “I feel overwhelmed” “I can handle this” “We can’t do this. It won’t work. We’re not allowed” “Actually, things might get better” “This could be a better way of doing it” “This way is more effective” “S/he really made the effort to help us implement this change”

9. Facilitate: to make easier

10.  Listen & ask questions  Humor  Acknowledge conflict – “The only thing more painful than confronting an uncomfortable topic is pretending it doesn’t exist”  Be aware of diversions from crucial conversations  Reframe – “launder” language  Balance Drama & Structure:  Drama: try to uncover relevant, constructive, ideological conflict – leads to passionate discussions and better decisions  Structure: Agenda, Roles & Team Operating Principles

11. Help others understand their role: – ground rules for attendance, – conduct, – follow-through. Uses group processes: Brainstorming Consensus Building Voting methods

12.  Resistance always occurs in one form or another in all task-oriented groups  It is good when it surfaces problems, finds errors, or makes a good idea better – when it’s overt.  Resistance is bad when it is covert or driven underground (sabotage, malicious compliance, etc.)

13. Or said in a different way…How to Prevent Wasting Everyone’s Time by Running an Ineffective Meeting

14.  Meetings are the time/space where quality Improvement teams do their work  Well-planned and well-conducted meetings promote buy-in  Staff and providers are time-pressured  Early successes build momentum

16. Demoralizing Foster ambivalence and even hostility Promote disengagement Expensive (financially and psychologically)

17.  Planned in advance  Follows an agenda  Allows enough time for ‘work’ to be accomplished  Leads logically to the groups next step:  Reserve last 5 minutes for action items & agenda setting

18.  Objective  Who needs to be there  Agenda

19.  Leader or facilitator  Recorder  Time keeper  Follow the agenda  Assign action items  Schedule next meeting

20.  Minutes distributed  Follow through on all assignments  PDSA worksheet completed and distributed (if applicable)

21. Thank you!