1. UPDATE YOUR STATUS TO ENGAGED : HOW TO ENGAGE YOUR STAFF DURING A TIME OF TRANSFORMATION AF Williams Family Medicine Center University of Colorado Department of Family Medicine University of Colorado Health Kathy Cebuhar, Practice Coach Justin Emerick, Practice Manager Corey Lyon, Medical Director

2. SESSION OBJECTIVES 1. LEARN IMPLEMENTATION STRATEGIES THAT CAN IMPROVE STAFF ENGAGEMENT AND SATISFACTION 2. IMPROVE COMMUNICATION WITH AND AMONG STAFF 3. IDENTIFY AND RECRUIT PRACTICE TRANSFORMATION CHAMPIONS FROM WITHIN YOUR PRACTICE

3. POLL QUESTION Text “COREYLYON” to 37607

4. SUPPORT STAFF SHIFT Care By Design model  University of Utah Process changes to increase support role of Medical Assistance  Also increase provider to MA ratio

5. MORE WORK? More work per patient; not more patients

6. GOALS OF OUR MA NEW MODEL Ensure all team members are functioning at the top of their scope and ability: right job; right person Improve patient, provider, and staff satisfaction Improve access Build on the culture of quality and team based care Improve the health and health care of our patients and their families

7. MODEL BRIEF OVERVIEW 2-2.5 MAs to 1 provider ratio Expanded rooming process MA stays in room to assist with documentation, and implementing plan MA completes post-exam tasks, provides after visit summary (AVS) Increase MA scope to help care for patient

8. GOALS OF NEW MODEL FOR MA’S – INCREASE RESPONSIBILITIES MAs collect/update patient information Sets the agenda Medication reconciliation Utilize standing orders for patient care Identify gaps in care, tee up orders Documentation assistance Greater In-Basket support Reduce patient waiting time Everyone practices at top of scope

9. IMPLEMENTATION STRUGGLES LARGE STAFFING CHANGES  20 MAs hired between November 2014 – September 2015  Extended orientation (6-8 weeks) INCREASED MA RESPONSIBILITIES  Complaints regarding unbalanced workload distribution  MA disengagement  Spectrum of MA skill level  MA concerns around compensation INCREASED PATIENT VOLUME CHALLENGES FOR PROVIDERS

10. METHODS FOR ENGAGEMENT AT AF WILLIAMS FAMILY MEDICINE BOOK CLUB  Crucial Conversations  Leadership and Self Deception CLINIC-WIDE CELEBRATIONS  Annual Award Ceremony  Cake  Potlucks and movies  Cook-off challenges BI-ANNUAL STAFF AND PROVIDER SATISFACTION SURVEYS

11. CINCO DE MAY0 CELEBRATION Golden and Silver Spoon Winners: Gaby B. & Maria P.

12. METHODS FOR ENGAGEMENT AT AF WILLIAMS FAMILY MEDICINE FOCUS GROUPS AND LUNCH &LEARNS  Medical Assistants  Registered Nurses  Providers WHITE BOARD  Weekly questions  Quotes  Info sharing STAFF INPUT ON CLINIC WORKFLOW ADJUSTMENTS  Lead MA Position  Clinic Flow Position

13. IMPROVING COMMUNICATION CLINIC WIDE COMMUNICATION SERIES  Styles of communication  Effective vs. ineffective methods of communication  What’s Your Work Style?  Professionalism development  Conflict resolution skill building FACILITATED CRUCIAL CONVERSATIONS  Mediated conversations between staff members with support from CNC or practice coach SESSION HUDDLES  Staff/Provider Changes  Procedures/Staff Visits  Workflow adjustments  Fun Facts

14. CLINIC WHITE BOARD & HUDDLE WHITE BOARD

15. IMPROVING COMMUNICATION CLINIC WIDE REAL-TIME FEEDBACK LOOPS  Leadership to Staff/Staff to Leadership  Staff to Staff/Leadership to Leadership  Staff to Providers/Providers to Staff TEAM BUILDING EXERCISES  Staff only  Providers only  Both staff and providers MONTHLY POD MEETINGS  Adjust workflows  Discuss what’s going well/what needs improvement

16. PRACTICE TRANSFORMATION CHAMPIONS PCMH QI TEAM PARTICIPATION  Identify inefficiencies in current workflows  Part of NCQA application process  Establish improved workflows  Disseminate information  Monitor dashboard data for improvements/adjust as necessary (PDSA)  Dedicated time (paid time) ESTABLISHED LEAD MA POSITIONS  Advocates for change  Workflow experts/super users

17. CURRENT STRUGGLES UNINTENDED CONSEQUENCES OF THE LEAD MA POSITIONS COMPENSATION CONTINUED STAFF TURN-OVER PERSONALITY CONFLICTS

18. NEXT STEPS CONTINUED TEAM BUILDING STAFF “SUPPORT GROUP”  facilitated by clinic psychologist or practice coach

19. QUESTIONS & IDEA SHARING CONTACT INFORMATION Corey.Lyon@ucdenver.edu – AF Williams Family Medicine Medical Director Corey.Lyon@ucdenver.edu Justin.Emerick@uchealth.org – AF Williams Family Medicine Clinic Manager Justin.Emerick@uchealth.org Kathy.Cebuhar@ucdenver.edu – CO Dept. of Family Medicine Practice Coach Kathy.Cebuhar@ucdenver.edu