1. Team training strategies to promote quality and efficiency
Larry Mauksch, M.Ed
Consultant and Trainer
Clinical Professor Emeritus,
Department of Family Medicine
University of Washington
Editor, Families, Systems, and Health

2. Objectives Identify core elements of team effectiveness
Learn a model blending communication training and team  development
Plan ways to incorporate video creation and review into training
Larry Mauksch, M.Ed University of Washington Department of Family Medicine

3. Team Training: Sports versus Healthcare and use of Practice
Larry Mauksch, M.Ed University of Washington Department of Family Medicine

4. Time Demands in Primary Care Am J Public Health
Time Demands in Primary Care Am J Public Health. 2003;93:635–64; Ann Fam Med 2005;3:
2500 patients
Conservative time estimates
Ten most common
Chronic illnesses
Well controlled
3.5 hrs/day
Poorly controlled
10.5 hrs/day
Preventive care
Level A and B recommendations
7.4 Hours per day
Add the 60 % of patients with acute problems,
plus paper work, phone calls and charting
= 24 hours / day
Cut panel size to 1250
= 12 hours / day

5. Estimating Panel Size in Primary Care with Team-Based Task Delegation Ann Fam Med 2012 10(5) 396-400

6. Why Are High-Functioning Teams Essential To Primary Care
Too much work for one person
Collaboration produces better outcomes
Effective teams help sustain healthy behaviors in their members
Fewer errors

7. Transdisciplinary Functions and Roles in Primary Care
PCP
Nurse
LPN
Front Desk
Behavioral
health
Care Management
Relationship 5
Agenda setting and activation 4 3
Self management-simple 2
Self management-complex 1
Primary care counseling
Plan confirmation and care integration
Proactive follow-up and stepped care
Intensity: 5 =always; 4= often; 3 = periodic; 2 = support; 1 = reinforce and connect
Larry Mauksch, M.Ed UW Family Medicine

8. Levels of MA/LPN(RN?) Activity
Limited
Warm
Engaged
Activating
Relationship/Empathy X
Vitals/ Visit prep
Update Meds/ check refills
Agenda/Priority/Organize
Activate / Questions?
Prev/HCM/screening
Initial history (Scribe)
SMS: goal/action plan
Proactive f/u (registry mgmt)
Closure/navigation
Frequency ++
+++ +

9. Critical Considerations for Teamwork Salas et al, Human Resources Mangmnt, 2014
Conditions
Culture
Context
Composition
Cooperation
Coordination
Communication
Coaching
Cognition
Conflict

10. Primary Care Team Building Activities
Huddles &
Debriefs
Team
Training
Peer
Coaching
Video
Creation
Role
Modeling X XX
Cognition
Cooperation
Coordination
Conflict
Communication

11. Big Five Teamwork Behaviors Leasure et al “No I in Teamwork” Acad Med
Leadership
Mutual performance monitoring
Backup behavior
Adaptability
Team orientation

12. Phases of Teamwork Planning (Huddles) Action (The provision of care)
Debriefing (Reviewing the experience, celebrating success, and planning change and learning)

13. TEAM COMMUNICATION TRAINING
Team members reinforce use of communication skills in one another
Shared learning of skills builds team function

14. Common Training Sequence
Introduction to PCOF
Group rating and discussion of C/B Videos
Teamlet members observe each other using extended appointment slots
Groups meet to share learning and set goals
Within teamlets
Across teamlets
Recurrent observations and team meetings for reinforcement
Do the cycle again to learn more skills and achieve more goals
Larry Mauksch, M.Ed University of Washington Department of Family Medicine

15. Giving Feedback It is timely and requested
Kind
Honest
Provisional and curious
Specific
Not judgmental
About something that the receiver can change

16. Direct observation: Logistics
Orienting patients
Activity in the room
Feedback and Reflection

17. Orienting patients
Example:
I have a colleague observing me today. We do this in our clinic to help one another maintain high standards of patient care and team work

18. Patient Template: Teamlet training
8:30-8:40 discuss needs of first three patients
8:40-8:45 MA bring patient to exam room and explains teamlet training- at some point is joined by MD, ARNP or PA
8:45 -9:30
8:45 to 9:00 MA interview patient and MD observes
9:00 to 9:30 MD interviews patient and MA observes
9:30 to 9:40 debrief encounter
9:40 MA gets next patent and repeat cycle two more times
Larry Mauksch, M.Ed University of Washington Department of Family Medicine

19. Activity in the room-Seating
Counter
MA/RN MD B
Exam table
This is an animated slide showing where the observer should sit if the patient sits in chair B, chair A or if both chairs are taken. A
Door

20. Observer behavior during interview
Avoid upstaging interviewer with eye contact or non verbal behavior, e.g., head nodding, non verbal empathy
If patient speaks to you, look at” the other” or at the floor, and then to your paper to avoid reinforcing being included in the conversation
Never interrupt person being observed
OK to plan ahead to invite observer in to help
If interviewer leaves the room:
Engage patient in brief conversation or respond to patient questions but be careful not to undermine the interviewer, or
Leave with interviewer

21. Observer Foci 1) Skills on the PCOF 2) Overlap with Lean approach
Those done well
Wonder about doing something differently
2) Overlap with Lean approach
Going where the action is
Value stream thinking- study the present, plan the future
Standard work
Raising skills to the ceiling of role capacity
Work supported by coaching
Reveal waste
Change designed by folks who do the work

22. Common and Better Video: Faculty development primer
Common Missing core skills
Should not be bad caricature
Better if observer rates it and doesn’t see much to improve
Better Re-create the scenario but with core skills
Should be better, but not perfect
Make both videos the same length

23. Toward Patient-Centered Teamwork: Promoting Cultural Change
Educational Goal
Understand core concepts
(Facts; Knowing)
Skill learning
(Knowing; comprehension )
Enhance self awareness
(Doing; application)
Team ownership and reinforcement (Doing; analysis)
Cultural change
(Synthesis)
Educational Strategy or Tool
Read to create vocabulary
Group discusses “Common” and “Better” Video with vocabulary tutoring
Rate video with PCOF,
Online training to increase vocabulary and skill recognition
Maximize structured direct observation:
Observe others, be observed
Video and rate self
Team critique of video
Follow patients across team encounter
Share learning and establish goals
Leaders as video role models, champions
System wide training
Inter-system sharing

24. FILL IN ONE OR MORE OF THE PRACTICE CHANGE OPTIONS BELOW
Practice Reflection and Commitment to Change Tool JOUR OF CONTIN EDUC IN HEALTH PROFESSIONS, 35(3):166–175, 2015
The most useful information for me was:
This highlighted the following gap in my practice:
FILL IN ONE OR MORE OF THE PRACTICE CHANGE OPTIONS BELOW
I will change my current practice in the following way:
Barriers I anticipate:
What changes to my current practice am I considering?
What would enable me to change
What confirmed my current practice?
What supports my current practice?
I am not convinced there is a need to change my current practice because: