1. PCMH Health Workforce- in Montana Community Health Centers Paula Block, RN Montana Primary Care Association, pblock@mtpca.orgpblock@mtpca.org / 406.442.2750

2. Montana Community Health Centers

3. Clinic Mighty Mouse- workforce  Workforce Changes  Focus on Team that really supports patient care processes and provider work- using MAs or Medical Assistants  2 MAs per provider, one doing direct care and other administrative support  MA leads the daily team huddle, (have done the pre-work, know patient needs)  MAs- coordinate clinic flow and operations. (MAs empowered once they know expectations and the big picture.)  ‘Quality Nurse’- population management & QI  Standardized workflows & defined job duties (backed by standing orders)

4. Clinic Mighty Mouse- training  Training Needs  On-line web program for staff office training, (includes PCMH type trainings such as cultural competency, goal setting, patient safety, motivational interviewing, care planning)  Providers assess clinical support staff training needs and help train  Communication emphasis for all on ‘how to talk to patients’ (helps spread PCMH message to patients)

5. Clinic Big & Beautiful- workforce  Workforce Changes  Strategic planning on PCMH tenets of care  Who does work now? Can we ‘back it up’? (receptionist prints med list for patient to review with nurse)  Ongoing and continual review & re-review!  Care teams  Share office, (providers, MAs, nurse, admin assistant, & more)  Nurse leader of patient care team  Use ‘Special Teams’- lab, x-ray, triage, outreach  Chart & dictation staff now part of team as admin support  Use EHR in disciplined, structured, supporting way

6. Clinic Big & Beautiful- training  Training Needs  Microsoft Excel- nurses and MAs (sort & filter skills needed for population management)  Facilitative Leadership- management staff  EHR- ongoing  Lean / other QI improvement models, communication, IHI team based care, motivational interviewing, patient self management, behavioral change, population management, health literacy, using evidence to improve care

7. Tool- Team Visualization or “Jelly Beans”  See AHRQ site “Implementing Care Teams”, for directions  Below is a common result

8. Tool- Task Assignments  See AHRQ’s “Implementing Care Teams” for directions  Above is an example  Ask 3 questions  What is task?  Who does it now?  In perfect world, who could do it? TaskWho does it?Who could do it? Book appointmentsRNs, ClericalClerical TriageRNs & MDsRNs Med refillsRN, MDs & clericalClerical with MD Suture removalMDRN Dressing changeMD, RNMA

9. Resources  Facilitative Leadership, www.interactonassociates.comwww.interactonassociates.com  Team exercises on AHRQ, under “Implementing Care Teams”, http://www.ahrq.gov/professionals/prevention- chronic-care/improve/system/pfhandbook/mod19.htmlhttp://www.ahrq.gov/professionals/prevention- chronic-care/improve/system/pfhandbook/mod19.html  Lean for health care, http://leanhealthcarewest.com/http://leanhealthcarewest.com/  IHI, (Institute for Healthcare Improvement), www.ihi.orgwww.ihi.org  Web on-line learning example, www.essentiallearning.comwww.essentiallearning.com  Goal setting, Comprehensive Motivational Interventions, www.comprehensivemi.com/about/brief-action-planning www.comprehensivemi.com/about/brief-action-planning