Transcript Creating a Culture for Quality and Teamwork

Creating Effective
Practice Teams
Nancy Jaeckels
Institute for Clinical Systems
Improvement
January 28, 2010
© 2010 Institute for Clinical Systems Improvement
Collaborative Care Model
 Collaborative care starts with a team focus
 To meet health care home criteria, a
successful team and a culture that
supports team approach is needed
 The question isn’t if teams have value but
whether we acknowledge the fact and
become better team players
General team
characteristics/definition
 Two or more individuals
 Have individual purpose, specific role, specific
tasks and knowledge and skills but….
 Consist of interdependency
 Identify themselves as a team
 Differ from a small group in that teams take
collective action towards a common goal that
can only be reached through task
interdependency
Who’s on the team?
Everyone who touches the process is a
member of the team
 Receptionist
 Medical assistants/nurses
 Providers
 Lab/x-ray
 Care manager
 others
Integration of culture and good
team characteristics
 Goal is more important than the role
– Need shared vision at the team level
– New attitudes
 Leadership
 Need right people in the right role - redefined
roles
 Good communication techniques
 Standardized care
 New structures/processes
Leadership and culture to
support
 Leadership needs to set the culture and the “new
attitudes” towards team-based care
 Leadership also sets the vision and reinforces
the common goal the team is working towards
– Is your leadership bought in and understanding health
care home concepts?
– Are they involved in the meetings that set a vision and
goals for this work so they can talk that talk?
Right people in the right role
 Collaborative care teams need to have the right
people in the right role
 Don’t force people into work they don’t want to
do
 Be specific and clear on roles and expectations
 Find your catalyst and use people’s strengths to
give you the best team
Redefining roles
 Redefine as needed in the redesigned
work flows (use care team analysis
worksheet)
 Use team members to highest skill
 Use team members to fullest licensure
 Cross train and have contingency plans for
team member absence
 Identify change champions and use them
Building an effective team
through measurement and
communication
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Need to define goals as a team
Report on progress along the way
Share data
Need communication plan
– Bulletin boards
– Team huddles
– Multi-messaging media
 Lack of communication results in “stories”
Building an effective team
through measurement and
communication
 Communicate as a team as well as the larger
staff/office
– Scheduled time to close the office and update and
involve all staff
 This shows commitment, value, and engagement by
leadership
– Team huddles - daily
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Short term issues
Quick trouble-shooting
Plan for the day or tweaks needed
Feedback on how it is going
Don’t forget the patients
 Involve the patients in your health care
home
 Communication 2-ways
– Sharing of information in patient friendly form
– Asking for and receiving information
 Engagement
– Self-management support
– Relationship/care management/contacts at
home and office
Standardization
 “….it would take a primary care doctor 18
hours per day to provide all the
recommended preventive and chronic care
services to a typical patient panel. As a
result, only half of the evidence based
medical care is provided.”
- Bodenheimer, T.
New standardized work flow
processes
 Efficiency
– LEAN principles
 Create work flows as a team - and walk through
them as if you were a patient
 Utilization of resources
 Cross training and role definition
 Quality improvement model - using PDSA (plan,
do, study, act) to make process changes
Work flows/new processes
 Flow through from patient’s perspective
 Identify each key touch point
 Who does what at each of those points
Scheduling, check in, pre-visit prep, visit,
care management, check out, post-visit
follow-up, billing, phone triage, etc.
All of us are smarter than
any one of us
Challenges and approaches
 Lack of buy-in
– Identify and use your champions (early adopters)
– Leave the laggards alone for now
– Maintain the leadership commitment and involvement
 Change fatigue
– Take breaks
– Frequent check-ins on how everyone is doing
– Plan incentives and small goals that are easier to
achieve
Steps to do:
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Get leadership committed and involved
Identify your team and begin communication
Create work flows as a team
Define team roles specific to the work flow
Create a specific communication plan (I.e., daily
team huddles at what time)
 Cross train and do PDSA quality training as
needed
Questions?