Module Menus

In this module (learning objectives)

The importance of practice facilitation (video).

Practice facilitator competencies.

Working in a practice facilitation programs.

The focus of quality improvement (QI) work.

Meeting primary care practices where they are.

Practice facilitator skills sets.

What practice facilitators do.

How practice facilitators learn.

About this training program.

Conclusion.

In this module (learning objectives)

Introduction

First tasks:

• Conduct background research.
• Find out who is your point of contact.
• Establish contact with the practice.
• Handle problems reaching the point-of-contact.
• Have the first conversation.
• Scenario: Making a first impression at Cape Lofton Primary Care Associates.

Working with practice champions:

• Initial tasks for establishing a relationship with the practice champion.
• Strategies if a practice says no to medical record access.
• Address problems during start-up.
• Apply your knowledge: Raising concerns with a practice champion.
• Voices from the field (video).

Holding kickoff meetings:

• Plan the kickoff meeting.
• Lead the kickoff meeting.
• Review program goals and requirements.
• Confirm the practice's commitment.
• Introduce yourself.
• Apply your knowledge: Planning a kickoff meeting.

Helping a practice understand practice facilitation:

• Teach the practice how to work with a facilitator.
• Techniques to educate practices on facilitation.
• Distinguish between improvement work and research.
• Scenario: Explaining research activities to the practice champion.

Learning about the practice:

• Determine the practice's current priorities.
• Find out the practice’s motivation for participating in QI work.
• Align the facilitation program’s and practice’s priorities.
• Example of aligning facilitation program’s goals and practice’s priorities.
• Apply your knowledge: Aligning priorities.

Observing the practice:

• Observe for 2-3 days before making suggestions.
• Gather information on relevant practice history.
• Create a practice profile.
• Scenario: Meeting clinicians and staff at Cape Lofton Primary Care Associates.
• Keep track of practice members.

Conclusion

In this module (learning objectives)

Developing positive relationships:

• Practice facilitation is relationship-based.
• Apply a strengths-based mindset.
• Relationship pointers.

Communication skills that foster connection and engagement:

• Active listening skills.
• Scenario: Active listening skills at Fawnview Primary Care.
• Asking Powerful Questions.
• Apply your knowledge: Communication skills.

Help practices stay on track:

• Be a professional pesterer.
• Friendly pesterers.
• Voices in the field (video).

Curating outside resources to support quality improvement:

• Outside resources and when to look for them.
• Steps to conducting an environmental scan.
• Curate the materials.
• Summarize the information.
• Engage practice facilitators with specialized expertise.
• Expert consultants.
• Examples of when to use expert consultants.
• Apply your knowledge: Expert consultation.

Conclusion

In this module (learning objectives)

Introduction:

• Why have a meeting?
• Meetings influence culture.
• Practice facilitators play a variety of roles.

Planning effective meetings:

• Steps in planning effective meetings.
• Strategies for scheduling meetings.
• Preparing for the meeting.

Making meetings productive:

• Running productive meetings.
• Reinforcing practice priorities and group norms.
• Meeting ground rules.
• Techniques for ensuring full participation.
• Voices from the field (video).
• Managing distractions using a “parking lot.”
• Ending the meeting and creating minutes efficiently.
• Apply your knowledge: Managing a meeting.

Running a brainstorming session:

• Rules and steps for brainstorming.
• Steps for brainstorming sessions.
• Scenario: Running a brainstorming session.
• Ending the brainstorming session & follow-up.

Conclusion

In this module (learning objectives)

Introduction:

• The six domains of high-quality healthcare.
• What do practices care about?
• What is quality improvement (QI)?

QI Frameworks:

• QI frameworks.
• Three common QI frameworks.
• Scenario: Recommending a quality improvement approach at Wickston Clinic.
• Voices from the field (video).
• Align your methods with the practice’s framework.
• Scenario: Aligning with Plainesville Clinic’s quality improvement approach.
• Apply your knowledge: Starting QI work with a new practice.

Key Driver Diagrams:

• Introduction to key driver diagrams.
• Creating a key driver diagram.
• Apply your knowledge: Key driver diagramming.
• Quality improvement is a team sport.

Conclusion

In this module (learning objectives)

The Model for Improvement?

• What is the Model for Improvement?
• Step 1: Create the aim statement.
• “Why” motivates change.
• Example of a good aim statement.
• Apply your knowledge: Identifying good aim statements.
• Step 2: Determine how to measure improvement.
• Apply your knowledge: Recognizing types of measures.
• Step 3: Identify changes to try.
• Scenario: Teaching the MFI to Pinto Run Clinic.

Plan-Do-Study-Act Cycles:

• Step 4: Test changes using PDSA cycles.
• The four stages of a PDSA cycle.
• Voices from the field (video).
• Pinto Run uses PDSA cycles to test changes.
• Scaling up a change with PDSA ramps.
• Using a PDSA worksheet to help a practice stay on track.

Conclusion

In this module (learning objectives)

Introduction

Types of process maps.

Symbols for creating process maps.

Steps for creating process maps.

Apply your knowledge: Create your own process map.

Facilitating a process mapping session:

• Before you start a process mapping session.
• Techniques for facilitating a process mapping session.
• Voices from the field (video).
• Scenario, Part 1: Process improvement at Hensler’s Creek Family Medicine.
• Scenario, Part 2: Mapping the process at Hensler’s Creek Family Medicine.
• Apply your knowledge: Create a swimlane diagram.

Redesigning a process:

• Helping a practice redesign a process.
• Scenario, Part 3: Redesigning the process at Hensler’s Creek Family Medicine.
• Use PDSA cycles to test changes to the process.

Conclusion

In this module (learning objectives)

Two tools for explaining practice results.

The 5 Whys:

• Introduction.
• The 5 Whys in 3 steps:
  • Step 1: Create a problem statement.
  • Step 2: Ask “Why?” 5 times.
  • Step 3: Design a change or counter-measure.
• Apply your knowledge: The 5 Whys.

Fishbone diagramming:

• Introduction.
• Fishbone Diagram Template.
• The 5 steps of fishbone diagramming.
• Voices from the field (video).
• Scenario: Fishbone diagramming at Fort Gallagher Geriatrics.
• Apply your knowledge: Fishbone diagramming.

Conclusion

In this module (learning objectives)

Introduction

Promoting self-reflection with practice assessments:

• Assessments of models of care.
• Specialized assessments.
• When to use a practice assessment.
• Apply your knowledge: Explain a required practice assessment.
• Administering a practice assessment.
• Re-administer practice assessments to measure progress.

Group rating sessions:

• Techniques for running a group rating session.
• Watch out for practices underrating themselves.
• Scenario: Third Avenue Free Clinic uses BBPCA to assess itself.

Getting feedback with surveys.

Survey basics:

• Survey considerations.
• Custom surveys.
• Steps to create a custom survey.
• Voices from the field (video).
• Standardized surveys.
• CAHPS® Clinician and Group (CG) Survey.
• Visual surveys.
• Caution in interpreting survey data.
• Surveying patients with low literacy.
• Apply your knowledge: Design a survey.

Using assessment and survey data to generate improvement ideas:

• Presenting practice assessment and survey data.
• Generating improvement ideas from practice assessment and survey data.
• Asking good questions.
• Follow-up on high priority goals.

Conclusion

In this module (learning objectives)

Introduction to standardized quality measures:

• What are standardized quality measures?
• When do practices use standardized measures?
• Similar standardized measures.
• Payment methods.
• Good quality pays.
• Scenario: Understanding quality incentives at Cape Lofton Primary Care Associates.
• Learning about measure specifications.
• Finding standardized measures.
• Components of measure specifications.
• Example of a specifications sheet.
• ICD-10 Codes and CPT Codes.
• Apply your knowledge: Identifying components of measure specifications.  

Using standardized quality measures:

• Tracking performance.
• Helping practices calculate their performance.
• Improving performance.

Benchmarking:

• Practice-level benchmarking.
• Provider-level benchmarking.
• Scenario: Discussing benchmarks at Cape Lofton Primary Care Associates.
• Voices in the Field.

Fall-out analysis and Pareto charts:

• Analyzing why patients "fall-out" of a measure.
• Steps for conducting a fall-out analysis.
• Pareto charts.
• Steps for creating a Pareto chart.
• Apply your knowledge: Create a Pareto chart.

Conclusion 

In this module (learning objectives)

Introduction:

• Goals of a “last 10 patients” chart audit.

How to conduct a “last 10 patients” chart audit:

• 8 steps overview.

• Step 1. Identify inclusion criteria.
• Step 2. Determine which data to abstract.
• Step 3. Generate a list of 10 patients.
• Step 4. Review records for targeted care.
• Step 5. Review encounter notes.
• Step 6: Interview clinicians and staff.
• Step 7: Summarize the findings.
• Step 8: Use findings to generate improvement ideas and assess improvement.

Voices from the field (video).

Apply your knowledge: Create a summary sheet.

Engaging a practice in a “last 10 patients” chart audit:

• Techniques to engage a practice in a “last 10 patients” chart audit.
• Scenario: Generating improvement ideas at Great Hawks Medical Clinic.
• Apply your knowledge: Generating improvement ideas with a practice.

Conclusion

In this module (learning objectives)

Creating data, graphs, and charts:

• Approaches for presenting performance data.
• Raw numbers.
• Tables.
• Apply your knowledge: Evaluate tables.
• Bar graphs.
• Run charts.
• How to create a run chart.
• Patterns in run charts.
• Scenario: Reviewing a run chart with a practice.
• Tracking changes using run charts.
• Small multiples.
• Voices from the field (video).

How to present performance data:

• Eight strategies.
• Strategy #1: Relate the data to the practice’s goals.
• Strategy #2: Reflect whether changes reflect improvements in care or documentation.
• Strategy #3: Give details on data and methods.
• Strategy #4: State conclusions directly.
• Apply your knowledge: Titles for slides.
• Strategy #5: Prepare for data validity concerns.
• Strategy #6: Help the practice recognize the value of imperfect data and small data.
• Imperfect data: The 5 stages of data grief.
• Strategy #7: Use questions to stimulate meaningful discussion.
• Strategy #8: Erect data walls.
• Scenario: Responding to data concerns at Clinic Yellow Sun.
• Apply your knowledge: Respond to data concerns.

Conclusion

In this module (learning objectives)

Traditional training sessions and educational emails:

• Necessary but not sufficient.
• Key messages.
• Drafting educational emails.
• Designing effective implementation training.
• Conducting training sessions.
• Apply your knowledge: Designing effective training.

Creating job aids:

• Introduction to job aids.
• Job aid formats.
• Steps to developing a job aid.

One-to-one coaching:

• Introduction to elbow support.
• Steps for conducting elbow support sessions.
• Voices from the field (video).
• Small sample audit and feedback.
• Deciding whom to coach.
• Scenario: Feedback sessions to implement improvements on second blood pressure measurement.

Motivating change and overcoming resistance:

• Change is difficult.
• Handling objections to change.
• Four types of push back and ways to address resistance to change.
• Apply your knowledge: Develop key messages.

Conclusion     

In this module (learning objectives)

Learning about joy in work:

• Introduction to joy in work.
• Joy in work as a practice improvement goal.
• The benefits of a joyful practice.
• Factors that can affect joy in work.
• Red flags that joy in work may need attention.
• Scenario: Christine raises morale issues at Clinic YellowSun.
• When joy in work isn't seen as important.
• Apply your knowledge: Raising concerns about joy in work.

Using quality improvement methods to increase joy in work:

• Steps to address joy in work.
• Step 1. Gather baseline data.
• Step 2. Analyze root causes and identify opportunities for improvement.
• Step 3. Use the Model for Improvement to set improvement aims, define measures of success, and generate change ideas to test and scale.

Strategies to increase joy in work:

• Overview of strategies.
• Strategies to lessen workloads.
• Strategies to build competence and share responsibilities.
• Strategies to increase control over work.
• Strategies to increase feelings of connection and appreciation.
• Voices from the field (video).
• Apply your knowledge: Working with a practice to improve inbox management.

Conclusion