Team Integration Strategies

Transcription

1 Team Integration Strategies Making the Change to Team-Based Care Melissa Schoen, Schoen Consulting Cindy Barr, Capital Link Advancing the Financial Strength of L.A. County Clinics February 10,

2 Dividing Into Teams So I hear you have recently been reorganized into teams Who is on your team? I don t really know. Carla is my MA. What do you mean? Depends We are all one team. 2

3 How do you define your teams? 3

4 Teams Defined by Location Primary Care Satellite I Primary Care Satellite II Site Director Operations MA Site Director RN MA Call Center Scheduler MA Lab Float MA Eligibility and Enrollment Specialist MA Interpreter/ Peer Educator RN Care Manager Receptionist Registered Dietician Receptionist Scheduler MA Behavioral Health Community Health Worker Care Manager/ LCSW Referral/ Float MA 4

5 Teams Defined by Life Stage Adult Medicine Sample Pediatric Medicine Sample Team Lead Clerk MA Eligibility and Enrollment Specialist Team Lead RN MA Lactation Consultant Receptionist Scheduler MA Lab Float MA Eligibility and Enrollment Specialist MA Lab/ Immunization Nurse Care Manager MA Registered Dietician Receptionist Scheduler MA Child Development Specialist Behavioral Health RN Educator Behavioral Health Referral/ Float MA 5

6 Teams Defined by Clinical Focus Infectious Disease Sample Chronic Disease Adult Sample MA Team Process Lead Financial Counselor Grants Manager RN Care Manager Team Lead MA Community Health Worker (CHW) Receptionist Scheduler MA Lab & Testing Coordinator Eligibility and Enrollment Specialist MA Lab/Float MA Social Worker MA Registered Dietician Receptionist Scheduler MA Physical Therapist Behavioral Health RN Educator Care Manager Psychiatrist Psychiatric NP Behavioral Health MA/Referral Coordinator 6

7 Stepping Back 7

8 Prerequisites for Team Based Care Team development prerequisite Safety Net Medical Home Initiative: Qualis Health, Commonwealth Fund, Group Health 8

9 Leadership: Key Building Block Team development is step 4 The 10 Building Blocks of High- Performing Primary Care Thomas Bodenheimer, MD, Amireh Ghorob, MPH, Rachel Willard-Grace, MPH and Kevin Grumbach, MD, Annals of Family Medicine, March/April

10 Think about a great team... 10

11 Key Elements of Care Team Building Factors associated with good performance of teams: - Good Leadership - Strong Communication - Clear Division of labor & understanding of roles - Training - Team supporting policies of organization (e.g. time for meetings, training, etc). - Defined Goals Vision Specific Measurable Operational Objectives Building Teams in Primary Care: Lessons Learned, Tom Bodenheimer, 2007, published by CHCF 11

12 Team Based Care Cultural Shift Collaboration vs. autonomy Flat structure vs. hierarchy Silos vs. integrated Facilitation vs. directive leadership 12

13 What is your clinic staff culture? Does it support your transition to care teams? What can you do to manage this? 13

14 What, as leaders, do you need to do... Culture Change Culture eats strategy for lunch Part of new hire process Build into the culture Training Sustained communication Address the resistance Engage staff in the change efforts 14

15 Change is Continuous and Takes Time Ensure you allow for time to make the changes - Some health centers did it gradually Continue to re-evaluate and make adjustments - Quantitative AND Qualitative - Staff input and continuous learning as part of the organizational culture 15

16 Other things to consider Are the changes embedded in your organization? Do job descriptions reflect the roles and the changes made? Are there systems in place to support care team work? - Scripts, protocols, standing orders Is there continuous training? Are you re-evaluating and adjusting based on success measures? - Success measures appropriate for different levels: org, site, team Is this happening across the organization? - Ensure local leadership is on board 16

17 Stages Teams Evolve Teams defined, roles established with active patients assigned to teams Team roles refined, teams expanded if needed, continuity of care, panels actively managed, communication systems in place Clear team roles, integrated behavioral health, focus on population health, stratified panels, evidence based care, care coordination 17

18 Measures of Success Continuity of Care Access - TNAA - Cycle times/wait times Empanelment - % of patients empaneled - # of patients per panel Patient Experience Staff Experience - Surveys - Turnover rate - Time studies Quality Indicators - Prevention (mammo, pap smears, screening) - Hypertension - Diabetes 18

19 Team Integration Strategies Sustaining the Change to Team Based Care Melissa Schoen, Schoen Consulting Cindy Barr, Capital Link ASF 200 Los Angeles February 10,

20 Common Challenges Challenges to Team Composition - Lack of clinical focus - Recruitment lags - The pull for leave coverage - Staff turnover - Supervisors vs. Leads 20

21 Common Challenges Challenges to Team Process - It is faster to just do it myself! - But do we get paid for that? - How do I know they can really do that? - What will the patient think? - How much time will that take? - Where am I supposed to do that? 21

22 What challenges have you had in transitioning to team based care? 22

23 Addressing Challenges Leadership Considerations May need to adjust overall staffing Individual Performance issues Financial Impact Team members learning to work together Getting some to let-go of responsibilities Building Trust Personalities New kinds of roles and leadership needs (e.g. how to delegate and/or support) Overcoming the entrenched beliefs about roles 23

24 Systems to Support Team Based Care Facility Design - Co-locate team members Data - Is what we are doing making a difference? Empanelment Teams responsible for a population of patients Daily Huddles Protected time for meetings Team Communication systems - Face-to-face vs. paper vs. electronic - Don t forget about soft-skills Schedule responsibilities - Pre-visit scrubbing Plan for staff turnover - Integration of training systems - Cross-training 24

25 Change is continuous and takes time Ensure you allow for the time to make the changes - Some health centers did it gradually Continue to re-evaluate and make adjustments - Quantitative AND Qualitative - Staff input and continuous learning as part of the organizational culture 25

26 How are you measuring your team s success? 26

27 Assess Your Practice Use tools available - PCMH-A - LEAP Assessment Include your staff in assessment process - More realistic findings better results - Understand your patient needs from those doing the work - Support buy-in and communication 27

28 Assess Your Practice PCMH-A 28

29 Assess Your Practice LEAP Resources Tool and results analysis available at: 29

30 Assess Your Practice LEAP Resources Tool and results analysis available at: 30

31 Assessment continued Have the teams take the surveys - Provide guidance to the team Workflow mapping - Clear responsibilities that everyone understands Clinic observations - Confirm results on the survey by seeing what s really happening - Follow-up a patients - secret shopper Include patient perspective - Focus groups - Patient Advisory Groups Use the results to make changes - Continue to measure 31