Patient Care Teams v 2.0

Transcription

1 + Patient Care Teams v Answering Tough Questions about Patient Care Teams 1

2 + Change is all Around Us forcing us to 3 constantly redefine ourselves and our goals What Makes a High-Performing Practice these days? Preparedness for Payment Reform? Measures of high quality care and outcomes for patients? Engaged staff and providers? Strong Patient Care Team environment/culture? + Team Based Care Deconstructed 4 Since 1993, for Coleman Associates, when Smith and Katzenbach published The Discipline of Teams in the Harvard Business Review, it became clear that for healthcare to experience some of the boosts that other industries had credited to a team culture. in healthcare we would have to move FROM a provider- patient relationship centered model TO a team-based model of work that is wholly patient centric. 2

3 + Team Based Care Delayed 5 This is much harder than it sounds culturally We are still very much in process Everyone touts team based care yet the models are wildly diverse not always in a good way In most instances, patients are not yet raving about our new ways of working in teams Where are you? What s next for you? + No Longer Just A Good Idea 6 Why team based care is the future... Patient demand for services seems to be increasing.especially in areas of behavioral support. Patient expectations are changing. Our expectations about our work day/work life balance are changing. The amount of outside the visit work seems to be growing as technology leads us to new ways of giving care. 3

4 + No Longer Just A Good Idea 7 Why team based care is the future... The current model seems to be leading to stress / burn out. Primary care provider numbers are decreasing. We can train support staff more quickly than physicians teams must take on more. Some support functions are easily automated. + No Longer Just A Good Idea 8 From a changing financial picture Reimbursement structures are shifting forcing us to look for new ways to provide effective care. The catch-as-catch-can system of healthcare delivery is not a financial model. 4

5 + Defining Team-Based Care 9 A team based care approach establishes a crossfunctional group of people who operate in a way that is hierarchically flat and organized around a panel of patients. This means. Staff are consistent. Patients are known and consistent (empaneled). Efforts are observed that establish relationships between staff and patients -- and between providers and staff. Patient provide feedback that this is a home (PCMH) where they can are recognized, cared for, and valued. + A Sample Patient Care Team (PCT) 10 Nurse Referrals Provider Financial Support Patient MA Lab Behavioral Health Front Desk 5

6 + Team-let vs. Full Patient Care Team 11 Dental Hygienist Nurse Provider Diabetes Educator Patient MA Pharmacy Behavioral Heath Front Desk + A Sample Dental Patient Care Team Configuration Hygienist 12 Hygienist RDA Dentist Patient RDA Treatment Coordinator 6

7 + Different Medical Configurations Some Team Members are Shared 13 Nurse Provider 1 Behavioral Heath Provider 2 MA Front Desk MA + Evolution Care Team Members 14 Historically the core Medical Team : MA Nurse Provider Lately Behavioral Health Clerical Support in name only (front office/ phones) 7

8 + Why the Front Desk is Integral 15 The team is stronger when it bridges the front and the back. They are the first face and should to be kept in the know in order to exercise the best judgment in customer service. The front office knows the team s patients and can contribute in huddles. They can be very helpful in reducing No-Show rate. They can dramatically reduces Missed Opportunities via Jockey-ing the Schedule. + A Larger Consideration for Consistent Care Teams 16 Giving healthcare is caring for patients. It is more about a panel of patients than about who did not show up to work today. How many weeks a year is your team s provider out (CME, PTO, etc.)? What happens with the rest of the team in those cases? What is your sick day usage and how can you plan and afford to efficiently cover every team? Many care teams stay in business even when the provider is out. 8

9 + Reference Maslow s Hierarchy 17 Team Identity, Trust, Candor Accountability, Collective Results Co-location & Coordination (Demonstrated Leadership Support), Team Dance Techniques Defined Panel and Consistency of team Abraham Maslow (1943) Defined Members & Schedules + Patrick Lencioni: What Makes a Team, a Team? 18 The Five Dysfunctions of a Team by Patrick Lencioni. He uses this diagram. 9

10 + Steps to Establish Coleman 19 Teams Defined panels of patients Consistent team member staffing Selected and cultivated team members STARS with STARS (David Cottrell) Co-location of team members Staffing model emphasizes artisan vs. assembly line decrease handoffs Patient perspective Autonomy choose own leader & establish identity Team-based data & recognition of collective results Opportunities to work and grow together + Performance Measures for Teams 20 Cycle Time No-Show Rate Closed notes Call volume outside of visit Completed referral rate Completed visits/productivity Missed Opportunities Third Next Available Appointment or phone access Dropped call rate Quality metrics tied to panel needs 10

11 + The Entire Team Owns Performance 21 + Establishing a Culture Around Data 22 Public Transparent Simple one page Understandable even to a novice Not anonymous Up-to-date Connects what we do everyday to the numbers **MOST IMPORTANTLY it stirs to action 11

12 + A Schedule that Works for Teams + 15 Minute SPS Schedule 24 Blocks are used for care teams to schedule quick-turnaround appointments or as catch up so teams can catch up from complex visits. Same days are built in every hour (can vary seasonally or based upon local demand) 12

13 + A Simplified Patient Schedule makes Jockey-ing Easier! 25 All visits are the same length You build in same-days Team has its own slots to see patients they feel they need to call in to see Patient access improves Phone and front desk staff satisfaction improves because they can say yes more often + Jockey the Schedule 26 Call No-Shows immediately at or just before the appointment time. Possible reschedule, creating open slot. Protect open slots by moving early arriving patients into about-to-expire slots. Allow front desk/phone staff to fill open slots must have minimal schedule rules and team trust. Jockey-ing is based upon trust and communication front to back. Decrease Missed Opportunities radically. 13

14 + Jockey-ing(cont d) 27 Jockey-ing Patient Arrivals: Move patients mindfully (as in previous screen) and try to fill all of your capacity (whether it s with walk ins or same days) Continuity is priority, but if not possible, access is king! Principle of Redesign: Match Capacity with Demand, Prepare for the Expected + The Coleman Team Dance 14

15 + Team Dance Steps used in DPI 29 Visit Prep Robust Confirmation Calls PCT Huddle QuickStart Jockey the Schedule Red Carpet the Patient Robust Intake 30-Second report Use the RN Tactically Midway Knock Sheep and Shepherd Charting at the Time of Visit SoftLanding Over Communicate + The Team Preparation: Visit Prep & Huddles 15

16 + The Team: The Most Valuable Tool! 31 Team members are co-located as the Patient Care Team Model builds Co-Location is vital to support direct and timely communication Teams prepare, communicate and work to get ahead of the game + Preparing for the Patient 32 Financial Prep Chart/Visit Robust Confirmation Calls Team Huddles 16

17 + Sample Visit Prep Tool 33 + Preparing You and the Patient Robust Confirmation Calls 1 Day Before Visit 34 Slash your No-Show rate and help prepare even better for visit by doing Robust Confirmation Calls. What is patient coming in for? Any other issues going on? Does the time still work for them? Will they have transportation needs? Any changes in eligibility? Confirm demographics Reach as many patients LIVE (a hard confirmation) versus leaving messages Try left message numbers repeatedly Principle of Redesign: Prepare for the Expected 17

18 + Preparing for the Visit and the Day Patient Care Team Huddles Day of Visit 35 Why Huddle? You huddle to become a patient-focused team producing optimal results with patients which won t happen otherwise. Who Huddles? All members of the team attend the Huddle When do you Huddle? During the 1st appointment slot of the clinic session Start and end on time! Where? In the exam room with the door shut and computers on + Patient Care Team Huddles Day of 36 Visit The Huddle Process: Team huddles around computer with schedule up Leader is the person with the knowledge rather than title. Each patient scheduled for that session is brought to life by provider and team Team members share information learned during prep & robust confirmation calls Team anticipates what will be needed for each visit and where they might get stuck Team strategizes how to get unstuck Provider gives instructions as applicable for each patient 18

19 + Success Stories! 37 + A Transformed Team in Action 19

20 + Read more 39 Visit us at ColemanAssociates.com + Leveraging your Care Teams in a World of Payment Reform 20

21 + Building Team Wisely 41 What if you are not ready for Value Based Payments? How can you get ready? Where are you on the Patient Care Team Continuum? What is the next step for you? + A Strong Patient Care Team 42 Is needed to catch the very details that are are rewarded in a Value Based Payment world Keeps the pressure off of the provider alone which helps with job satisfaction Engages staff in a genuine way Allows your clinic to embody the PCMH concepts 21

22 + Teams that Make Dollars and 43 Sense A team should have a mandate and expectations that they produce certain results. It s managements job to connect the dots for staff + The Coleman Team Dance 22

23 + What do Engaged Team Members 45 Look Like? They look like a team They are active in their work They are thinking ahead They are willing to fail and are vulnerable They learn and anticipate each others moves They to the top of their license and everywhere below They know and talk about their metrics Chicago DPI Project White Paper What is DPI? (Dramatic Performance Improvement) + Team Dance Steps used in DPI 46 Visit Prep Robust Confirmation Calls PCT Huddle QuickStart Jockey the Schedule Red Carpet the Patient Robust Intake 30-Second report Use the RN Tactically Midway Knock Sheep and Shepherd Charting at the Time of Visit SoftLanding Over Communicate 23

24 + How do you know your team is high performing? Be objective and watch the data. 2. Analyze team huddles for early signs of team trouble. 3. Analyze current visits and compare to expectations. 4. Observe team members and their attention to results Key Diagnostic Tool: Your 48 Dashboard Watching the numbers closely will alert you to small problems before they become colossal problems Respond to data daily Productivity No-Shows TNAA Cycle Times Encounters completed Patient comments Positive data indicates a reliably strong model 24

25 + Dig into the Data for Each Team 49 Look for High and Low Performing Teams Identify high performing teams and see what they re doing well. Identify low performing teams and look for opportunities for any training or coaching. + Take Action on Low Performers 50 Set the bar high. Your patients deserve the best! Meet regularly with each low performing team (but don t fixate on them or get distracted by them). Give the team a pop quiz on the data/model. Require a commitment to better performance through establishing short term goals. Provide a specific timeline and action plan for reaching goals. 25

26 + Praise and Reward Outstanding 51 Performers! Public praise and recognition of excellent patient care teams Provide carrots (Adrian Gostick) Statistics posted publicly in the clinic Celebration when goals are reached Look for ways to replicate their performance with other PCTs. Can these individuals coach other teams? + Assess Team Composition 52 Team composition affects team s collective skills and its attitude towards working in new ways. Review composition of team. Assess team trust and candor. Is there at least one natural leader on the team? Is your team composition flawed? If so, alter it. 26

27 + 2. Analyze Huddles 53 The early a.m. team huddle is the litmus test of team organization and timeliness. Its purpose is to make the day more productive and effective. Lack of diligence and poor team dynamics can be frequently spotted here. + What Makes A Great Huddle? 54 Characteristics of great huddles: Everyone is on time & present for entire huddle. Huddle is well organized and led. Everyone is taking notes and participating fully. The focus is on tactics and people, not paperwork. 27

28 + How to Improve Huddles 55 Confront individuals who arrive late Ask team members to explain the purpose of the huddle (Do they get it?) Does team have skills and discipline to do a good huddle? (If not, change team composition) Have team members observe an exemplary team huddle Ask exemplary teams to teach and coach other teams how to do great huddles + 3. Analyze Current Visits 56 Tracking and Mapping Visits Mystery Shopper Calls Walking a mile in the patients shoes can be very eye-opening 28

29 + 4. Observe Attention to Results 57 How is data shared with care teams? How do teams react/respond to their data? With all of the competing priorities of the team, do the data metrics reflect the correct priorities? What is the culture around data and results? + Address Team Dysfunctions Head 58 On Everyone rowing the oars in the same direction. Culture is set by managers. Culture is nurtured by everyone. A culture of artificial harmony (Lencioni), Candor (Catmull), commitment, accountability Embrace the boldness needed to solve problems without just throwing people or dollars at them threat and constraint... (Malcolm Gladwell The Creation Myth) 29

30 + Let s Reference Maslow s Hierarchy 59 Team Identity, Trust, Candor Accountability, Collective Results Co-location & Coordination (Demonstrated Leadership Support), Team Dance Techniques Defined Panel and Consistency of team Abraham Maslow (1943) Defined Members & Schedules + Patrick Lencioni: What Makes a Team, a Team? 60 The Five Dysfunctions of a Team by Patrick Lencioni. He uses this diagram. 30

31 + 1 Provider only vs. Team Visits + The Foundation of a Strong Tactical 62 Nurse Role.is found in optimally functioning Patient Care Teams (PCTs) A Patient Care Team is a group of people who work together consistently & effectively with the singular goal of taking care of a panel of patients. 31

32 Slide 61 1 some of these visits could be identified during the huddle, as well. Can you think of other "nurse solo" visits? Perhaps stable chronic disease & other stuff that's on that table that we got showing what the various clinics were doing for solo vs flip visits -Pamela Weisse, 12/28/2016

33 + Principle: Use RNs TACTICALLY (NOT JUST FOR TRIAGE) 63 Often nurses are used as directed assistants rather than as selfdirected tacticians who make a crucial difference in flow and capacity. + Primary Care RN role BECOMING more Tactical 64 RN coordinates flow of clinic will see overflow patients or assist with urgent clinical situations as needed in an ideal clinic this is done in tandem with MAs and front who are Jockey-ing the Schedule RN fields incoming clinical phone calls/returns pages/checks RN line messages RN performs triage and assessment of drop in who is not on RN or provider schedule may or may not flip visit to provider 1:1 RN visits (chronic care, pre-natal, med rec) RN sees patients who have been proactively identified in huddle either solo or in concert with provider and flips when appropriate in a coordinated effort to maximize patient experience and optimize patient flow and provider productivity 32

34 + A Flip Visit 65 Flip visit: Is when the nurse does a large portion of the visit but then flips it to the provider to add their expertise. The Flip visit may go back to that same nurse for education, follow up, additional planning, or the provider may just finish the visit and let the patient go from there. Clinica Family Health Services, Colorado + Flip Visit Vs. Nurse Solo Visit 66 Flip Visit Scheduled or Walk-in No protocol for RN Solo Visit Solo Visit Scheduled or Walk-in Protocol in place for RN Solo Visit Patient s needs are outside of your skill set GREAT interview skills Provider takes Nurse hands off OR stays with patient Patients needs are within your skill set GREAT interview skills Provider agrees for RN to finish Finishes as an RN Solo Visit 33

35 + The Community Health Worker 67 Opportunity Hotspotting (by Atul Gawande) with Jeffrey Brenner How do you better meet the needs of your patients particularly the ones that visit more frequently need more guidance? + 68 So never lose an opportunity of urging a practical beginning, however small, for it is wonderful how often in such matters the mustard seed germinates and roots itself. ~ Florence Nightengale Social reformer & founder of modern nursing 34

36 + Read more 69 Visit us at ColemanAssociates.com 35