LA Net Presentation to PCPWG Workgroup

Training Practice Facilitators
LA Net’s lessons learned
Lyndee Knox, PhD
L.A. Net
Los Angeles Ca
Lyndee.knox@gmail.com
LA Net
• Practice Based Research and Resource Network
– 23 FQHCs/CHC
– 165 practice sites
• Focused on improving the health of low-income
communities through
– Provider & community led research & advocacy
– Identification and translation of innovations in
primary care
– Quality improvement
LA Net’s practice facilitation program
• Team approach
– 5 Facilitators (2 FTE, 3 part time consultants)
– Expert consultants on PCMH, Lean, innovation
• Focused on Care Model and PCMH
transformation
Zoe-Anne Fitzhugh, RN,
MS, CCRN, CHES
Aminah Ofumbi, MSN
June Levine, RN
Director of
Facilitation Services
Vanessa Nguyen, MPH
Christine Edwards, PhD
To access the “herding cats” video that was played, go to:
http://www.youtube.com/watch?v=m_MaJDK3VNE
Currently Funded by AHRQ to
• Develop Consensus Report on Practice
Facilitation (2010)
• Develop “how to manual” for starting and
running a facilitation program w/ experts in PF
(currently underway)
• Describe process of training and supporting PFs
to deliver QI to safety net practices using AHRQ’s
Care Model Change Package/Toolkit and assess
impact
AHRQ Care Model Facilitation in the Safety Net
Change package &
Toolkit for guiding
practices through
comprehensive
change
Working in 18 Community Health Center
practices
daily
simple
prescriptive
X
monthly
X 10 months
months
onsite
Weekly
All on-site
X
X
PF + academic
detailing
Practice led w/
focus on CCM
Dimensions of Facilitation
years
long
distance
complex
X
practice
driven
Change Model
Phase 1: Getting started – relationship building
Phase 2: Assess data and set priorities
Stage 3: Redesign care and business systems
•
QI skills
•
Panels management
•
Patient care plan and patient centered care
•
Health literacy needs addressed and appropriate information
•
Depression screening
•
Planned interactions & pre visit planning
•
Self management and connections in the community
•
Eligibility & insurance up to date
•
Cycle time, advanced access
Stage 4: Continuously Improve Performance and Sustain Changes
•
Overcome barriers
•
Leverage grant funding and pursue enhanced reimbursement
•
Leverage community resources
•
Find exemplars
•
Prepare for PfP
How staffed
• Hired 5 PFs in Summer of 2010
– 2 newly minted MPHs (2 FTE)
– 2 RNs (1 FTE)
– 1 PHD CME educator (.5 FTE)
• Selection criteria
–
–
–
–
Excellent people skills
Willing to learn
Commitment to mission of supporting PCPs & poor
Prior experience in QI or clinical setting desirable but
not required
Training our PFs – Core competencies
from Consensus Meeting
• 1-week intensive
–
–
–
–
–
ARHQ Toolkit & Change package
Basics of QI
Assessment/measurement skills
Academic detailing w/ 8 practices
Documentation (Encounter forms, Practice progress)
• Weekly training & supervision based on their experiences
in field
• Leadership buy-in
• Collecting and reporting data that matters (optimizing registry
use!)
• Change model, change model, change model
Costs and infrastructure needs
COSTS of Training NOVICE PFs w/ FEW EXISTING training resources/IN PERSON - $69,909
1-Week Training - Total = $11,769
– Trainer: $5000
• Travel & hotel
– Time of PFs: $5769
– Admin support & Materials: $1000
Weekly training = $3507/month or $35,070 over 10 months
– Trainer=$1200/month (4 hours @$75/hr)
– PF time =$2307/month
Supervision= $2307/month or $23,070 over 10 months
INFRASTRUCTURE
RN trainer
Mechanism for tracking PF progress (Survey Monkey) to guide training/feedback/supervision
Mechanism for tracking practice progress
Meeting space
Lessons learned-GENERAL PRINCIPLES
• Needs to be ROBUST and help keep PFs FOCUSED (lost in poppies)
• Needs to be INTERNALLY CONSISTENT–Start w/ change model, then define
core competencies, then develop curriculum and reporting tools
• Needs to be designed for DOUBLE USE – for PFs, and then by PFs w/
practices. (micro-modules – 15 min chunks)
• Regular REPORTING IS an ESSENTIAL PART of training. Cannot do good
training without this. PF progress & Practice Progress (practice registry)
• IT and the WEB are your friends. Collaborative software like BASECAMP
and DROPBOX, gotomeeting, Survey Monkey, and YAMMER can help lower
costs for training
Lessons Learned: General Principles
• Supporting a “real time” KNOWLEDGE NETWORK
across your PFs is very valuable and may lower
formal training costs and improve outcomes
(Yammer)
• Who you choose to lead the training is important. If
they don’t BUY-IN to your change model your
training will suffer
• Needs to model EMPOWERMENT and CAPACITY
building (same as you want PFs to do w/ practice)
Lessons learned - Content
NEED DEEP SKILLS IN
– Setting up basic QI systems and teams (our practices didn’t have them)
– Registry use and optimization, EHR use for same (for QI data and pre
visit, planned care, etc.)
– How to get practices to buy-in to collecting and using data for change
and setting up systems in practice to do this
– When to empower, when to “do for” – e.g. Concepts of empowerment
and the developmental process that goes with this (knee jerk – don’t
do for them does not work)
– Doing environmental scans of community resources, QI projects,
expertise in practice, expertise outside of practice AND REACHING
OUT
Lessons learned – Mechanisms
• Continuous learning may be most potent – YAMMER for at the moment
learning (need smart phone)
• Need low-cost REPORTING format that PFs can maintain and get reports
from (Survey Monkey –not quite enough)
• CENTRALIZED/COLLAB TRAINING w/ other groups (OKPRN – Jim Mold)
• Need COLLABORATIVE software platform like BASECAMP and DROPBOX
for training & for practices
• Need CURATED quick and easy tools for PFs to use in key areas such as: QI
plan generator, Data wall/dashboard/project board, Presentation
templates
Our situation
• Small Non-Profit
• Hard to fund this type of work
• Want to sustain PFs in L.A. County indefinitely
to support QI in safety net, and knowledge
generation/sharing
Where we are headed
Focusing on: Lowering costs, Double use, & Keeping PFs on track/expert systems so less experienced can do
• ORIENTATION – (core competencies and based on key drivers model)
– Self-study introduction using Hogg Manual, AHRQ Toolkit
– Shared training w/ other PBRNs/organizations (OKPRN ,others?)
– Two-day FIELD EXPERIENCE- Shadowing existing PF
• MONTHLY TRAINING based on weekly REPORTING & change MODEL
provided through WEB
– Use SURVEY MONKEY for reporting
– Use Collaborative IT platform using BASECAMP AND DROP BOX (Project ECHO)
– Building “bank” of training modules – eventually on You Tube?
• DAILY SUPPORT - through learning/knowledge network using YAMMER w/
a network of PFs & expert consultants (need smart phone, issues re:
confidentiality)
• Thanks & Questions?
Estimated cost and infrastructure needs
Infrastructure
Bank of training materials (micro modules) from multiple organizations
.25 FTE coordinator ($18,750 or in-kind)
Introductory training (25 hours) $1,000 PF time
• You Tube videos or centralized resource
• Field visit
Monthly web training (Centralized or using existing micro modules)
• Survey monkey for reporting = $90/month (not optimal)
• Platform for web-based training
– GotoMeeting or EVO= $90/month or free
– Exploring Project ECHO model for multi-uses
– Basecamp or similar
Continuous learning (need smart phones & shared email address)
• Yammer = $90/month

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