Team-Based Care 101 for Health Professions Students

Welcome

The National Cooperative Agreement on

Health Professions Students in FQHCs

Presented by the

the Community Health Center, Inc.

& the National Nurse-Led Care Consortium

WEBINAR 2: Team-Based Care 101 for Health Professions Students

May 9, 2017

Speakers

From Community Health Center, Inc.:

Anna Rogers, Director of the National Cooperative Agreement

Reema Mistry, MPH, Project Coordinator, National CooperativeAgreement

Kerry Bamrick, Senior Program Manager, Weitzman Institute

From National Nurse-Led Care Consortium:

Casey Alrich, Director, Practice Transformation and Quality Improvement

Cheryl Fattibene, Chief Nurse Practitioner Officer

From Family First Health

Brittany Hanchett, Director of Quality and Compliance

From Fairfield University

Jim Haddon, PMHNP Student

Learning Objectives:

1. Participants will describe two components of a high-

performing team

2. Participants will be able to describe two effective

communication strategies

3. Participants will be able to describe how to optimize

team roles

Get the Most Out of Your Zoom Experience

• Send your questions using Q&A function in Zoom

• Look for our polling questions

• Recording and slides are available after the presentation on our website within

one week

• Upcoming webinars: Register at www.chc1.com/nca

Community Health Center, Inc.

Foundational Pillars

1. Clinical Excellence- fully Integrated teams, fully

integrated EMR, PCMH Level 3

2. Research & Development- CHC’s Weitzman Institute is

the home of formal research, quality improvement, and R&D

3. Training the Next Generation: Postgraduate training

programs for nurse practitioners and postdoctoral clinical

psychologists as well as training for all health professions

students

CHC Profile:•Founding Year - 1972

•200+ delivery sites

•140k patients

The Community Health Center, Inc. and its Weitzman Institute will provide education, information, and training to interested health centers in:

Visit www.chc1.com/NCA.

Why Primary Care Teams?

Improved clinical

outcomes

Better patient

access and experience

Improved support for

complex patients

Reduced burnout

Become a recognized

PCMH

Formation & Optimization of

Interdisciplinary Care Teams for

Practice Transformation

M a y 9 t h , 2 0 1 7

Casey AlrichCheryl Fattibene

Hello!

National Nurse-Led Care

Consortium

The National Nurse-Led Care Consortium (NNCC) is a membership

organization that supports nurse-led care and nurses at the front

lines of care.

NNCC provides expertise to support comprehensive, community-

based primary care.

o Policy research and advocacy

o Technical assistance and support

o Community health initiatives

Acknowledgments

The NNCC would like to thank Arizona State University,

Interprofessional by Designtm and the National Center for

Interprofessional Practice & Education at the University of Minnesota

for its partnership and collaboration in the development of this training.

Teams and Teamwork in Primary Care

Values/Ethics for Interprofessional Practice

• Work with individuals of other professions to maintain a climate of mutual respect and shared values.

Roles/Responsibilities

• Use the knowledge of one’s own role and those of other professions to appropriately assess and address the health care needs of patients and to promote and advance the health of populations.

Interprofessional Communication

• Communicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease.

Teams and Teamwork

• Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, delivery, and evaluate patient/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable.

Core Competencies for Interprofessional Collaborative Practice (2016 Update)

Interprofessional Education Collaborative (2016)

Defining Your Team

Patient Family

Community

Primary Care Provider

Student

Social Worker

Registered Nurse

?

Behavioral Health

Communicating Effectively

Effective Communication

Organized Concise

Easy to understand

Respectful

SSituation

BBackground

AAssessment

RRecommendation

COMMUNICATION

TOOL #1: SBAR

S = Situation

A brief and focused description of the problem or need.

Presentation of the situation usually includes:

Name and location of the patient.

Description of the problem:

o What’s the problem?

o When did it start?

o How severe is it?

Description of the situation is usually 1-3 sentences.

B = Background

Essential information related to the problem/need.

Presentation of background may include:

Brief demographic information (e.g. age).

Diagnoses related to the problem or need.

Brief history.

Current medications, allergies.

Most recent vital signs.

Relevant test results including date and time; results of previous tests for

comparison.

Other team members and community services.

A = Assessment

Your focused assessment of what is happening.

Your assessment will be based on the situation and background, your

role, scope of practice, and may include:

Significant change in an ongoing problem.

Preliminary diagnosis or concern regarding acute problem.

Issue with medication taking, adherence, and/or interaction.

Inadequate community supports.

R = Recommendation

Your recommendation of what should be done to address the problem or

need.

Your recommendation should be consistent with your role and scope of

practice and may address:

Appointment scheduling.

Tests or procedures.

Treatment or medications.

Interventions and action planning.

Referral needs.

Preparing to Use SBAR

Assess the situation, scenario, and gather information.

What is going on?

How is he/she experiencing the problem or need?

Current medications, labs, functional assessments, and related dates?

Review the health record for information relevant to the problem or need.

What are the physical and behavioral health problems/diagnoses?

What has happened recently?

Ask team members for information relevant to the problem or need.

What can they contribute to defining or understanding the problem?

Identify who you plan to contact/involve in the patient’s care.

What information will they need?

Build Your SBAR

Item Definition Example

(S) SituationOne sentence description of

needPatient arrived for appointment on wrong day.

(B) Background

Details that give information to

make an assessment. (Can be

from patient’s view and from

your clinical view as you inquire

and research)

1. Patient arrived for 11 am appointment today.

2. Appointment is at 11 am tomorrow.

3. Patient comes from 40 miles away.

4. Patient needed to have friend drive them to

appointment.

5. Team member X has 1+ appointment available

on schedule.

6. We don’t know if the mistake was with the

patient or the call center.

(A) Assessment Your position on the issue We should see the patient today.

(R)

Recommendation

Your specific method for

solving the problem

I recommend that we use the 1+ time or have team

member see this patient.

Scenario 1: Patient came in on wrong

day for appointment, agitated and

wants to be seen.

COMMUNICATION

TOOL #2: HUDDLEHuddles are short, daily meetings

in which a “teamlet” or pod (a

Primary Care Provider/Clinician

and a Medical Assistant and

other support staff) reviews their

patient list for the day for

coordination, continuity, and

efficiency.

Characteristics of

Successful Team

Huddles…1

Huddles typically last no more than 10 minutes.

Scheduled time and place.

Identified team members are present (start/stop on time).

No interruptions rule: This rule reduces distractions of phone calls,

emails, or other items.

Characteristics of

Successful Team

Huddles…2

Close proximity

Time and communication efficiency: SBAR

Formatted for your clinic practice-patient needs

Routine and roles assigned (facilitator, timekeeper)

All inclusive: team-based, everyone contributes

Formatted for your team

Characteristics of

Successful Team

Huddles…3

Pre-work completed/use of tools (SBAR, checklists, agenda, shared

documents, chart review)

Addresses whole person interprofessional care

Assess, adapt, and adopt

Practice, practice, practice

Roles and Responsibilities

for Effective Teamwork

All roles are understood and respected.

Scope and responsibilities of each role are explicit.

Each team member understands how his/her role

fits in the work of the team.

Role Clarity

Competencies

Scope of practice

Licensure

Values and ethics

Education / accreditation

standards

RACI Matrix

Responsible, Accountable, Consulted, Informed

Defining these roles for a task improves clarity,

ownership and communication

Identify functional roles (e.g., front desk, RN, etc.)

Identify activities or decisions

Good for QI projects or introducing new EBIs

RACI Matrix Example

Institute new colorectal cancer

screening

Medical

Directo

r

RN MA Clinic

Directo

r

Studen

t Intern

Research new iFOBT colorectal cancer

screening toolR I A

Arrange for training for iFOBT work flows R C

Create new screening protocols R C

Identify patients in need of screening in

the EHRI R I

Educate patients and provide iFOBT

cardsR I

Run weekly reports to see how many

returned cardsI R

Call patients to remind them to return

cards or discuss follow-upC R

Responsible – Does the task, one per row

Accountable – “Buck stops here”, not necessary

Consulted – Prior to task, someone affected

Informed – After the fact, useful to know

Optimizing Team Roles

Optimizing Team Roles

Demand

Team composition

Visit scheduling

Workflows

Optimization Principles

All team members work to their highest level of expertise, skill

and licensure.

Team composition driven by:

o patient/family/population needs and

o characteristics of practice.

Look for potential for cross-training to maximize flexibility and

flow.

Outcomes of Role Clarity

and Optimization

Realistic expectations of team members

Efficient workflow

Improved decision-making

Team member satisfaction, perception of being

valued

Less conflict

Building Continuity

What’s Your Script?

Introducing Team Members

to Patients and Families

1. Greet and introduce by name

2. State role on team

3. Explain purpose/focus of interaction

Introducing Team Members

to Each Other

1. Introduce by name and role:

“I am a medical assistant, nurse, student…”

2. Describe focus of work and contribution to team:

“I support the work of the team by…”

3. Share information about specialized education, certification

that relate to work with patients and families as useful:”

“ I have specialized education in diabetes care”

Strategies and Tools to

Engage Patients and

Families

Visual education

Welcome center

Resources

Scripts

Display patient

feedback and

success stories

Facilitation

Adapted from: ASU Interprofessional by DesignTM Teaching & Learning Strategies

Interactive Training Methods

Demonstration / Consensus Building

Case Studies

Role Play ScenariosSelf-Appraisal / Reflective

Practice

Video Checklist

Resources

▪SBAR training videos:

▫https://www.youtube.com/watch?v=CtdNQ-sfKg8

▫https://www.youtube.com/watch?v=fsazEArBy2g

▪Huddle Resource Guide

▫https://cepc.ucsf.edu/healthy-huddles

▪Care Team Redesign Case Studies

▫https://www.niddk.nih.gov

▫https://www.brookings.edu/research/redesigning-the-care-team-the-critical-role-of-

frontline-workers-and-models-for-success

▪RACI Matrix Tutorial

▫https://www.smartsheet.com/comprehensive-project-management-guide-everything-

raci

Final Questions

THANKS!

Cheryl FattibeneChief NP Quality Officer

cfattibene@nncc.us

Casey AlrichNP SAN Director

calrich@nncc.us

Tiffanie DepewNP SAN Project Manager

tdepew@nncc.us

Reminders

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