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Jessica Langley, MS, Exec. Director of Education and Provider Markets, National Healthcareer AssociationLindsay Gainer, RN, MSN, Director of Clinical Services and Innovation, North Shore Physician Group
Audrey Lum, RN, MPA, Chief Clinical Officer, Union Health Center
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of PAHCOM.
Continuous Workforce Development: The Next Rung on the Medical Assistant Career Ladder
Why do you your MAs?Tell us what kind of imprint they have made within your practice.
Why are we here?
• Care for chronic diseases accounts for 75% of our nation’s spending.
• 1% of health dollars are spent on public efforts to improve overall health
• Nearly half of Americans suffer from chronic conditions.
• Seven out of every 10 deaths in the US are attributed to a chronic condition and almost half of the patients fail to receive the appropriate treatment.
Continuous Workforce Development with a
focus on Medical Assistants
• Professional Evolution• Trends and Drivers• Challenges and Obstacles• Training and Skills Gaps• Elevating the Profession• Why Career Laddering• Examples
– North Shore Physicians Group– Union Health Center
Agenda:
5
• $2.8 trillion in health expenditures
• Millions more patients entering the health care system
• Shortage of 130,000 physicians and 260,000 registered nurses by 2025
• 50% of the 18 million individuals employed in the U.S. healthcare workforce are front line health care workers
Healthcare Trends and Drivers
277h Annual PAHCOM Conference
• Care Coordination (ACOs and PCMHs) and Population Management
• Healthcare Regulation/MU
• Electronic Health Records
• Emphasis on Clinical Outcomes
• Performing to “Top of License”
• Engage and Invest in Front Line Workers
• Career Advancement Opportunities
Professional Evolution
Challenges and Obstacles
• Lack of Standardization– Scope of practice, curriculum, training, education, etc.
• Professional Acceptance (trust and support)• Lack of MA Skills and Professionalism• Executive, Provider, and Staff buy-in• Training Demands (time, resources)
7277h Annual PAHCOM Conference
Training and Skills Gap
Gaps that are critical to patient outcomes. • Communication in all aspects –
with patients, providers, supervisors; written and oral
• Critical thinking, problem solving, knowing when to ask for help
• Documentation and note taking • Injections • Knowledge of anatomy and
physiology • Medical terminology • Medications and pharmacology • Taking patient history and vitals • Triage and evaluating symptoms,
including abnormal lab values
Gaps that are important to the efficiency and effectiveness of the practice. • Coding and billing • Communication skills and abilities,
including tailoring communication to audience (e.g., providers, patients from diverse backgrounds)
• Computer skills, including database management
• Multi-tasking • Prioritization and managing work
load and patient flow; time management
• Professionalism in all aspects – behavior, presentation, punctuality, interactions with staff and patients, meeting office expectations
• Teamwork • Telephone skills and etiquette • Writing ability, including grammar
and spelling
Elevating the Profession
• Education• Credentialing• Partnerships• Team Based Care• Career Laddering
Why are we focusing on career laddering?
• Is the need being expressed by employers or MAs?• What is the driving force to implement a career ladder? • What % of MAs are able/motivated to move forward in their careers?• What kind of post-onboarding training, assessments, or certificates do you offer your
MAs today?• What training are you currently offering, will be offering – is it voluntary or required? • What is your training philosophy around MAs? Is it valued and is budget allotted for
training?
Career Laddering Examples• North Shore Physicians Group
– Lean Transformation– Enhanced Medical Assistant Role– Clinical Curriculum Redesign– MA as flow manager
• Union Health Center– Health coaching for chronic patients– Curriculum Design– Career Ladder: PCA’s, Health Coach, Floor Coordinator
• Southcentral Foundation– Nuka Model of Care– Performing to Top of License– “Grow-your-own” strategy– Career Steps: CMA I, CMA II, and CMA Supervisor
• Northwestern Memorial Physicians Group– Clinical Career Ladder Program for MAs– Requirements: 1 year of employment, must be certified, must be in good standing– 3 Levels: MA, MA I, and MA II
Team Based Care Examples
• Cabin Creek Health System – Preventative medicine and chronic disease management– Senior Medical Home– MAs as health coaches
• University of Utah Community Clinics– Team-based model of care– 5:2 ratio of MAs to providers– MAs as Ambassadors
• Massachusetts General Hospital– MAs as Clinical Partners
• Kaiser Permanente – Northern California– Population Management Assistant
• Cambridge Health Alliance– Planned Care Site Coordinators
• St. Peter Family– Diabetic Care Manager
• University of Utah Hospital and Clinics– Medical Practice Assistant
Benefits and Outcomes
• Increased professional engagement/team work• Maximize practice/operational efficiency
– Increased patient load– Higher patient engagement– Reduced ER visits/Re-admits– Lower no show rates
• Consistent and standard skill training• Increased employee retention• Increased employee and patient satisfaction
NORTH SHORE PHYSICIAN GROUPLINDSAY GAINER, RN, MSN DIRECTOR OF CLINICAL SERVICES AND INNOVATION
Career Laddering and Team Based Care
• Multi-specialty, multi-location physician group
• 11 Primary Care, 8 Specialty offices, 1 Urgent Care, 1 Extended Care program
• Locations - 8 mile radius of NSMC
• Diverse patient population: income, ethnicity, education
• Group employs inpatient and outpatient specialties – 365 Physicians
NSPG Practice Profile
North Shore Physicians Group
The Perfect Storm
Providers Medical Assistants
Burden of Work
Care Model Redesign
Standard Clinical Training Lean Transformation Expanded MA Role Team-based Care
Medical Assisting Training• No standard education upon practice entry• Needed consistent, baseline competencies
for all MAs– Clinical Curriculum Redesign
• Increased need for clinical skills (PCMH)• Physicians needed more assistance• Needed fundamental redesign of care
model
Enhanced Responsibilities• MAs as Flow Managers• Expanded Rooming Process• Ancillary Services• Population Management• Health Coaching• One Call Resolve
Focus on Medical Assistants
Goals of Training
• Create baseline standard competencies for all MAs• Utilize MAs more effectively in patient care delivery• Empower MAs as critical members of the care team• Improve MA job satisfaction and retention• Impact MA quality and performance• Improve provider work-life balance and satisfaction
Best Practices
Flow Manager
Provider and MA work side-by-side at flow station
Single piece flow for all work –No Batching.
MA is the gatekeeper for all work at the flow station
MA is empowered to ensure provider is in flow and on time
Leadership and Professional Development
Medical Assistant Council
Employee Education Assistance Program
Recognition of National Certification
Career Ladder
NSPG Medical Assistant Council
• Formed in 2010• MA representative from each
site• Focused on standardizing and
improving clinical processes• MA Council members serve as
Process Advocates
Employee Education Assistance Program
• Launched in 2011• Funds may be used for a variety
of job-related professional development or continuing education activities
• Lifetime maximum of $2500• Employee commits to 2 years of
employment• NSPG physicians contribute to
the fund annually
• National certification recognized in 2011 • MA Career Ladder launched in Fall 2013
Career Ladder
Career Ladder Requirements
• All current staff received training• Training was highly rated by staff• Managers report improved
teamwork• Increased staff involvement with
patient care• Trustworthy and credible clinical
skills• Strengthened professionalism in
clinical relationships
Outcomes
UNION HEALTH CENTERAUDREY LUM, RN, MPA, CHIEF CLINICAL OFFICER
Career Laddering and Team Based Care
• Comprehensive primary and specialty care center in New York, New York
• 10+ PCPs and 30+ specialists• Received NCQA Level 3
recognition in 2010
https://www.youtube.com/watch?v=2qDd-eUDMzw
Union Health Center Practice Profile
Recognizing a Need
Secured 2 Grants
Developed its own 12 month didactic and clinical curriculum
Trained MAs to take on patient education and coaching activities
Initial MA Training Curriculum• Dedicated two-hour weekly sessions
help during clinic workday over nine months
– Defined scope of MA role in patient care
– Identified gaps in MA communication and clinical skills
– Reviewed basic MA curriculum, tailored to current skill levels
– Taught basic interviewing skills and principles, motivational interviewing, techniques of self-management support
Ongoing Commitment to Education• Weekly Team Refreshers
– Two-hour session every other week for PCAs and health coaches
• Continuous Process Improvement– Teams encouraged to identify inefficient
processes and protocols, pilot potential solutions, successful solutions can be rolled out across the practice
• Health Coach Shadowing– Opportunity for select PCAs with
advanced knowledge to learn from health coaches, train to earn promotion
Training Opportunities
Training Topics for MAs
Health Coach
Career Ladder Empowers MAs
• 1 floor coordi nator per tea m (6 providers )
• 27% pay inc rea se
Floor Coordinator
• 2. 5 heal th coac hes per team (6 provi ders)
• 13%-20% pa y increase
Health Coach
• 1 PCA per provider
Patient Care Assistant (PCA)
https://www.youtube.com/watch?v=01MD4o5jGng
Floor Coordinator•Manages patient flow in clinic across all provider teams•Reviews scheduled patients with PCP each day during huddles•Closes communication gap between PCP and care team
Health Coach•Works one-on-one with patients (12-19 patients/day) to establish self-management goals, conduct telephonic follow-up•Leads group visits for patients with chronic conditions•Meets with social worker and RN case manager to discuss complex cases
Patient Care Assistant (PCA)•Assist PCP with managing patients on the DM registry•Provides basic patient education on chronic conditions, self-management•Works with care team to review charts for preventative protocols•Manages vital signs, rooms patients, pre-visit planning
Career Ladder Levels
Challenges
• Gaining the trust and support of providers• Training PCAs to implement the care model• Building PCAs confidence in expanded role• Changing patient base
Strategies to Improve Provider, Patient Buy-In
Engaging in Program Development
•Clinical staff actively involved in ongoing training development and supervision•Care team RN ensures MAs are performing designated duties effectively•Nutritionist attend a “train-the-trainer” program to learn effective teaching techniques and share with the team
Fostering Ongoing Collaboration,
Teamwork
•Providers lead group visits, encouraged to share any patient concerns with health coach and rest of the team•Team meetings to discuss potential adjustments to health coach role, address inefficiencies, barriers in workflow•Task forces formed to pilot potential solutions and provide update on progress at subsequent meetings
Educating Patients and Caregivers
•Providers encouraged to mitigate patient resistance to new model through warm handoffs to health coaches and PCAs•Patient education materials detail the benefits of the PCA and health coach involvement
Outcomes
Operational Efficiency
Reduced wait time, no shows,
and walk-insPositive Patient
Experience
Increased Patient
SatisfactionImproved Employee Retention
Increased Clinical
Outcomes
+3500 Patients served in 2014
vs. 2010
1. Create the incentive for change/sense of urgency - staff turnover, staff satisfaction, professionalism, career development within the company.
2. Assess financial impact of salary increases to organization to get Executive buy-in.
3. Assess baseline competencies, educational preparation, and certification of current employees.
4. Design an internal educational program to assure standard competency across organization.
5. Design the requirements for the career ladder / Re-write and create new job descriptions.
6. Educate managers on the process of promotion and the application process so that they can coach their staff who wish to advance on the career ladder
7. Go-live with ongoing central support and coaching of managers
How can you start thinking about creating a career laddering program?
• This research is supported by The Hitachi Foundation as part of its Pioneer Employers Initiative
• ©2014 The Advisory Board Company.
All rights reserved.
Resources
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Thank you!
277h Annual PAHCOM Conference
Jessica Langley, MSExec. Dir. Of Education and
Provider MarketsNational Healthcareer
(913) 661-6587
Lindsay Gainer, RN, MSNDir. Of Clinical Services and
InnovationNorth Shore Physicians Group
[email protected] (978) 573-4361
Audrey Lum, RN, MPAChief Clinical OfficerUnion Health Center
(212) 812-3562
