NavigatingVirtual

FacilitationVanessa Nguyen, MPHKris Neuhaus, MD, MPHVictoria Hall, RN, MPH

http://www.sambradd.com/facilitation-resources-communities-of-practice/

http://www.sambradd.com/facilitation-resources-communities-of-practice/

WAIT, YOU WANT ME TO DO ALL THIS VIRTUALLY??

http://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/pfhandbook/fig3.1.gif

Medium Opportunity Challenge/Obstacle

Text communications • Email • ‘live chat’

i.e. Gmail, ICQ

Cost-effective, generally accessible, easily learned and used by most people Quick, succinct information sharing

May complicate relationship building efforts through misinterpretations. May be seen as less formal, less thoughtful

Web conferencing (audiovisual) • GoToMeetin

g, WebEx, Google Hangouts

Provides opportunity for face-to-face interaction Enhances relationship-building among team members in different locations

Need appropriate equipment: webcam, microphone for computer May be new to some people; are they willing to learn?

Other online tools • Collaborativ

e workspaces

• Remote access: GTM, TeamViewer

• Doodle, etherpads

People in different locations can work on the same document/computer Allows for editing, feedback & information sharing in real-time

May be new to some people; are they willing to learn?

VIRTUAL TEAM BUILDING

We don’t have Counselor Troi

… to advise us on matters of protocol.

WEARE

TRIBAL

Initial assessment of virtual team Challenge level Specifications

FACTORS LOW MED HIGH DESCRIPTION

Team issues

Project goals x Team composition x Team tasks x Time frame x

Boundary issues

Organizational x Cultural x Language x English, bi-lingual Spanish, PortugueseTime x 4 zones, confusion scheduling meetingsDistance x too far to travel for most sites

Organizational Policies

Nature of organization solo, LLC, large multi-specialtyHR policies x IT policies x Security policies x Knowledge management x Financial barriers x cost for dedicated site manager time

Technology issues

Availability x variable registry functionCompatibility x multiple EHRs, CDS (third party pop health)Competence x varied knowledge/skill with EMR function

TOTAL (add checks for each) 5 10 2  

LOW TOUCH MEDIUM TOUCH HIGH TOUCH

Text-based communication may be adequate:•Email•Home page referral

“Rich channels” needed:•Telephone•Video conferencing•Live chatting

Whenever possible:•Face-to-face contact•Frequent “rich channel” follow-up

•Routine project and tasks•Experienced virtual team members•Within one organization•High levels of organizational support•Suitable technology available•Short term project, tight deadline

•More complex project•Little or no virtual team experience• Inter-organizational team•Varying levels of organizational support•Unequal access to technology

•Complex, non-routine tasks•Little or no virtual team experience• Inter-organizational team•Varying levels of organizational support•Unequal access to technology• International/intercultural team/different languages•Long time frame

PRACTICAL ASPECTS

Addressing VF LimitationsBiggest challenge - participants are/become noncommittal so can (appear to) be inaccessible• Identify precise communication barriers:

technology, time, interest? (go back to template/re-evaluate)– Leadership buy-in? “Sell it” again– Stay close to those who are accessible and

committed– Replace participants or adopt substitutes

• Reevaluate goals – are they obtainable?

Addressing Common Limitations of VFUsers may become non-committal and (at least appear to be) inaccessible

Identify precise communication barriers: technology, time, interest? • Leadership bought in?• Replace participants or adopt

substitutes• Stay close to those who are

accessible and committedReevaluate goals – are they obtainable?Find ways to make your work relevant to their other priorities

Users may be unfamiliar with virtual technology

• Assess willingness to change/learn • Start with more traditional

technology (i.e. phone, email, letters) to teach about newer technologies

• Find ways to make virtual technologies applicable to work being done outside your specific project

Takes longer time to build trust

• Allow for extra time at the beginning in project timeline to allow for the creation of team processes

• Create opportunities for informal interactions to help develop rapport

Lessons learned from CKD

• Data from study–Practices are highly driven by performance

data –Practices are juggling many competing

demands; ideally your project should coincide their current priorities/goals –Work towards 1-2 specific, measureable,

realistic goals • Change takes time & their will likely be unexpected challenges along the way

• Allow time for relationship/team building

Tips for success~ Know the territory ~

• Become very familiar with clinic systems– Leadership structure– Health IT: EMR, CDS– TRANSLATE example?

• Find/know your place on the team

Tips for success~ Equip team ~

• Clearly define objectives, roles and responsibilities• Standing meetings, send

meeting reminders• Keep it short and simple,

avoid information overload• Teach by example• Ultimate goal = make

yourself unnecessary

Tips for success~ Build relationships ~

• Communicate! – the good, bad, and the ugly – transparency builds trust• Follow-through is crucial• Be flexible and adaptable to

last-minute changes – the practice comes first• Celebrate milestones!

Distance shouldn’t be a factor in a relationship but communication, trust and commitment should be.

Acknowledgements

Linda Kahn, PhDBonnie Vest, PhDNadia Ramos, BA

Emily Bullard, MPH

Lyndee Knox, PhD

Chester Fox, MD

Resources: is.gd.vf101