PCMH Health Workforce-in Montana Community Health Centers

Paula Block, RN

Montana Primary Care Association,

pblock@mtpca.org / 406.442.2750

Montana Community Health Centers

Clinic Mighty Mouse- workforce

Workforce Changes Focus on Team that really supports patient care processes

and provider work- using MAs or Medical Assistants 2 MAs per provider, one doing direct care and other

administrative support

MA leads the daily team huddle, (have done the pre-work, know patient needs)

MAs- coordinate clinic flow and operations. (MAs empowered once they know expectations and the big picture.)

‘Quality Nurse’- population management & QI

Standardized workflows & defined job duties (backed by standing orders)

Clinic Mighty Mouse- training

Training Needs On-line web program for staff office

training, (includes PCMH type trainings such as cultural competency, goal setting, patient safety, motivational interviewing, care planning)

Providers assess clinical support staff training needs and help train

Communication emphasis for all on ‘how to talk to patients’ (helps spread PCMH message to patients)

Clinic Big & Beautiful- workforce

Workforce Changes Strategic planning on PCMH tenets of care

Who does work now? Can we ‘back it up’? (receptionist prints med list for patient to review with nurse)

Ongoing and continual review & re-review!

Care teams Share office, (providers, MAs, nurse, admin assistant, &

more)

Nurse leader of patient care team

Use ‘Special Teams’- lab, x-ray, triage, outreach

Chart & dictation staff now part of team as admin support

Use EHR in disciplined, structured, supporting way

Clinic Big & Beautiful- training

Training Needs Microsoft Excel- nurses and MAs (sort

& filter skills needed for population management)

Facilitative Leadership- management staff

EHR- ongoing

Lean / other QI improvement models, communication, IHI team based care, motivational interviewing, patient self management, behavioral change, population management, health literacy, using evidence to improve care

Tool- Team Visualization or “Jelly Beans”

See AHRQ site “Implementing Care Teams”, for directions

Below is a common result

Tool- Task Assignments

See AHRQ’s “Implementing Care Teams” for directions

Above is an example

Ask 3 questions What is task?

Who does it now?

In perfect world, who could do it?

Task Who does it? Who could do it?

Book appointments RNs, Clerical Clerical

Triage RNs & MDs RNs

Med refills RN, MDs & clerical Clerical with MD

Suture removal MD RN

Dressing change MD, RN MA

Resources

Facilitative Leadership, www.interactonassociates.com

Team exercises on AHRQ, under “Implementing Care Teams”, http://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/pfhandbook/mod19.html

Lean for health care, http://leanhealthcarewest.com/

IHI, (Institute for Healthcare Improvement), www.ihi.org

Web on-line learning example, www.essentiallearning.com

Goal setting, Comprehensive Motivational Interventions, www.comprehensivemi.com/about/brief-action-planning