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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
Casey AlrichNP SAN Director
Tiffanie DepewNP SAN Project Manager
Reminders
Complete our survey!
Sign up at www.chc1.com/NCA
