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Coaching for Practice Transformation 2 Elaine M. Skoch, RN, MN, NEA-BC Director, Systems Transformation HealthTeamWorks

Learning Objectives Describe the role of practice coaches in helping practices transform to the Patient Centered Medical Home. Identify the core competencies and elements for successful coaching. Outline possible scenarios for helping practices begin the journey to PCMH 3

So what is a PCMH & how is the PCMH different from the traditional practice of medicine? 4

PCMH Defined A medical home is not simply “a place” but a model of the organization of primary care that delivers the core functions of primary health care. Agency for Healthcare Research and Quality (AHRQ) 5

At its Core…PCMH is about being Patient centered Providing: Comprehensive, continuous and coordinated care Improving access to care Commitment to quality 6

Transformation to the Patient Centered Model of Care is About More than “Checking off the Boxes” 7

Transformation to PCMH Revolves around the patient…is “person centered” Creates healthcare “partnerships” Requires a “systems” perspective Elements are inter-related and interdependent

Transformation to a PCMH (cont.) Calls for leadership, communication & teamwork with a common language & understanding of the goals at hand Requires changes in roles and responsibilities at all levels Team based; relationship centered

Transformation to a PCMH (cont.) Necessitates flexibility Focuses on: Access and barriers to care Care management & care coordination Continuity of care Aided and supported by technology

Transformation… Cannot be achieved merely through new technology Takes time Can take unexpected turns

Creating a Patient Centered Medical Home… Requires attention to relationships: Between the practice and the patient Among members of the practice Between the practice & the community

Elements of the PCMH Patient Centeredness Comprehensive, whole person care Self-management support Improving Access to Care Team Based Care Care Management & Coordination Population Management Performance Improvement Health Information Technology 13

Practice Redesign… Requires review of: Work processes and team structure Organizational structure Utilizing technology to support the delivery of care

The Quality Improvement Coach 15 Supports practices in meeting practice redesign goals Provides expertise that is not currently available resource Advises practices on sequencing and developing timelines Acts as liaison to learning community Builds practice capacity and program sustainability QI Methodology Using Models of Care Understanding Health Systems Art of Facilitation Reprint with HealthTeamWorks Permission Only © HealthTeamWorks

Coaching is: 16 All about relationships Continuous assessment of practice teams, culture and change process Understanding what is (current state) and helping practices create the vision and strategy for the future state Support practices in meeting program/project goals within timelines Reprint with HealthTeamWorks Permission Only © HealthTeamWorks

HealthTeamWorks Core Competencies of QIC 17 Developed from: Chronic Care Model, Joint Principles of PCMH and experience of HealthTeamWorks Core competencies are utilized for the following purposes: Standardize knowledge, skills and abilities that QICs are expected to use with/for practice transformation Allows QICs to self asses their own strengths and areas for improvement Used as a tool for on-going training and education Identified strengths are utilized for peer learning Reprint with HealthTeamWorks Permission Only © HealthTeamWorks

Core Competencies of QIC (cont.) 18 Health Care Delivery System Elements of the Medical Home Leadership and Culture Performance Improvement and QI Tools Evidence Based Guidelines in Care Delivery Data Management Health Information Technology Facilitation Reprint with HealthTeamWorks Permission Only © HealthTeamWorks

Role & Functions of QI Coach What does the Quality Improvement Coach do with practices? Reprint with HealthTeamWorks Permission Only © HealthTeamWorks

Role & Functions of QI Coach Overall Role Functions Facilitator, Teacher, Liaison Role Model Problem Solver Systems Thinker Innovator Good Communicator Supportive and Collegial Motivate practices and individuals Utilize adult learning techniques Understands and implements programmatic charter Learning Community/Collaboratives Reprint with HealthTeamWorks Permission Only © HealthTeamWorks

Role & Functions of QI Coach Monthly Role Functions Review caseload data and narratives Supporting practices QIC assessments on caseload Practice interventions PDSA reviews Meetings with QIC/Program teams Program data meetings Program team collaboration Reprint with HealthTeamWorks Permission Only © HealthTeamWorks

Role & Functions of QI Coach Daily Role Functions Preparations for practice meetings Documentation of practice meetings Scheduling Supporting practices’ needs Providing resources Special Projects Attending team meetings Attending agency meetings Reprint with HealthTeamWorks Permission Only © HealthTeamWorks

Finding Professional Satisfaction in Quality Improvement Coaching 23 Everyday I come to work I know that I am making a contribution to care delivery and increased patient satisfaction. I enjoy the opportunity to help identify and grow informal leaders in the practice and to create shared leadership that promotes engagement and excitement rather than the status quo of traditional (hierarchical) leadership models. I like helping practices think and step outside their box to make changes that will positively affect their patients’ health and lives. I enjoy empowering practices to find solutions to their problems through teamwork. Reprint with HealthTeamWorks Permission Only © HealthTeamWorks

Transformation requires letting go of the familiar and leaving the comfortable behind. 24

Transformation to the Medical Home is a Journey not a Destination! 25

Questions? 26 Elaine M. Skoch, RN, MN, NEA-BC Director, Systems Transformation HealthTeamWorks