1. Training Practice Facilitators LA Net’s lessons learned Lyndee Knox, PhD L.A. Net Los Angeles Ca Lyndee.knox@gmail.com

2. LA Net Practice Based Research and Resource Network – 23 FQHCs/CHC – 165 practice sites Focused on improving the health of low-income communities through – Provider & community led research & advocacy – Identification and translation of innovations in primary care – Quality improvement

3. LA Net’s practice facilitation program Team approach – 5 Facilitators (2 FTE, 3 part time consultants) – Expert consultants on PCMH, Lean, innovation Focused on Care Model and PCMH transformation

4. http://www.lanetpbrn.net/wp- content/uploads/2010 /08/Zoe- e1281642153733.jpg June Levine, RN Director of Facilitation Services Zoe-Anne Fitzhugh, RN, MS, CCRN, CHES Vanessa Nguyen, MPH Christine Edwards, PhD Aminah Ofumbi, MSN

5. To access the “herding cats” video that was played, go to: http://www.youtube.com/watch?v=m_MaJDK3VNE http://www.youtube.com/watch?v=m_MaJDK3VNE

6. Currently Funded by AHRQ to Develop Consensus Report on Practice Facilitation (2010) Develop “how to manual” for starting and running a facilitation program w/ experts in PF (currently underway) Describe process of training and supporting PFs to deliver QI to safety net practices using AHRQ’s Care Model Change Package/Toolkit and assess impact

7. AHRQ Care Model Facilitation in the Safety Net Change package & Toolkit for guiding practices through comprehensive change

8. Working in 18 Community Health Center practices

9. onsite long distance All on-site complex simple PF + academic detailing months years 10 months prescriptive practice driven Practice led w/ focus on CCM X X X X X Weekly daily monthly Dimensions of Facilitation

10. Change Model Phase 1: Getting started – relationship building Phase 2: Assess data and set priorities Stage 3: Redesign care and business systems QI skills Panels management Patient care plan and patient centered care Health literacy needs addressed and appropriate information Depression screening Planned interactions & pre visit planning Self management and connections in the community Eligibility & insurance up to date Cycle time, advanced access Stage 4: Continuously Improve Performance and Sustain Changes Overcome barriers Leverage grant funding and pursue enhanced reimbursement Leverage community resources Find exemplars Prepare for PfP

11. How staffed Hired 5 PFs in Summer of 2010 – 2 newly minted MPHs (2 FTE) – 2 RNs (1 FTE) – 1 PHD CME educator (.5 FTE) Selection criteria – Excellent people skills – Willing to learn – Commitment to mission of supporting PCPs & poor – Prior experience in QI or clinical setting desirable but not required

12. Training our PFs – Core competencies from Consensus Meeting 1-week intensive – ARHQ Toolkit & Change package – Basics of QI – Assessment/measurement skills – Academic detailing w/ 8 practices – Documentation (Encounter forms, Practice progress) Weekly training & supervision based on their experiences in field Leadership buy-in Collecting and reporting data that matters (optimizing registry use!) Change model, change model, change model

13. Costs and infrastructure needs COSTS of Training NOVICE PFs w/ FEW EXISTING training resources/IN PERSON - $69,909 1-Week Training - Total = $11,769 – Trainer: $5000 Travel & hotel – Time of PFs: $5769 – Admin support & Materials: $1000 Weekly training = $3507/month or $35,070 over 10 months – Trainer=$1200/month (4 hours @$75/hr) – PF time =$2307/month Supervision= $2307/month or $23,070 over 10 months INFRASTRUCTURE RN trainer Mechanism for tracking PF progress (Survey Monkey) to guide training/feedback/supervision Mechanism for tracking practice progress Meeting space

14. Lessons learned-GENERAL PRINCIPLES Needs to be ROBUST and help keep PFs FOCUSED (lost in poppies) Needs to be INTERNALLY CONSISTENT–Start w/ change model, then define core competencies, then develop curriculum and reporting tools Needs to be designed for DOUBLE USE – for PFs, and then by PFs w/ practices. (micro-modules – 15 min chunks) Regular REPORTING IS an ESSENTIAL PART of training. Cannot do good training without this. PF progress & Practice Progress (practice registry) IT and the WEB are your friends. Collaborative software like BASECAMP and DROPBOX, gotomeeting, Survey Monkey, and YAMMER can help lower costs for training

15. Lessons Learned: General Principles Supporting a “real time” KNOWLEDGE NETWORK across your PFs is very valuable and may lower formal training costs and improve outcomes (Yammer) Who you choose to lead the training is important. If they don’t BUY-IN to your change model your training will suffer Needs to model EMPOWERMENT and CAPACITY building (same as you want PFs to do w/ practice)

16. Lessons learned - Content NEED DEEP SKILLS IN – Setting up basic QI systems and teams (our practices didn’t have them) – Registry use and optimization, EHR use for same (for QI data and pre visit, planned care, etc.) – How to get practices to buy-in to collecting and using data for change and setting up systems in practice to do this – When to empower, when to “do for” – e.g. Concepts of empowerment and the developmental process that goes with this (knee jerk – don’t do for them does not work) – Doing environmental scans of community resources, QI projects, expertise in practice, expertise outside of practice AND REACHING OUT

17. Lessons learned – Mechanisms Continuous learning may be most potent – YAMMER for at the moment learning (need smart phone) Need low-cost REPORTING format that PFs can maintain and get reports from (Survey Monkey –not quite enough) CENTRALIZED/COLLAB TRAINING w/ other groups (OKPRN – Jim Mold) Need COLLABORATIVE software platform like BASECAMP and DROPBOX for training & for practices Need CURATED quick and easy tools for PFs to use in key areas such as: QI plan generator, Data wall/dashboard/project board, Presentation templates

18. Our situation Small Non-Profit Hard to fund this type of work Want to sustain PFs in L.A. County indefinitely to support QI in safety net, and knowledge generation/sharing

19. Where we are headed Focusing on: Lowering costs, Double use, & Keeping PFs on track/expert systems so less experienced can do ORIENTATION – (core competencies and based on key drivers model) – Self-study introduction using Hogg Manual, AHRQ Toolkit – Shared training w/ other PBRNs/organizations (OKPRN,others?) – Two-day FIELD EXPERIENCE- Shadowing existing PF MONTHLY TRAINING based on weekly REPORTING & change MODEL provided through WEB – Use SURVEY MONKEY for reporting – Use Collaborative IT platform using BASECAMP AND DROP BOX (Project ECHO) – Building “bank” of training modules – eventually on You Tube? DAILY SUPPORT - through learning/knowledge network using YAMMER w/ a network of PFs & expert consultants (need smart phone, issues re: confidentiality)

20. Thanks & Questions?

21. Estimated cost and infrastructure needs Infrastructure Bank of training materials (micro modules) from multiple organizations.25 FTE coordinator ($18,750 or in-kind) Introductory training (25 hours) $1,000 PF time You Tube videos or centralized resource Field visit Monthly web training (Centralized or using existing micro modules) Survey monkey for reporting = $90/month (not optimal) Platform for web-based training – GotoMeeting or EVO= $90/month or free – Exploring Project ECHO model for multi-uses – Basecamp or similar Continuous learning (need smart phones & shared email address) Yammer = $90/month Training coordinator =.25 FTE or more?