PCMH Health Workforce- in Montana Community Health Centers

1. PCMH Health Workforce-in Montana Community Health Centers Paula Block, RN Montana Primary Care Association, pblock@mtpca.org / 406.442.2750

2. Montana Community Health Centers

3. 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)

4. 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)

5. 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

6. 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

7. Tool- Team Visualization or “Jelly Beans” • See AHRQ site “Implementing Care Teams”, for directions • Below is a common result

8. 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?

9. 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