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LA Net Presentation to PCPWG Workgroup

Training Practice Facilitators
LA Net’s lessons learned
Lyndee Knox, PhD
L.A. Net
Los Angeles Ca
[email protected]
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
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
Zoe-Anne Fitzhugh, RN,
Aminah Ofumbi, MSN
June Levine, RN
Director of
Facilitation Services
Vanessa Nguyen, MPH
Christine Edwards, PhD
To access the “herding cats” video that was played, go to:
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
AHRQ Care Model Facilitation in the Safety Net
Change package &
Toolkit for guiding
practices through
Working in 18 Community Health Center
X 10 months
All on-site
PF + academic
Practice led w/
focus on CCM
Dimensions of Facilitation
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
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
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
• Change model, change model, change model
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
RN trainer
Mechanism for tracking PF progress (Survey Monkey) to guide training/feedback/supervision
Mechanism for tracking practice progress
Meeting space
• 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
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
• 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)
Lessons learned - Content
– 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
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
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
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:
• Thanks & Questions?
Estimated cost and infrastructure needs
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
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