Download A Practice Coaching Manual - Improving Chronic Illness Care PDF

TitleA Practice Coaching Manual - Improving Chronic Illness Care
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Table of Contents
                            Integrating Chronic Care and Business Strategies in the Safety Net: A PRACTICE COACHING MANUAL
	Table of Contents
	Acknowledgments
CHAPTER 1Introduction
	CHAPTER 1: Introduction
CHAPTER 2What is practice coaching?
	CHAPTER 2: What is practice coaching?
		Why Practice Coaching?
		What Roles Do Practice Coaches Play?
		What Do Practice Coaches Do?
		How Is Practice Coaching Structured?
		Who Serves as a Practice Coach?
		Which Practices Benefit From Coaching?
		Does Practice Coaching Work?
		What Makes a Good Practice Coach?
		How Much Does Coaching Cost?
		How Does Coaching Compare to Participating in a Collaborative?
		Successful Coaching Case Study #1Coaching Preventive Care Improvement in Primary Care Practices34-36
		Successful Coaching Case Study #2Coaching Local Development of Interventions To Improve Depression Recognition and Treatment in Substance Abuse Clinics27
CHAPTER 3An approach topractice coaching
	CHAPTER 3: An approach to practice coaching
		In a Nutshell
		PHASE I: Laying the Foundation for Success
		PHASE II: Active Practice Coaching
		Suggested Modifications to our Practice Coaching Approach
References
	References
Appendix of Meeting Agendas and Tools
	EXAMPLE: Practice Team Orientation Call Agenda
AGENDA
	EXAMPLE: Practice Team Site Visit Preparation Call
AGENDA
	EXAMPLE: Assessment Day Agenda
TEAM MEETING         1:00 – 2:00
PRACTICE OBSERVATION        2:00 – 4:30
	TOOL: Clinic Observation Assessment
Self-Management Support
Delivery System Design
Decision Support
Clinical Information System
Community Resources and Policies
Health Care Organization
	EXAMPLE: Learning Session Agenda
Reflections on where we are         1:00 – 2:55
Break           2:55-3:10
Where To Start          3:15 – 4:50
Wrap-Up & Next Steps        4:50 – 5:00
	TOOL: The “Change Your Practice” Menu
	TOOL: Getting Started Logistics
	TOOL: Tell Us What You Think!
PART 1:  Circle the number of the statement you most agree with.
PART 2:  Write any additional comments that may help the trainers improve.
                        
Document Text Contents
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Integrating Chronic Care and Business
Strategies in the Safety Net:



A PRACTICE COACHING MANUAL













Written by Katie Coleman, Marjorie Pearson, and Shinyi Wu

Edited by Cindy Brach





Prepared for Agency for Healthcare Research and Quality

U.S. Department of Health and Human Services

540 Gaither Road, Rockville, MD 20850 | April 2009 | WWW.AHRQ.GOV

Contract No./Assignment No: HHSA2902006000171

http://www.ahrq.gov

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Table of Contents


Acknowledgments............................................................................................ 3

CHAPTER 1: INTRODUCTION .............................................................................. 5

CHAPTER 2: WHAT IS PRACTICE COACHING?........................................................... 9
Why Practice Coaching? .................................................................................10
What Roles Do Practice Coaches Play?................................................................11
What Do Practice Coaches Do? .........................................................................11
How Is Practice Coaching Structured? ................................................................13
Who Serves as a Practice Coach? ......................................................................14
Which Practices Benefit From Coaching? .............................................................14
Does Practice Coaching Work?..........................................................................15
What Makes a Good Practice Coach? ..................................................................16
How Much Does Coaching Cost? ........................................................................18
How Does Coaching Compare to Participating in a Collaborative? ...............................18
Successful Coaching Case Study #1....................................................................20
Successful Coaching Case Study #2....................................................................21

CHAPTER 3: AN APPROACH TO PRACTICE COACHING ...............................................22
In a Nutshell ..............................................................................................23
PHASE I: Laying the Foundation for Success .........................................................24
PHASE II: Active Practice Coaching....................................................................27
Suggested Modifications to our Practice Coaching Approach .....................................35

REFERENCES.................................................................................................37

APPENDIX OF MEETING AGENDAS AND TOOLS ........................................................41
EXAMPLE: Practice Team Orientation Call Agenda.....................................................42
EXAMPLE: Practice Team Site Visit Preparation Call ....................................................43
EXAMPLE: Assessment Day Agenda .......................................................................44
TOOL: Clinic Observation Assessment ...................................................................45
EXAMPLE: Learning Session Agenda ......................................................................47
TOOL: The “Change Your Practice” Menu ...............................................................49
TOOL: Getting Started Logistics ..........................................................................51
TOOL: Tell Us What You Think!............................................................................54





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PHASE II: Active Practice Coaching

The second phase of the project was active practice coaching and lasted about six months.

The six month design was an attempt to provide inexpensive and time-limited technical

assistance to help teams get started. We know that six months of technical assistance is short

compared to other quality improvement initiatives, and it may be insufficient for teams with

little or no prior experience with quality improvement. This phase consisted of five activities.

ACTIVITY 1: Introduce Prework and Prepare Practice Team for Site Visit

As with the practice team orientation call, all members of the team and the practice

leadership should participate in this meeting to introduce prework and prepare the practice

team for the first site visit. In this AHRQ pilot, we conducted this call about three weeks

before the learning session, allowing the site time to complete those elements of the prework

that had to be done before we arrived: the clinical assessment, the financial assessment, and

the Assessment of Chronic Illness Care (ACIC). Participants included the medical director of

the site, administrative director of the site, physicians, nurses, medical assistants, front desk

staff, and ancillary clinical staff, including dietitians and nurse care managers.

The primary purpose of this call was to discuss the plan for the upcoming site visit and to

introduce the prework to the teams. However, it is likely that some new staff will

participate, so it may help to conduct a brief refresher of the project and allow time for

questions and answers about the general aims of the program before jumping in. Reminding

the team that this is just a refresher and they can talk with other team members or leaders

or e-mail questions may help keep this portion of the agenda short. For a sample agenda of

the practice team site visit preparation call, see the Appendix.

You’ll notice in the companion toolkit that one of the first steps for teams when they are

working to improve quality is to select measures that are important to them. Data gathered

during prework is primarily for the teams’ use during the learning session to decide what

areas of care they first want to improve. In addition, the data provide a baseline to measure

progress, an important tool for engaging senior leaders. Finally, the data provide the coaches

with some insight into the needs of the teams with whom they are working. Introduce teams

to the prework assessments. Examples of each of the prework assessments are available in

“Integrating Chronic Care and Business Strategies in the Safety-Net” toolkit. They include:

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 Clinical Assessment: Clinics start on their quality improvement journeys by selecting

and measuring the outcomes for a subpopulation of patients. In the case of our

initiative, the sites worked with diabetic patients, so the clinical assessment provided

a baseline of clinical quality for each team’s diabetic population. It is to be filled out

to the extent possible through automated data. If a clinic does not have automated

data, a small chart review may be necessary. Each team is expected to complete this

assessment before the coaches arrive for the learning session. A copy of this

assessment, called Quantitative Monthly Diabetes Report Template, is available in Key

Change 2.3 in the toolkit.

 Financial Assessment: In our experience, the financial functions and performance of

a practice are often fairly far removed from the daily clinical practices. In order to

capitalize on possible reimbursement and cost-saving opportunities, sites can

complete a financial assessment before the coaches arrive for the learning session.

If multiple provider teams within one site are being coached, only one financial

assessment is needed. A copy of this assessment, called Finance Collaborative

Prework, is available in Key Change 2.1 in the toolkit.

 Assessment of Chronic Illness Care: This survey assesses how well teams are set up

to deliver high-quality chronic illness care according to the elements of the Chronic

Care Model. This survey is to be completed by each individual of the clinical team

before the coaches arrive for the learning session. A copy of this survey, called

Assessment of Chronic Illness Care, and a companion Scoring Guide are available in

Key Change 2.1 in the toolkit.

This short prework call also provided an important opportunity to prepare the teams for what

to expect during the coaches’ first site visit. Be sure to allot time to discuss:

 Completing the administrative process assessment: This fun, poster-sized

assessment assesses how well administrative processes such as answering phones and

rooming patients are working. This tool is a poster-sized template that can be printed

and hung on the wall. All staff and even patients are invited to place a checkmark in

the box that corresponds to their perception of the processes. This assessment is

completed during the coaches’ first visit. A copy of this assessment, called Primary

Care Practice: Know Your Processes, is available in Key Change 2.1 in the toolkit.

 Conducting the observational assessment: The observational assessment is designed

to give coaches a sense of how the practice works with patients. During the

assessment, coaches will spend a couple hours looking at the practice supports for

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6. PLAN-DO-STUDY-ACT CYCLES TO GET STARTED WITH:



Description of change Responsibility OCT NOV DEC

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TOOL: Tell Us What You Think!
Date

PART 1: Circle the number of the statement you most agree with.

THE TRAINERS …

Were helpful:


1 2 3 4 5
not at all a little sort of mostly totally



Knew the topic:


1 2 3 4 5
not at all a little sort of mostly totally



Gave us what we needed to get started:


1 2 3 4 5
not at all a little sort of mostly totally



Communicated clearly:


1 2 3 4 5
not at all a little sort of mostly totally



PART 2: Write any additional comments that may help the trainers improve.

Things I liked:




Things I didn’t like:




Other recommendations/comments:

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