The Power of
Communication in
Practice
Transformation
Presented by
Tracy S. Hofeditz, MD,
FAAFP
Why Better Communication is so
Important
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Becoming a Medical Home depends on
enhanced processes of communication.
Team Based Care is a central paradigm of the
PCMH and is dependent on healthy team
communication.
The application of every one of the Joint
Principles depends on finding better ways to
communicate.
Team Huddles
Anatomy of a Huddle
General Rules
•
Daily meeting at regular times of the day
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Keep huddle to < 10 minutes
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Keep huddles a predictable and consistent
part of the day
Try to make each huddle fun, education and
something to help everyone’s day go better.
NCQA Standard 3C:-The care team manages
patient care in the following ways:
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Non-physician staff remind patients of appointments and collect
information prior to appointments
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Non-physician staff execute standing orders for medication
refills, order tests and deliver routine preventive services
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Non-physician staff educate patients/families about managing
conditions
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Non-physician staff coordinate care with disease management
or case management programs
NCQA Standard 3D:-The physician and nonphysician staff use the following components of
care management support:
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Conducting pre-visit planning with clinician reminders
Writing individualized care plans
Writing individualized treatment goals
Assessing patient progress toward goals
Reviewing medication lists with patients
Reviewing self-monitoring results and incorporating them into the
medical record at each visit
Assessing barriers when patients have not met treatment goals
Assessing barriers when patients have not filled, refilled or taken
prescribed medications
Following up when patients have not kept important appointments
Reviewing longitudinal representation of patient’s historical or
targeted clinical measurements
Completing after-visit follow-up
NCQA Standard 3E:- The practice engages in the following
activities for patients who receive care in inpatient or
outpatient facilities or patients who are transitioning to other
care:
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Identifies patients who receive care in facilities
Systematically sends clinical information to the facilities with patients as
soon as possible
Reviews information from facilities (discharge summary or ongoing updates)
to determine patients who require proactive contact outside of patientinitiated visits or who are at risk for adverse outcomes
Contacts patients after discharge from facilities
Provides or coordinates follow-up care to patients/families who have been
discharged
Coordinates care with external disease management or case management
organizations, as appropriate
Communicates with patients/families receiving ongoing disease
management or high risk case management
Communicates with case managers for patients receiving ongoing disease
management or high risk case management
For patients transitioning to other care, develops a written transition plan in
collaboration with the patient and family
Aids in identifying a new primary care physician or specialists or consultants
and offers ongoing consultation
Problems Prior to Huddles
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Lack of communication
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Employees felt in the dark
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Duplication of work
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Tasks being completed without all
available information or input from others
Initial Problems With Huddle
Process
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Rambled
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Wasted time
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Often focused on negative things
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Phones interrupting our meeting
Uninterrupted Time
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Staff clock in at 8 am.
Phones continue to go to the answering
service until 8:30 am.
First patient is on the schedule at 8:30
am.
Huddle anytime between 8:10 and 8:15
am so that we can be done by 8:25 am.
Solution
Designed P. I. T. format
P atients
I nternal Appointments
T asks
PATIENTS
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Providers lead:
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Identify patients with special needs, or for whom they will need
special assistance.
Update information in the hospital log and facilitate follow-up
from discharge.
Focus on chronic disease patients and confirm flow sheets and
self-management sheets are prepared.
Scheduler often gives additional background for the purpose of the
visit.
INTERNAL APPOINTMENTS
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Practice Manager leads:
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Staff meetings
Meetings with outside resources
Training and appointments outside the office
so they will know when the Practice Manager
is available if they have a question or a
problem to solve.
Deadlines such as timesheets being turned in
and tasks being completed.
Discuss birthday lunch plans.
TASKS
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Practice Manager leads:
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Reports new information about NextGen.
Engages team in very short problem solving
discussions.
Deals with solutions for broken equipment
such as computers, printers, faxes, etc.
Clarifies or answers questions about new
policies or processes.
Materials Needed
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Schedule
Hospital Log
Practice Manager’s Outlook Calendar
Miscellaneous handwritten notes
Length of time 5-10 minutes
Watch for Dysfunctions
in Your Team
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Importance of everyone being involved
and accountable, not just the leaders of
the process.
Leaders must create the environment for
all to contribute to help all be more
successful.
Importance of using reports to judge
progress and for setting goals.
Dysfunction #1
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Absence of Trust
Members of teams with an absence
of trust…
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Conceal their weaknesses
Hesitate to ask for help
Hesitate to provide constructive feedback
Dread meetings
Dysfunction #2
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Fear of Conflict
Teams that fear conflict…
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Ignore controversial topics that are critical
to team success
Fail to utilize input from all team members
Have boring meetings
Dysfunction #3
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Lack of Commitment
A team that fails to commit
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Breeds lack of focus
Undermines success
Revisits discussions and decisions over
and over again
Dysfunction #4
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Avoidance of Accountability
A team that avoids accountability…
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Creates resentment among team members
Encourages mediocrity
Misses deadlines
Places undue burden on team leader
Dysfunction #5
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Inattention to Results
A team not focused on results…
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Fails to grow or improve
Loses achievement-oriented employees
Encourages team members to focus on
individual goals
Members of high functioning teams
will:
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Trust one another
Engage in unfiltered conflict around ideas.
Commit to decisions and plans of actions.
Hold one another accountable for
delivering against those plans.
Focus on the achievement of collective
results.
References
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Lencioni, Patrick; The Five Dysfunctions of
a Team
http://flpbs.fmhi.usf.edu/pdfs/Five%20Dys
functions%20of%20a%20Team.pdf
Huddle Resources
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Huddle video
(http://www.youtube.com/watch?v=Wttxm7jAnb4)
Huddles: Improve Office Efficiency in Mere Minutes (Family Practice
Management 6/07) www.aafp.org/fpm/20070600/27hudd.html
The Teamlet Model of Primary Care. Annals of Family Medicine.
Bodenheimer, T. (2007)
(http://www.coloradoguidelines.org/pcmh/hidden/PPC%203/The%2
0Teamlet%20Model%20of%20Primary%20Care--Bodenheimer-Annals%20of%20FM--2007.pdf)