Wednesday, July 6, 2016

Clinical Research Oriented Workshop (CROW) Meeting: July 1, 2016

Present:   Marianne Burke, Justine Dee, Nancy Gell, Kairn Kelley, Ben Littenberg, Gail Rose, Adam Sprouse-Blum, Connie van Eeghen

Start Up: Receiving gifts for speaking engagements… call Victoria Jones if you have questions.  

1.                   Discussion: Feedback on case study example for Practice Facilitator learner in PCORI study, in particular whether it meets the goals and how to improve it
a.       Goals of case study
                                                   i.      Understand what A3 looks like when used by office practice
                                                 ii.      Reinforce key IBH tactics
b.       Case Study that will be used as part of a 12 hour online asynchronous training module (supplemented by synchronous support) for facilitators, with Lee Bryan, to guide a person in a primary care practice, new to BHI, facilitation, AND LEAN to know how to facilitate Integrated Behavioral Health (IBH).
c.       Title/Problem Statement
                                                               i.      Why call it title? Problem would help frame
                                                             ii.      Patients identified by whom?
                                                           iii.      Not receiving appropriate care (what kind of care?)
d.       Background
                                                           iv.      It’s a TOOL, don’t put anything in here that you’re not likely to need to go back to. To capture issues that should be present in the thinking of the other boxes.
                                                             v.      BG (typo, BH)
                                                           vi.      Too terse (scheduled? Get seen? Still in treatment? Disappeared?) (failure to schedule, don’t show up to first appointment, etc.) What does still in treatment mean
                                                          vii.      Team develops this so they know what it means, want to model shorthand, but hard to model this clearly for a learning example
                                                        viii.      Link the training as clearly to the example as possible (work the case example as you go)
                                                            ix.      Barriers to access: Functional ability is very broad (obstacles to getting to the office: transportation, childcare, stigma, anxiety, organization, personal limitations)
                                                             x.      Trying to teach them how to do a good background (warm up and tell themselves what’s going on in the practice around BHI) to lead into the question “How does it work?”
1.       “TELL ME WHAT YOU ALREADY KNOW.” Tell me what causes the problem
2.       Drivers/what’s causing this problem often come out, but that’s not the purpose of background
3.       Get them warmed up, thinking broadly about what’s really going on in this practice, serves as a list to go back to when issues get brought up but might be forgotten (issues that we shouldn’t lose sight of)
                                                            xi.      No such thing as a bad background, it’s a learning tool.
                                                          xii.      What’s the relationship between the issues in the background and the issues in the “issues the team identifies”? Issues are identified from the current process step, the background sets the stage to draw the process and learn how to understand what’s not working in the background.
                                                        xiii.      Is this where venting comes in? People need a spot to get the psychological blocks cleared, and people learn it’s a safe spot for discussing problems with creativity
e.       Current State
                                                        xiv.      It’s hard for people to scale minutes to days (ok to put 2 days in parentheses or an asterisk to point below, ok to explain scale is always supposed to be in the same units)
                                                          xv.      Check in min-max: standing on line in check-in is part of check in from the patient experience (but this process is done from the staff person), currently buried in the delay beforehand
f.        What are the goals for each section, explain them, check the contents of the box to see if they demonstrate it well
g.       Next: make a pencil example, popup example of what should go in [section] interactive form to train the facilitator, then they need a real problem they’re working with (that’s what need the case study)
h.       Before one can produce an A3 one needs to define a process with a customer [What’s an A3 kind of problem?] Useful for process driven, demonstrate they can pick good problems (within domain of BHI there are lots of bad A3 problems. **** give multiple choice examples **** should we tackle this or that? Need a customer they can get feedback from. We ought to be working on wait time, work-space problem, lighting, etc. From Ben “Here’s what it requires, here are some examples of great questions and lousy problems, who is the customer and what are the process steps, if you can’t answer those questions it’s not for A3, red x and green check.” Box. Think of a problem, write down the problem name. Who is the customer? How can you know? What are the process steps?”
i.         Next step: refine and revise case study.
2.                   Future meetings
a.       Stay with current time of Thursdays at 1:30 until end of August.

3.                   Next Workshop Meeting(s): Fridays, 1:00 p.m. – 2:00 p.m., at Given Courtyard South Level 4.   
a.       July 8: (no Gail) Nancy – draft of paper
b.       July 15: (no Gail) Justine – preliminary stages of research, with educational training module and focus group
c.       July 22: (no Ben, no Gail)
d.       July 30: (no Ben)

Recorder: Kairn Kelly mostly, with formatting by Connie van Eeghen

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