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Team Training for Transformation*
Collaborate. Innovate. Connect.
Robert Stenger MD, Principal InvestigatorRebecca Morgan, Project Manager
April 28, 2020
*This project is supported by the Health Resources and Services Administration (HRSA) of the U.S.
Department of Health and Human Services (HHS) under T0BHP28582, Primary Care Training and
Enhancement, $1,730,660. This information or content and conclusions are those of the author and
should not be construed as the official position or policy of, nor should any endorsement
be inferred by HRSA, HHS or the U.S. government.
What is the Residency Program?
A three year graduate
training program following
medical school.
During this training, residents
acquire skills, knowledge
and abilities to practice full
spectrum family medicine
in frontier and rural areas.
What is the Family Medicine
Residency of Western Montana?
A three year family medicine residency
Program began in July 2013
Dually accredited – ACGME & AOA
Program based in Missoula and Kalispell,
Montana
A Rural Focused Program with rural
electives and required rural rotations
10 slots per year – Total of 30 slots
Year 1 – All Residents are in Missoula
Years 2 & 3 – 7 Residents in Missoula; 3
Residents in Kalispell
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Our Mission Statement
The Family Medicine Residency of Western Montana program exists
to provide superior, comprehensive education in
Family Medicine. We are committed to developing family
physicians who are compassionate, clinically
competent, and motivated to serve patients and communities
in the rural and underserved areas of Montana.
Rural Network
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Primary Care Training &
Enhancement (PCTE) Grant
One of 32 awardees in the nation
Award of $1.7 million for a 5 year grant
period
July 2015 – June 2020
Four Sub-awards to Rural Communities:
Anaconda
Hamilton
Polson
Ronan
Providence St. Joseph Medical Center
Primary Care Training &
Enhancement (PCTE) Grant
Project Title: Team Training for Transformation (TT4T)
Project Focus & Goals:
Strengthening teamwork & building an engaged, stronger
workforce linking a family medicine residency program & 4 rural
Montana communities
Improving health & quality of care in rural, underserved Montana
Implementation Methods:
Transformation Teams in 4 communities to complete 2 projects
in 5 years
Two in-person meetings per year (March & November)
Incorporating Team Training into the Residency:
Residents participate in team training, learning models for
transforming rural practices & enlisting communities in health
care transformation
Team Member Attributes
Thinks beyond self
Walks their talk
Is curious
Has no pre-set or single agenda
People listen to them
Thinks “outside the walls of the hospital or exam room”
Gets things done
“Believes they can fly” (like bumblebees)
Process for selecting teams &
attributes of ideal team members
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Team Training for Transformation
Transformation Activities
Transformation activities
Form a “transformation team” with interdisplinary members
Hone team skills through training and practice
From seven broad areas, select 2 projects to accomplish
over 5 years
Participate in 3 day “intensives” (training)
Incorporate rotating Family Medicine residents into team
activities
Transformation Project Topics
Transformation opportunities (7 areas):
establish new care models
coordinate care in multiple settings
improve patient/community experience
use health IT to enhance quality
elevate workforce performance
integrate population health into care system
use data to drive system improvement
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Toolkit of Resources Developed
Team Training Curriculum
Team Development
StrengthsFinder, Teambuilding, Team
Dynamics
Quality Improvement
Lean – Value Stream Mapping, A3 Problem
Solving
Project Management
Communication tools, Project Charter,
Complex Change Model
Transformation Teams – A Team of Teams
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Questions?
…to serve patients and communities in the rural
and underserved areas of Montana.
Thank you!
www.fmrwm.umt.edu
Team Training for Transformation
(TT4T)
Marcus Daly Memorial Hospital
Dr. Jones, Kim Suckow, Kathy Padilla, Laurie Pinheiro, Gail Simpson, Mira McMasters
What TT4T did for the project?
• Gift of time
• Helped team determine the project
• Create a “doable” scope of project
• Provided expertise in staff and speakers
• Team Building
• Skill Building
• Think bigger than just MDMH
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Why did we choose depression?
• Recent teenage suicides in community
• Known opportunities in Hospital
• Member of team was concerned about their own
children’s risk of suicide due to pressures
• CMS Measure for the Accountable Care
Organization
• Other measures considered had too large scope
or had been done before
How did we compare?
Rate per 100,000 Population US
2016
Montana
2017
Ravalli
2012-2016
Suicide Rate 13.5 29.6 24.9
StateSuicide
Rate
1 MT 29.6
2 WY 27.1
3 AK 27.0
4 NM 23.5
5 ID 22.8
State Suicide rates retrieved by the CDC for 2017.
County rates 2007-2016 with 95% CL-Karl Rosston Presentation at TT4T on 11/6/19.
2017-Montana was #1 in
suicides per 100,000.
County Suicide Rate
1 Deer Lodge 39.6
2 Rosebud 39.2
3 Roosevelt 38.4
4 Stillwater 34.7
1
0
Ravalli 24.9
Ravalli County in #10 in the State
Why we should have chosen depression?
• Culture change was needed within our organization
regarding mental health
• Depression is one of the most treatable of all psychiatric
disorders.
• For every suicide, there are 25 attempts
• Suicide(s) within 24 hours after being seen in
Emergency/Clinic was happening at our facility
• It’s not just a “clinic” or “ED” problem-Universal Health Care
Screening
• We were not maximizing in the local resources we had to
help our patients
• You can’t help your patients until you help your employees
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Project Aim
Improve early detection of depression and
suicide for appropriate referral/intervention
for patients 18 years and older in multiple
levels of care.
Triggers
suicide risk
assessment
Must Haves
• Commitment
• Research
• Clear Scope of Project
• Physician Champion
• Interdisciplinary Team
• Team and/or Skill Building
• Sustainability plan when project is done
• Ongoing communication outside of team
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Plan• Increased depression screening using the PHQ-2/9
screening tool in the Clinics, Emergency, Observation,
and Inpatient
• Physician Champion (Dr. Jones) peer to peer meeting to
discuss plan and break down barriers
• Leadership rounding with staff to identify barriers when
screening was not done
• (2) Medical Staff Policies and Procedures to assist how
MDMH takes care of mental health patients
• Create a Sustainability Plan to continue project after
TT4T group
ResultsMeasure Goal Baseline EOY 2019 Result
PHQ-2/PHQ-9
Depression Screens
Completed
>55% 10% 70% Screened
4.5% Positive
Screens
• Increased awareness of levels of depression (mild, moderate,
severe, and suicidal) as well a situational depression.
• Increased referrals for positive screens to Care Provider
• Implemented Universal Health Care Screening for Depression
• Debunked myth that resources are not available to help mental
health concerns.
• Expanded scope in 2020 to include Postpartum Screening and
Follow-up using Edenburgh Screen
• Culture shift to see Mental Health as important as physical
health
Questions?
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Hand in Hand for Health
Team Training for Transformation – MHA 2020
Project Description
Our team provided support to the clinician group working with our Integrated Medication Assisted Treatment (iMAT) program.
iMAT funded by the Substance Abuse & Mental Health Services Administration
(SAMSHA) grant
Hand in Hand for Health Mission Statement:
“We will bolster Employee and Community Awareness through outreach, promoting inclusivity and knowledge.”
What is iMAT?
Integrated Medication Assisted Treatment
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TEAM PROBLEM/OPPORTUNITY STATEMENT RISKS ASSUMPTIONS
PROJECT OBJECTIVES(Primary metric & how measured)
PROJECT SCHEDULE(List all anticipated activities & dates)
CURRENT STATE
- New Team at Performing Stage
- Determining members, ad hoc, etc.
TARGET STATE
- Norming by 4/19
- Performing by 6/19
- Quarterly Admin Updates (first one in 6/18)
- Recognizable Logo
PROCESS SCOPE: IN/OUT
In Scope:
- Community Awareness
- Outreach
- Research Support
Out of Scope:
- Interfacing directly with patient care
- Discussing patients
PROCESS IMPROVEMENT CHARTER: Hand in Hand for HealthPROJECT INFORMATION
1) Internal outreach ideas
- Using the data collection to determine the general
perception of the program within Providence St. Joes
2) External outreach ideas
- Safety Fair
- Women for Wellness
- Career Fair
- High School/Parent nights
- Rotary
- Church events
- Diabetes Fair
MEETINGS NEEDED:
Lean & Peer Coach Check-Ins:
11/6/19-11/8/19, Fairmont
Project Team:
Others:
Our team will provide support to the clinician group
working with the Substance Abuse & Mental Health
Services Administration grant (iMAT program). We
will bolster Community Awareness through outreach
promoting Inclusivity and Knowledge.
- Meeting Bi- weekly; is there protected time for
all group members?
- We have all team roles filled (are there creative
opportunities to involve others?)
- We will have a doable task for each resident.
- Our fellow coworkers not involved with the team
understand what iMAT is
- Public Servants know what iMAT is
Project Team & Roles:
Lisa Grainey*
Eristina Moore
Shelbie Piedalue*
Mike Watkins*
Maria McNeil-Williams*
Operations/Process Leaders:
Shiloh McCready
Sponsors:
Landon Godfrey
(*) cross over to the clinician-led group for
the iMAT program
1) Community Education through publicly
attended fairs
- Handout
- Simple Survey
2) Roadshow Presentation
- Informative
- Motivate to Action
3) Team Effectiveness
- Working well together and present
Secondary (Monitoring):
- Knowledge Survey
- Sign in sheet
- Short Evaluation
- Bi-Annual Net Promoter Score Survey
(anonymous)
Project Best Practices
Move it along
Make deadlines and stick to them
Ask team members to be honest about their availability
Internal Challenges
Continued push back from staff members
Lack of buy in from some clinic providers
Resistance from surgery department
Gaining traction to get requests (for money) approved in a timely manner
Realizing our team needs to be fluid with membership
Project Challenges & Barriers
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Project Challenges & Barriers
External Challenges
Preconceived notions about “addiction”
Biases about Medication Assisted Treatment- IN GENERAL
Biases about Medication Assisted Treatment from sober community, Narcotics Anonymous
Lack of knowledge about buprenorphine
Lack of community awareness of the severity of substance use in our area
Limited access to treatment programs, especially inpatient
treatment programs
Fear of social chastisement for seeking treatment
Project Successes
Surveys
Internal Awareness: 123 surveys completed from all
departments in hospital and clinic
External Awareness: 339 surveys completed at Women 4 Wellness (community health fair)
More education on iMAT & Substance Use Disorder was needed, especially open for the community to attend
Project Successes
Internal Awareness
5x5 presentation @ department huddles
Maria: presentation for OR Nursing Staff
Mike: presentation to ED Staff
re: Marcus’s role as Peer Support Specialist
External Awareness/Community Ed
Rotary Club
Local Churches
Women 4 Wellness
A Day of Hope
Health Occupations (SJMC High School Internship Program)
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Understanding the Opioid Crisis: Hope & Treatment in Our Community
Presentation + Panel Q&A
Advertised through Social Media, Radio, Newspaper, word of mouth
~70 attendees (diverse group including: medical staff, teachers, judges, EMTs, counselors, church leaders, local business owners, CSKT, SKC)
Featured on NBC Montana Kalispell, Top News Story
Front page article in Valley Journal
13 attendees interested in NARCAN training
Pre & post survey: likely to refer before & after, feedback
Understanding the Opioid Crisis: Hope & Treatment in Our Community
Evaluation Plan for Project
Goals:
Internal awareness of iMAT program
External awareness of iMAT program
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Evaluation: Internal Awareness
After each 5x5
presentation at
Huddle, there was an
opportunity for staff to
ask questions and verbally acknowledge
their understanding
Evaluation: External Awareness
0 5 10 15 20 25 30
Radio $944
Newspaper$388
Posters $39
other $0
Word of Mouth $0
Social Media $175
How did you hear about event?
Responses
Evaluation: External Awareness
0
5
10
15
20
25
30
35
very likely likely undecided unlikely never
Understanding the Opioid Crisis:
How likely are you to seek treatment, or
help someone you know seek treatment?
Pre-presentation Post-Presentation
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Did you like that there were refreshments
available at this event?
yes no
Evaluation: External Awareness
Evaluation: External Awareness
Recognizable logo
Swag given out at community events
Brochures Magnets Lip balm Stickers Sunscreen Carabiners Pens Gel Packs
Hard Case
Bandaids
Pouch
Bandaids
W4W 108 91 215 28 140 24 228 176 57
OB clinic 100 50 30 20
St Luke's 25
SEP 100 150
men's golf tournament 50 120
women's golf tournament 55
Report out 21
community event 46 31 43 50 12 39 102 28 76
SEP 200 50 25 224
iMAT clininc
Safety fair 72 12 15
iMAT clinic 78 12
total given out 629 322 367 148 272 84 370 204 300 207
Sustainability Plans for
Transformation Team
Protected time
Collaborating with leadership on ministry goals
Passing along Team Training Toolkit
Share leadership knowledge to help develop other co-workers
HHH has internally submitted a proposal for continued community project work beyond the HRSA grant
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Questions?
HHH Team, Nov-2016
HHH Team, Nov-2017
HHH Team, Mar-2019