Coaching Supports Patient Aligned Care Teams
Coach-to-Coach Meetings
Critical to the RLRVAMC coaching model were the weekly 1-hour coach-to-coach meetings. Most of the coach training occurred during these sessions, either formally or via feedback and discussion. Coaches discussed their teams’ progress, brought back questions from the teams, and sought guidance from one another. Executive leaders, who were also coaches, were present at these meetings and provided the opportunity to implement broader operational changes quickly. Coaches also served as a communication venue for frontline staff to express their concerns to primary care leaders during these meetings.
Limitations
Practice facilitation that uses internal coaches for a clinical PACT microsystem may present several potential challenges. Large primary care practices require a pool of coaches who are willing to commit the necessary time required for successful implementation of this model. Although the coaches dedicate this time as collateral duty, many express that the time spent with their teams is a rewarding experience outside of their administrative roles. The coaches express satisfaction when teams meet their goals and PDSA cycles are successful.
Coaches require significant amounts of training to reach the level of effectiveness required. Teams must realize and appreciate the importance of dedicating time away from the competing priority of patient care.
Implementation of the coaching model for physician trainees in the teaching clinic has not been successful due to the teaching clinic schedule and other issues. Also related to the complexity of the teaching clinic schedule, the coaching model did not significantly improve continuity. Coaches have recently been assigned to the teaching clinic, and each team will be identifying PDSA cycles to approach the implementation of PACT principles.
Conclusion
Despite the aforementioned challenges, the outcomes are clear. The implementation of the coaching model, using internal coaches, resulted in a significant improvement of the ability of the staff to achieve the national PACT metrics (Figure 3). More important, the model created a new structural organization for change within primary care that reversed a culture of top-down leadership to that of team empowerment.
Teams that experienced practice facilitation developed ownership in their processes, data, and performance improvement and now have a more direct mechanism of communicating with primary care leadership. The coaching model moved the teams forward from having received PACT education to having the confidence and tools to implement PACTs. Staff progressed from looking at the data given to them to collecting and interpreting the data themselves. The teams are able to articulate how they fit in to the PACT model and enthusiastically monitor their progress. As primary care moves forward with the medical home, the facilitative coaching model offers a promising option for successful implementation.
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects— before administering pharmacologic therapy to patients.
