4/21/2020

1

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

4/21/2020

2

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

4/21/2020

3

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

4/21/2020

4

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

4/21/2020

5

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

4/21/2020

6

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

4/21/2020

7

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

4/21/2020

8

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

4/21/2020

9

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?

4/21/2020

10

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

4/21/2020

11

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

4/21/2020

12

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)

4/21/2020

13

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

4/21/2020

14

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

4/21/2020

15

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

4/21/2020

16

Questions?

HHH Team, Nov-2016

HHH Team, Nov-2017

HHH Team, Mar-2019