Increasing the Registered Nursing Workforce Through a Second-Degree BSN Program Coaching Model

Slaughter²,

Qureshi³

et al. 2021

Am J Manag Care

Health care organizations in the United States face challenges in delivering high-quality primary care. 1,2 For reform measures to successfully improve health, affordability, and patient experience, as well as meaning in work for providers, the care delivery system must be transformed. 3 The patient-centered medical home (PCMH) model is a leading effort to improve quality of care 4-6 by reorganizing a practice's care delivery process to promote comprehensive care, patient-centeredness, care coordination, accessible services, safety, and high-quality care. 7 The model offers many pathways to reduce costs and improve quality, but evidence of its impact is mixed. [8][9][10][11][12] Due in part to variations in the amount and types of practices implemented, PCMH implementation varies significantly by site, with practices undergoing many changes. 13 Although there is no single way to achieve PCMH transformation, there is concordance in the main implementation steps. 9,14 PCMH recognition and certification require that core criteria are satisfied; they also provide various optional criteria. 15 Practices target PCMH changes that are required for recognition and utilize a variety of quality improvement (QI) activities for PCMH transformation. Practices are required to collect and use patient experience surveys and other data to improve their care and services. Which QI activities and PCMH changes are most useful is unclear. [16][17][18] Research has examined organizational climate, 19 QI culture, 20 structural factors associated with PCMH changes, 21 and which PCMH implementation resources are widely used, 16 but it has not studied these factors alongside a validated measure of PCMH implementation with established psychometric qualities. One such measure is the PCMH Assessment (PCMH-A), a proxy for patient-centeredness that measures the degree of PCMH implementation at the practice level. 22 PCMH-A scores are higher for recognized PCMH practices than for nonrecognized practices. 23 In this study, we investigate QI practices and PCMH changes associated with higher levels of PCMH transformation using the PCMH-A.

Section: Discussionmentioning

confidence: 80%

Practices and changes associated with patient-centered medical home transformation

Slaughter²,

Qureshi³

et al. 2021

Am J Manag Care

“…Previous literature has examined various forms of coaching,61–67 including compliance training for nursing staff68–70 and through simulated patient encounters 71. Studies suggest that coaching, shadow or otherwise, can help build and maintain competencies among physicians, nurses, and other staff, and increase adherence to practice guidelines 62,67,68,71…”

Section: Discussionmentioning

confidence: 99%

“…37,55,59 Some practices and groups therefore use peer shadow coaching for improvement and professional development. 60 Previous literature has examined various forms of coaching, [61][62][63][64][65][66][67] including compliance training for nursing staff [68][69][70] and through simulated patient encounters. 71 Studies suggest that coaching, shadow or otherwise, can help build and maintain competencies among physicians, nurses, and other staff, and increase adherence to practice guidelines.…”

Section: Discussionmentioning

confidence: 99%

Content and Actionability of Recommendations to Providers After Shadow Coaching

Quality Management in Health Care

Qureshi

Palimaru

et al. 2022

Background and Objectives: Health care organizations track patient experience data, identify areas of improvement, monitor provider performance, and assist providers in improving their interactions with patients. Some practices use one-on-one provider counseling (“shadow coaching”) to identify and modify provider behaviors. A recent evaluation of a large shadow coaching program found statistically significant improvements in coached providers' patient experience scores immediately after being coached. This study aimed to examine the content of the recommendations given to those providers aimed at improving provider-patient interactions, characterize these recommendations, and examine their actionability. Methods: Providers at a large, urban federally qualified health center were selected for coaching based on Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) patient experience scores (92 of 320 providers), shadowed by a trained peer coach for a half to full day and received recommendations on how to improve interactions with their patients. We coded 1082 recommendations found in the 92 coaching reports. Results: Reports contained an average of 12 recommendations. About half encouraged consistency of existing behaviors and half encouraged new behaviors. Most recommendations related to behaviors of the provider rather than support staff and targeted actions within the examination room rather than other spaces (eg, waiting room). The most common recommendations mapped to behavioral aspects of provider communication. Most recommendations targeted verbal rather than nonverbal communication behaviors. Most recommendations were actionable (ie, specific, descriptive), with recommendations that encouraged new behaviors being more actionable than those that encouraged existing actions. Conclusions: Patient experience surveys are effective at identifying where improvement is needed but are not always informative enough to instruct providers on how to modify and improve their interactions with patients. Analyzing the feedback given to coached providers as part of an effective shadow-coaching program provides details about implementation on shadow-coaching feedback. Recommendations to providers aimed at improving their interactions with patients need to not only suggest the exact behaviors defined within patient experience survey items but also include recommended behaviors indirectly associated with those measured behaviors. Attention needs to be paid to supplementing patient experience data with explicit, tangible, and descriptive (ie, actionable) recommendations associated with the targeted, measured behaviors. Research is needed to understand how recommendations are put into practice by providers and what motivates and supports them to sustain changed behaviors.

“…Previous literature examines shadow coaching in various forms, 13,14 including compliance training, 15,16 simulated patient encounters 17 with both physicians and nurse practitioners, 18 and individual provider coaching. Evidence focuses on the motivations 19 for and impacts of shadow coaching on the competencies 20,21 and providers' behaviour 22 .…”

Section: Introductionmentioning

confidence: 99%

Provider and coach perspectives on implementing shadow coaching to improve provider–patient interactions

Evaluation Clinical Practice

Qureshi

Slaughter

et al. 2021

Background Healthcare organizations want to improve patient care experiences. Some use ‘shadow coaching’ to improve interactions between providers and patients. A Federally Qualified Health Center (FQHC) implemented a half‐day observation of individual primary‐care providers by a ‘shadow coach’ during real‐time patient visits, including an in‐person verbal debrief afterwards and a written report with specific recommendations. Shadow coaching identified areas for improvement. We aimed to characterize lessons and barriers to implementing shadow coaching as a mechanism to improve interactions with patients and change organizational culture. Methods We examined provider and coach perceptions of shadow coaching through interviewing coached providers, stratified by provider type and Consumer Assessment of Healthcare Providers and Systems (CAHPS) performance, and the coaches who coached the most providers. We interviewed 19 coached providers and 2 coaches in a large, urban FQHC. Content analysis identified implementation barriers, facilitators and themes. Results Coaches reported needing ‘buy‐in’ throughout the organization and the need to be credible and empathize with the providers being coached. Most providers reported behaviour changes based on recommendations. Almost all providers recalled at least one coaching recommendation that was actionable. Providers and coaches highlighted patient‐level and practise‐level barriers that impeded their ability to implement recommended improvements. CAHPS data was reported as an effective performance management metric for measuring change, counselling providers, and evaluating provider‐level efforts but was not always specific enough to yield tangible recommendations. Conclusions Regular messaging by leadership about the priority and purpose of shadow coaching was essential for both physician engagement and its mature implementation across the organization. Coaching could be embedded into a long‐term strategy of professional development with periodic re‐coaching. Re‐coaching sessions could target issues raised by providers, such as dealing with difficult patients or specific populations. Research on the timing and content of re‐coaching is needed.