The Power of Collaboration
Pediatric Practices Working Together to Transform into Medical Homes
By Julie Eisen
When I dialed into the conference call with Sally Faggella and Maria Mignone to discuss their experiences as team leaders involved in NICHQ’s Massachusetts Medical Home Initiative, the two were already engaged in conversation. “I babysat twins last night…got to feed them a couple of times and give them a bath. I had a good night!” said Faggella about her new grandchildren. “Cute! Well we had our first focus group last night," said Mignone. "It was great. Really successful, I think!” And the conversation winded down before we got down to business.
But that conversation actually is part of the business. Faggella, a nurse at Harvard Vanguard Medical Associates in Chelmsford, MA, and Mignone, a nurse at Pediatric Associates of Greater Salem, represent two of the 13 medical practices from across the state of Massachusetts that were selected last year to receive funding to implement a Medical Home model of care. Each practice will make concrete changes to provide their patients with more coordinated, compassionate, and family-centered care – such as improving intake forms or implementing a better way to transition adolescents into adult care. NICHQ is facilitating this transformation by providing a supportive framework and community for participating practices through a Learning Collaborative. As the name suggests, the emphasis is on collaboration and shared learning. And when it comes to professional collaboration, the personal often forms the foundation for the professional.
Laying the Groundwork
Faggella and Mignone met in October 2011 at the project’s first Learning Session, a two-day event held in Shrewsbury, Massachusetts, where teams received didactic training and interactive lessons for starting the first stage of medical home transformation. In addition to providing knowledge and skills, the Learning Session gave participants the opportunity to network and to put faces to names. Establishing these relationships early was important, because after the Learning Session, much of the collaboration happened virtually, with teams regularly engaging in webinars featuring a new topic or providing the opportunity to share progress. Additionally, the teams have used an online portal NICHQ calls the Improvement Lab (ILab), where they share documents and communicate with one another on a discussion board.
Each team, which is composed of a team leader, two supporting clinicians, and two parent partners, also includes a Care Coordinator from the Massachusetts Department of Public Health. Care Coordinators traditionally work with families and clinicians to ensure that patients receive timely and continuous access to care, so they can be key players in the practice’s successful implementation of the medical home model. Bobbie Goldman was assigned to both Faggella’s and Mignone’s practices.
The Seeds of Collaboration
While most of the Care Coordinators on the project work exclusively with one team, Goldman supports both Faggella and Mignone, which turned out to be serendipitous for both of them. In order to share her time between the two teams, she pushed them to form a partnership from the start. “Much of the collaboration between Maria and me has been facilitated by Bobbie Goldman,” says Faggella. “Bobbie has been great at bringing information back and forth and encouraging us to make progress each week. We are able to share information and accomplish much more in a shorter period of time than I ever would have done on my own.” As a result, Faggella and Mignone are accountable not only to their care coordinator, but also to each other.
As a pair, the two are able to work through assignments, such as creating better forms for gathering medical histories and medication checks. Ultimately, however, the goal is to share these documents and experiments with all of the participating practices – and with the support from Goldman, the two were able to bring their collaborative efforts to the larger group.
Spreading the Wealth
In one of the project’s first examples of widespread collaboration, Faggella and Mignone worked with Goldman to create a template for a more comprehensive care plan – a detailed medical summary of a patient’s clinical and social needs and how they will be addressed. Mignone posted the care plan on the ILab, which other team leaders were then able to use and edit for their own practices. “[This] looks great…it is very comprehensive,” wrote another Team Leader on the discussion board in response to Faggella’s and Mignone’s care plan. “I printed it to share with my team today…great work!” Other teams have continued to edit and alter the initial care plan to suit their needs. “It’s a building block,” says Faggella.
Likewise other team leaders have posted their own documents. “I steal from them all the time, shamelessly,” says Mignone. “I am a big advocate of not reinventing the wheel. If someone’s done it, I’m not going to pretend that I can do it better, unless I really think that I can.” Since the start of the Learning Collaborative, participating practices have shared general care plans, asthma care plans, and pre-visit assessment forms – to name just a few.
A Culture of Support
Beyond the business side of their collaboration, the Team Leads have developed an environment of moral support. In a recent discussion board post, Faggella shared an update on her practice’s electronic health record software, as well as an update on her new grandchildren, to which another team leader congratulated her and said she looked forward to seeing pictures. “Sharing working experiences has been incredible, but so has been the moral support and encouragement that we give each other,” she says. “And that is just as important as being able to accomplish our goal of developing a Medical Home.”