Practice Facilitation Handbook

Module 21 Appendix

Role Visualization Exercise for Self-Management Support

Complete the chart by describing what each team member will do for each of the listed tasks for self-management support. Not all team members will be involved in each activity, nor is the list of tasks exhaustive.

Role PCP Nurse MA Clinical Care Manager Dietitian/PT/OT Administrative Staff/Patient Navigator Other
Introduce SMS, describe roles              
Set visit agenda              
Collaborate on patient goal setting              
Provide information and skills training to patients              
Create an Action Plan              
Connect patients with resources in community and elsewhere in health system              
Oversee disease registry/ proactive followup              
Conduct previsit chart reviews              

Adapted with permission from Institute for Healthcare Improvement, Cambridge, MA.

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Page last reviewed May 2013
Internet Citation: Module 21 Appendix. May 2013. Agency for Healthcare Research and Quality, Rockville, MD.