Practice facilitators work independently in the field much of the time and must manage improvement work across multiple practices and organizations at the same time. It is important to document the content and outcomes of your encounters with practices routinely to help:
- Monitor the progress of practices through a particular improvement program or project and
- Keep track of the different priorities and activities across multiple organizations.
This documentation will also help your program director to know which issues to focus on during training and supervision sessions. It can also help both of you identify practices that may be experiencing difficulty in a particular area and need additional help.
Good documentation also supports team approaches to facilitation, by providing a way for team members to stay up to date on developments at a practice and to communicate their progress at the practice with each other. In addition, it provides a historic record of your work with a practice that can support handoff of the practice to another facilitator if you leave the organization for any reason. Finally, it helps maintain continuity between the practice and the facilitation program.
Identifying Tools for Documenting Encounters and Progress
Facilitators can use a variety of different methods to document encounters and track progress with their practices. You can use paper-based forms you create to record encounter data, simple spreadsheets on a computer, or online spreadsheets and survey programs designed to collect and manage information. Online solutions can be a good option because they are dynamic and can be accessed by both you and your program supervisor. Figures 15.1, 15.2, and 15.3 provide an example of how to document encounters with and progress of a practice.
The process you use to track your own encounters with each of your practices in many ways will parallel those being used by your practices. Instead of documenting patient visits, however, you will document practice visits; and instead of managing a panel of patients, you will manage a “panel” of practices.
Knowing Which Encounters To Document
It is important to document all “meaningful” encounters with a practice. This means any substantive work that occurs in support of the practice’s improvement goals. This work includes onsite visits, virtual support, email exchanges, and independent research or information gathering you may do for the practice in support of its quality improvement (QI) goals. The key words are substantive and meaningful.
Sharing the Practice Record With Your Practices
Depending on the system your facilitation program uses for documenting and tracking progress at the practice level, you may be able to involve individual practices in updating and maintaining their practice record. This is most feasible when you use Web-based or cloud-based information systems that allow multiple people to access and collaborate on the same document. For example, a quality improvement group in Los Angeles uses a combination of Smartsheets and Google Docs to create a dynamic practice record that both the facilitator and each practice can access and contribute to.
Inviting practices to contribute to their practice record increases the transparency of the process. It also helps the practice track its own progress with its improvement work. Finally, it can serve as a shared space and project management and collaboration platform between the facilitator and the practice.
Protecting Confidentiality and Privacy
When you opt to share and jointly maintain the practice record with an individual practice, remember that much of the information you work with as a facilitator at a practice is sensitive in nature. You need to be careful about the type and level of detail of the information you enter into the practice record. For example, you should not include detailed notes about personal conversations with a staff person about a conflict with another staff person at the practice.
In this case, you will need to find another way to capture and convey sensitive information of this type to your supervisor and address the issue in the shared practice record in a manner that preserves the privacy of the persons involved. For example, you can include a comment in your notes that the QI team may want to consider training on conflict resolution. But leave out any specific information about the staff persons involved or the content of the conflict that might make it possible to identify the parties involved.
Similarly, do not post any identifiable patient data on the practice record or information about other practices you are working with that has not been cleared for sharing. You will need to remind your practices and their QI teams about these limits as well.
Transparency and the ability to collaborate and share information are essential to effective improvement work. At the same time, sharing too much information or the wrong type of information can derail the process. A good rule to use is: If you are in doubt about sharing a piece of information, don’t. You can always make it available later, but you cannot retract it once it has been shared.
Reporting Progress Across Your Practices
You will need to report to your supervisor how your practices are faring as a group. Figure 15.4 shows one way of conveying the big picture by charting practices’ progress in implementing key changes. Note that progress is not linear. Practices that completed a key change in one month may backslide the following month.