Practice Facilitation Handbook

Module 19 Appendix

Table of Contents

A. Team Visualization Exercise

Activity 1: Team Visualization Exercisei

The goal of this exercise is to illustrate how the current models in most primary care practices do not function as team-based care. When working with your practice, be sure to get all care team members to participate. Each staff member will be given 60 jelly beans and a short, clear plastic cup. Also have a cup in the middle labeled “No one.”

  • Ask the group which staff member performs each of 10 tasks (listed below).
  • Instruct all staff members to drop a jelly bean into each staff member’s cup who they think currently performs that task.
  • Instruct staff members to drop a jelly bean into the “No one” cup if they don’t think anyone currently performs that task. For example, if a staff member thinks a task is currently performed by two physicians, a nurse practitioner, and a physician’s assistant, that staff member would put a jelly bean in each of the cups of those four providers.

Ask which staff member:

  1. SETS the intervals for blood monitoring for patients on warfarin?
  2. DECIDES when to call a patient with diabetes to come in for a visit?
  3. SELECTS the vaccines to be given to an 18-month-old baby?
  4. DECIDES to arrange a diabetes retinal screening referral?
  5. ORDERS the mammogram for a 55-year-old woman with severe hypertension and heart disease?
  6. INITIATES diabetes microfilament foot testing to prevent amputations?
  7. FINDS patients with severe persistent asthma who are not on controller medications and brings them in for an appointment?
  8. DECIDES which children with ADHD should come for a visit?
  9. DECIDES when a patient with major depression (PHQ 17) should come back for a visit?
  10. ADMINISTERS Screening, Brief Intervention, and Referral to Treatment (SBIRT) screening to patients in your practice?

At the end of the exercise, the group will probably discover that most of the jelly beans end up in the primary care providers’ cups. Facilitate a discussion using the following prompts:

  • What did you observe about this exercise? What did you learn from it?
  • What implications do you think this has for you all as a care team?
  • Why are there jelly beans in the “No one” cup? What can you do about that?
  • What should the distribution of jelly beans look like to be real team-based care?
  • What changes would you need to make to how you are currently practicing to do this?
  • How would this affect your workflow?
  • Are there goals you want to include in your quality improvement plan based on this exercise?

i Provided by Carolyn Shepherd, M.D., Clinica Campesina, and used with permission.

B. In a Perfect World: Task Reassignment Exercisei





Task Who Does It Now? In a Perfect World, Who Would Do It?
Book appointments    
Take incoming calls    
Chart preparations    
Medication refill requests    
Check in    
Suture removal    
Dressing change    
Flu shots    

Return to Module 19

Page last reviewed May 2013
Page originally created May 2013
Internet Citation: Module 19 Appendix. Content last reviewed May 2013. Agency for Healthcare Research and Quality, Rockville, MD.
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