AHRQ Practice Facilitation Training Modules: Additional Resources

Access AHRQ’ practice facilitation resources, such as the Primary Care Practice Facilitation Curriculum, and Tools and Resources for Practice Transformation and Quality Improvement, and other tools and resources for Improving Primary Care Practice.

Discover the stories of practice facilitators from Healthy Hearts Northwest as they worked with many small and rural practices in building quality improvement capacity in primary care: 16 key insights about practice facilitation. 

Here is the Job Aid (PDF, 402 KB) that summarizes the keys skills taught in the module Starting with a Practice.

How a Practice Facilitator Can Support Your Practice (PDF, 85 KB) can be shared with practices to explain the benefits of working with a practice facilitator, and tips on how to do so effectively.

This example of a practice facilitation program brochure (PDF, 325 KB) can give you ideas of how to prepare a brochure for your own facilitation program.

This sample email (PDF, 74 KB) can be used as a model for introducing yourself to your contact at a new practice.

This Quick-Start Guide (PDF, 112 KB)—Engaging Primary Care Practices in Quality Improvement: Strategies for Practice Facilitators—distills wisdom and best practices from experts who have honed their approaches through working on quality improvement (QI) and practice redesign initiatives with more than 6,000 practices in 44 States.

In this video, James Mold, M.D., describes how facilitators called practice enhancement assistants improved patient care, such as diabetes care and delivery of preventive services.

Practices can have their own personalities. Learn about 5 practice personas—the Chaos Practice, the Isolated Practice, the Naysayer Practice, the Old-Fashioned Practice, and the Overconfident Practice—and about tailored strategies to use when facilitating such practices.

This practice profile tool (Word, 27 KB) can be used to help you capture information about a practice when you are doing initial on-site observations at start-up

This Outpatient Primary Care Workbook provides a comprehensive assessment of Clinical Microsystems in a practice. It can be useful guide for you as you get to know a practice.

Here is the Job Aid (PDF, 592 KB) that summarizes the keys skills taught in the module Facilitator Fundamentals.

Read the module Professionalism for Practice Facilitators (PDF, 1 MB) from the AHRQ Primary Care Practice Facilitation Curriculum to learn more about how facilitators can conduct themselves professionally at a practice.

This Project Planning Form is a useful project management tool from the Institute for Healthcare Improvement.

Part of the Primary Care Team Guide, Identifying Practice Personas provides insights into different practice personalities and approach how to work with them.

The module Effectively Engaging Your Practice: Strategies for Practice Facilitators, developed by an EvidenceNow grantee, helps facilitators build positive working relationships with practices. It is available at https://www.metastar.com/eLearning/EffectivelyEngagingYourPractice/.

Learn more about Appreciative Inquiry, a strengths-based approach to improvement work, from the AI Commons and from Using Appreciative Inquiry with Practices from the AHRQ Primary Care Practice Facilitation Curriculum.

The National Resource Center for Academic Detailing is a resource on using clinicians as expert consultants.

Project ECHO provides expert consultation and learning for primary care providers across the U.S. 

You can find resources for improving primary care processes and patient outcomes at the following sites:

• EvidenceNOW Tools for Change.
• Practical Tools for Primary Care Practice.
• Family Physician Medicine’s Toolbox.
• AMA Steps Forward.
• Institute for Healthcare Improvement Tools.
• Safety Net Initiative Resources and Tools to implement the Patient-Centered Medical Home (PCMH) Model of Care.
• Center for Excellence in Primary Care Tools for Transformation.
• ACT Center- Accelerating Care Transformation (formerly MacColl Center for Health Care Innovation).
• Integrating Chronic Care and Business Strategies in the Safety Net Toolkit.

Here is the Job Aid (PDF, 548 KB) that summarizes the keys skills taught in the module Effective Meetings.

The Agenda-Minutes Template (Word, 14 KB) lets you take notes alongside a meeting agenda and provides space for action items.

How to Conduct an Effective QI Team Meeting provides tips for running both a QI Team Huddle and the QI Team Meeting.

Here is the Job Aid (PDF, 481 KB) that summarizes the keys skills taught in the module Introduction to Quality Improvement.

The video Quality Improvement in Healthcare combines history of quality improvement (QI), approaches to QI, and some perspectives on resistance to change and techniques to overcome it.

Health Quality Ontario’s Quality Improvement Guide (PDF, 3 MB) covers many of the QI approaches and tools covered in these training modules.

Read What Is Lean Healthcare? to learn about the "8 wastes in healthcare" and how Lean principles are being applied to healthcare.

Going Lean in Health Care, an Institute for Healthcare Improvement  Innovation Series white paper, covers key concepts in Lean Thinking and applies Lean Thinking to healthcare.

Use this Tennis Ball Game to teach practices: 1) how to approach improving a process, 2) how to build on knowledge gained from one test in designing a second test, 3) how multiple testing cycles lead to improvement, and 4) the concept of “breakthrough” improvement.

This guide (PDF, 660 KB) from the Health Resources and Services Administration presents an introduction to QI concepts and key topics for developing or improving a QI program within an organization.

The Quality Improvement Primer for Health Centers (PDF, 1 MB) provided an orientation to and basic tools for accelerating QI changes in a primary care practices that participated in a heart health improvement project. 

Here is the Job Aid (PDF, 495 KB) that summarizes the keys skills taught in the module Model for Improvement and PDSA Cycles.

The Institute for Healthcare Improvement (IHI) uses the Model for Improvement as the framework to guide improvement work. Find resources on IHI’s How to Improve page.

Use this Fillable Plan Do Study Act (PDSA) Tool for Health Care Quality Improvement (QI) or this paper PDSA Worksheet (PDF, 163 KB) with your practices to design and test changes to improve healthcare quality.

Here is the Job Aid (PDF, 454 KB) that summarizes the keys skills taught in the module Process Mapping.

Improving Your Laboratory Testing Process is a step-by-step guide that can increase the reliability of the testing process in your practices by helping them examine how tests are managed. The guide also  shows how process mapping forms one part of a comprehensive improvement activity and includes a Patient Experience Assessment survey.

The IHI has two flowchart videos on process mapping.

This presentation explains how primary care practices can use workflow analysis for quality improvement in all office systems—such as scheduling, patient flow, and billing. It provides step-by-step guidance and a process assessment tool.

View a list of Important Workflows in Primary Care Practices in the Mapping and Redesigning Workflow (PDF, 3 MB) module of AHRQ’s Primary Care Practice Facilitation Curriculum. Find maps of several of these processes in AHRQ’s Workflow Assessment for Health IT Toolkit.

Here is the Job Aid (PDF, 519 KB) that summarizes the keys skills taught in the module The 5 Whys and Fishbone Diagramming.

This Fishbone Diagram Template (PDF, 308 KB) can be used when identifying root causes of a problem.

This 5-minute video reviews how to create a Cause and Effect or Fishbone Diagram.

Here is the Job Aid (PDF, 419 KB) that summarizes the keys skills taught in the module Practice Assessments and Surveys.

CAHPS Clinician & Group Survey. The CAHPS® Clinician & Group Survey (CG-CAHPS) asks patients to report on their experiences with providers and staff in primary care and specialty care settings. Survey results can be used to determine the need for improvement activities and evaluate the impact of those efforts.

The Patient-Centered Medical Home Assessment (PCMH-A) (PDF, 1 MB) is intended to help sites understand their current level of “medical homeness” and identify opportunities for improvement. The PCMH-A can also help sites track progress toward practice transformation when it is completed at regular intervals.

The Building Blocks of Primary Care Assessment (BBPCA) (PDF, 553 KB) assesses the organizational change of a primary care practice as measured against the 10 Building Blocks of High Performing Primary Care. The BBPCA incorporates all of the original items from the PCMH-A, reorganized into the framework of the 10 Building Blocks, and it includes a number of supplemental questions to examine areas not addressed by the PCMH-A.

The Change Process Capability Survey (CPCQ) is a 32-item instrument that assesses medical group capability to improve care.

The Assessment of Chronic Illness Care is a practical tool to help practices improve care for chronic illness.

The Primary Care Health Literacy Assessment (Word, 40 KB), part of the AHRQ Health Literacy Universal Precautions Toolkit, helps practices examine their performance in key areas that influence patient understanding, navigation, and self-management and links to improvement tools.

The Quality Improvement Change Assessment (QICA) of Practices’ Heart Health Care Capacity assess primary care practices’ capacity to make changes needed to implement heart health evidence. The QICA identifies areas for improvement and, when completed at regular intervals, tracks practice transformation progress.

You can use this Word Action Plan Worksheet (Word, 34 KB) to help primary care practices create action plans based on the QICA and its seven high-leverage changes to implement evidence-based care.

The Clinical Microsystem Assessment Tool (PDF, 581 KB) assesses practices on the characteristics of high-performing clinical microsystems. Learn more about the Clinical Microsystems model and approach in healthcare.

This survey provides a template for evaluating provider and staff satisfaction within a healthcare organization. (Free site registration required to access survey template.)

Here is the Job Aid (PDF, 494 KB) that summarizes the keys skills taught in the module Standardized Quality Measures.

Understanding Value-based Payment: A Primer for Family Physicians (PDF, 571 KB) can help you understand the range of payment methods.

The ABCs of Measurement is a guide from the National Quality Forum (NQF) on measurement selection and the NQF endorsement process.

• National Quality Forum Quality Positioning System. Also visit NQF’s Core Quality Measurement Collaborative’s sets of measures that efficiently promote a patient-centered assessment of quality.
• CMS Measure Inventory Tool.
• CMS’ electronic Electronic Clinical Quality Measures (eCQM) Library.
• NCQA's Healthcare Effectiveness Data and Information Set (HEDIS®).
• CAHPS® Clinician and Group Survey, which measures of patients’ experience of care.

The Centers for Medicare and Medicaid Services offer a variety of ICD-10 resources, including guides, videos, and tips.

The AMA has resources for looking up CPT codes.

Benchmarking Resources:

• CAHPS Databases facilitate comparisons of CAHPS survey results by and among survey users.
• Quality Compass® lets you examine quality improvement and benchmark plan performance through online access to health plan HEDIS® and CAHPS® performance data.

Producing Accurate Clinical Quality Reports for Population Health: A Delivery System-Oriented Approach to Report Validation (PDF, 1 MB) shows how to design internal reports for quality improvement (QI) purposes.

Capturing High Quality Electronic Health Records Data to Support Performance Improvement A Learning Guide (PDF, 2 MB) explains how to improve electronic health record (EHR) data quality to stimulate practice quality improvement.

Here is the Job Aid (PDF, 446 KB) that summarizes the keys skills taught in the module “Last 10 Patients” Chart Audit.

This article from the British Medical Journal on the value of small samples sizes in rapid-cycle change provides useful information you can share with practices on the value of the process.

Here is the Job Aid (PDF, 645 KB) that summarizes the keys skills taught in the module Presenting Performance Data.

AHRQ’s Displaying the Data in a Health Care Quality Report shows how to make your tables and charts attractive and easy to interpret.

Tables, Graphs, Dashboards, & Reports: Data Visualization Best Practices (PDF, 711 KB) offers best practices on presenting healthcare quality data graphically for performance dashboards. It includes a checklist to ensure that data are clear and visually pleasing, reviews various chart types, and provides examples of dashboards.

Teach the practices you work with how to use run charts with Do It Yourself Run Chart for Primary Care Practices Excel spreadsheet to create run charts to track their progress in QI. It includes instructions, an example of a cholesterol management measure, and a programmed blank spreadsheet.

The IHI’s Run Chart Tool includes instructions and a Run Chart Template. (Free site registration required to access tool.)

Pivot tables are a powerful feature of spreadsheets that help you organize and summarize data in different ways. Pivot Tables & Charts for Health (PDF,  2 MB) demonstrates how to create visual data presentations.

Access the Job Aid (PDF, 546 KB) that summarizes the keys skills taught in the module Helping Practices Scale Improvements.

The Introductory Guide to Academic Detailing (PDF, 242 KB) includes advice on developing key messages and responding to objections to change.

How to Design Training provides basic steps for designing an effective training.

The Use of Manual Job Aids by Health Care Providers: What Do We Know? (PDF, 796 KB) provides an in-depth overview of job aids.

Access Engaging Doctors in the Health Care Revolution to gain an understanding of what motivates health care professionals to change. Read an application of the Levers of Motivation (PDF, 632 KB) to opioid management improvement work.

Practice Feedback Interventions: 15 Suggestions for Optimizing Effectiveness summarizes lessons from the research studies on using feedback to stimulate improvement.

Access webinars on audit and feedback, from the basics of describing what audit and feedback are to visual displays of data.

The IHI Framework for Improving Joy in Work provides information on why joy in work is important and guidance on steps leaders can take to improve joy in work by adopting a participative management style. Check out IHI videos Four Steps Leaders Can Take to Increase Joy in Work and How to Get Ready for “What Matters to You?” Conversations videos.

The AMA offers several courses on Burnout and Well-Being as part of its STEPS Forward toolkits. These include:

• Physician Burnout: Improve Physician Satisfaction and Patient Outcomes.
• Physician Well-Being: Protect Against Burnout and Encourage Self-Care.
• Creating the Organizational Foundation for Joy in Medicine.

Cultivating Leadership: Measure and Assess Leader Behaviors to Improve Professional Well-Being is another AMA STEPS Forward course that promotes the use of participatory management to improve joy at work.

Other AMA resources related to Joy in Work are:

• Mini Z burnout survey (Word, 43 KB).
• EHR In-Basket Restructuring for Improved Efficiency.

The Primary Care Staff Satisfaction Survey (p. 12 of Clinical Microsystems’ toolkit Assessing, Diagnosing and Treating Your Outpatient Primary Care Practice [PDF, 665 KB]) can be used to assess staff perceptions of a practice.

The California Healthcare Foundation has resources to better understand the causes and consequences of burnout and contains ideas for better supporting the primary care workforce. Read Building a Resilient Primary Care Workforce.

Learn how Hawaii Pacific Health launched a system-wide program called Getting Rid of Stupid Stuff to fix meaningless documentation requirements within the electronic health record (EHR) system.

Here are some resources to help practices wanting to create or improve care team functioning.

• Change Strategies to Create and Support High Functioning Care Teams to Deliver High-Quality Evidence-Based Care and associated tools from AHRQ’s EvidenceNOW Tools for Change.
• Building a Primary Care Team, from The Primary Care Team Guide.
• Daily Team Huddle: Boost Practice Productivity and Team Morale, an AMA STEPS Forward course.
• Teamlets, Health Huddles, and Morning Huddle video, from the UCSF Center for Excellence in Primary Care (PDF, 100 KB).
• Psychological Safety Video demonstrating creating an environment where team members feel safe speaking up.

You can access an Aspirin Workflow, similar to the one shown in the module, from AHRQ’s EvidenceNOW Tools for Change.

Learn about the conflict resolution method DESC in Module 6 of TeamSTEPPS for Office-Based Care. You can also view the video How To Coach the DESC Script.