Integrating Chronic Care and Business Strategies in the Safety Net (Coaching Manual)

Chapter 1: Introduction

Welcome! Most likely, if you're reading this you are interested in improving health care quality through practice coaching. This practice coaching manual aims to help effectively and efficiently improve clinical quality in an ambulatory setting by providing:

  • An Overview of what practice coaching is and how a variety of settings have used it to improve care.
  • A Summary of important characteristics and skills to look for when recruiting or training a practice coach.
  • A Description of a time-limited practice coaching intervention that includes a series of activities, companion agendas, and tools.

This practice coaching manual accompanies a comprehensive Web-based toolkit, "Integrating Chronic Care and Business Strategies in the Safety Net." The toolkit outlines a sequence of steps that practice teams can use to efficiently improve clinical quality along the lines of the Chronic Care Model. It also includes presentations, assessments, data tracking sheets, and sample action plans for use by teams as they transform their care. The toolkit and this practice coaching manual work together and refer to each other. We know that clinical teams often need help and support to effectively improve care, and we believe practice coaching may be useful to them as they do this work. This manual provides instructions and materials needed to support those using "Integrating Chronic Care and Business Strategies in the Safety Net" to transform care.

The development of these two resources grew out of a desire to help primary care teams improve clinical quality efficiently and effectively. Both are based on the Chronic Care Model (CCM), an evidence-based framework that has helped hundreds of clinical practices transform their daily care. The Chronic Care Model (CCM) is designed to help practices improve patient health outcomes through changing the routine delivery of ambulatory care. The Model calls for a number of interrelated system changes, including a combination of effective team care and planned interactions; self-management support bolstered by more effective use of community resources; integrated decision support; and patient registries and other supportive information technology.

Most often, the CCM has been implemented through Breakthrough Series (BTS) Collaboratives, an organized quality improvement approach that brings together practices from a variety of organizations four times a year to learn from leaders and colleagues about improving care. In between these learning sessions, teams return to their practices and try out new ways of delivering care through small, short-cycle changes called Plan-Do-Study-Act (PDSA) cycles. The practices that have participated in BTS Collaboratives to learn the CCM improved the care they provided for patients and improved patient health outcomes.1-8

In our 10 years of experience with BTS Collaboratives, we have seen that they are often expensive to organize and require practices to take time out from providing patient care to attend learning sessions. Often the practices that are willing and able to do this are more highly motivated and well-supported than others. We sensed a need for a less time- and resource-intensive intervention that would:

  • Make the tools and concepts taught in the Collaboratives available to more practices.
  • More closely integrate the business strategies necessary to sustain clinical change in the long term.

The manual is created primarily based on our practice coaching experience during the AHRQ-funded pilot project "Integrating Chronic Care and Business Strategies in the Safety-Net." It captures our coaches' approach to the teams, lessons learned from our experience, and feedback from the teams. It is supplemented by a literature review and interviews with leaders from other national coaching initiatives.

Chapter 2 reviews the many forms that practice coaching can take and summarizes coaching as it is depicted in the literature and by leaders in the field.

Chapter 3 provides step-by-step instruction for those interested in replicating the 10-month AHRQ pilot coaching intervention. Sample agendas and tools are available in the Appendix. This coaching model is being evaluated as part of a randomized trial.

This Practice Coaching Manual is Designed for:

  • Clinic or hospital leaders who want to use coaching to initiate or spread improvement efforts from one site to others.
  • Quality improvement coaches, improvement leaders, and anyone else interested in new ideas about how to facilitate practice improvement.
  • Public health departments, multistakeholder collaboratives, and medical associations or other organizations interested in improving clinical quality in medical practices.

This practice coaching manual and the companion toolkit are meant to provide the tools and structure for coaches to use in helping teams in a wide variety of settings improve clinical quality. Of course, modifications and tailoring for the specific context where you work may be appropriate. However, many of the tools in the companion toolkit are copyrighted and cannot be modified unless the original authors grant permission. As this is an emerging coaching model, we would love to hear from you about your experience using this manual and toolkit. We can be reached at under "About Us." Good luck!

Page last reviewed October 2014
Page originally created April 2009
Internet Citation: Chapter 1: Introduction. Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD.