Vanguard Medical Group has five sites across New Jersey and serves 50,000 patients each year. The family practice group strongly supports the goals of medical home transformation and uses innovation to drive quality initiatives, employing team-based care where each employee works to the top of their license.
Earlier feedback received from patients and care team members indicated that there were varied levels of performance among the medical assistants (MAs), making the implementation of new workflows for the MAs more difficult and time consuming. This variation was in large part due to (1) differences in prior education and experience, (2) lack of opportunity for MAs to access professional development beyond the initial new-hire orientation process, and (3) non-formalized communication with MAs about performance expectations beyond the annual review. Providers found themselves having to complete administrative tasks left unaddressed or repeat clinical tasks done incorrectly. MAs felt undervalued and that the practice was not invested in supporting their professional growth. Patients commented that MAs were inconsistent in terms of professionalism, phone skills, accurately relaying information, and the rooming process. As a result, MA performance was somewhat uneven, and essential intellectual capital of the largest component of the practice team was untapped and underdeveloped. MA clinical supervisors also identified areas for improvement, but were under pressure to do real-time training of new hires who were shadowing experienced staff, supervise externs, shift staffing to cover call-outs and vacations, address work flow issues, and jump in to cover stations needing extra help. These day-to-day realities trumped the creation of an additional professional development program by the MA clinical supervisors.
Despite these challenges, the clear need for MA training prompted the implementation of a professional development program to be delivered by nurse care coordinators. Because the nurse care coordinators serve as a clinical resource for the MAs at Vanguard, they are a logical choice to deliver the program. Using topics selected through a staff survey, the nurse care coordinators at each site deliver a monthly MA training session in a module format. The modules are written by the Director of Care Coordination using their own nursing background as well as vetted resources and websites at a health education level appropriate for MAs. The modules are updated annually.
The professional development cycle begins with the distribution of pocket-sized (2x4-inch) flashcards as a pre-session learning exercise. Each flashcard set is divided into general topics, including Professionalism in the MA Role, Diabetes Management, Rooming a Patient, and others. Cards can be added or removed from circulation as needed; each flashcard pack is numbered, tracked and recycled into MA training sessions for the following year. After four weeks, cards are collected and a pre-assessment is given to gauge MA learning and determine curriculum content. MAs sign in at each session and attendance is tracked by their supervisors as a component of their annual performance review.
Modules themselves rotate monthly, where a particular month's assigned module is taught at each site within the timeframe in a “Lunch and Learn” format. Monthly modules are approximately 45 minutes long and may include warm-up exercises, short electronic surveys, interactive presentations, materials/handouts, guest speakers, and peer teaching.
The MA professional development program has evolved since it was first implemented in 2013. Vanguard learned from previous iterations that an information-dense lecture approach is less useful than the current interactive format, and they continue to tweak the program in ways that motivate MAs to learn and use the information from each session. Vanguard does not collect quantitative data on the program, and they purposely eliminated the testing that was done in past years. They observed that “learning for the test” behavior created anxiety among MAs, rather than encouraging deeper learning and collaboration with peers.
Instead, qualitative data are collected, including MA reports of increased confidence and pride in their role, and feeling more valued by the practice. Initial feedback from all members of the care team has been positive. Providers have seen improvement in charting, phone skills and patient interactions. Clinical supervisors appreciate that the practice continues to incrementally raise the bar for MA accountability and performance, which aligns well with global practice goals of providing Star-Studded Service.
Vanguard's monthly module approach is applicable to a practice of any size, is flexible for customization, promotes standardization across multiple offices, and is easy to implement. The program costs are modest (50 sets of flash cards: $300), and both patients and the care team as a whole benefit from successful professional development of the MA staff.
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