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284 April 2007 Family Medicine Essays and Commentaries New Model Innovation Through Faculty Champions Mark B. Mengel, MD, MPH; Judith Pauwels, MD; Keith A. Frey, MD, MBA The Future of Family Medicine be “early adopters.”11 At a mini- continuous quality improvement project calls for transformation of mum, residency programs should processes are unlikely to work.13 medical practices to a “New Model” begin preparing for New Model Creating a burning platform may to meet challenges facing the dis- implementation by studying and demoralize faculty and serve as a cipline of family medicine.1 While discussing the model, examining disincentive to them considering certain components of the New demonstration projects and in- New Model change. Competing Model have been developed and novations that address new model multidisciplinary teams and formal tested by innovators,2-4 the barriers components, and analyzing their continuous quality improvement of cost, cultural issues, technology own systems. Such preparation, (CQI) processes often require problems, and lack of well-deﬁned particularly if it involves piloting of resources that small residency pro- reimbursement mechanisms have components, will stimulate organi- grams do not possess. slowed the diffusion of the New zational learning and will begin to What skills do faculty need as Model into both the practice and address the many barriers associ- we move forward? Traditional ar- residency settings.5-8 Additionally, ated with implementation.12 eas of competency include leader- physicians and clinic leadership are In seeking resources to help resi- ship, administration, management, products of prior training models dency programs begin to prepare teaching, curriculum development, and traditional areas of expertise.9 for New Model implementation, the research, patient care, and com- For their practices to move into the most valuable resources are a pro- munity service. However, differ- future, faculty leaders must become gram’s own faculty. Faculty mem- ent skills will now be needed, and champions of New Model concepts, bers are core resources, not only faculty development will need to and they are key to the success of for teaching and patient care but for target these new skills. We pro- this transformation.9,10 clinic performance, residency cur- pose the development of “faculty Should residency programs wait riculum development, role model- champions”: those faculty members until demonstration projects are ing for residents, and program lead- with passion for new ideas, who can concluded on the New Model of ership. Programs that develop their lead and teach others and who are practice, or should they move ahead faculty will be best situated to meet willing to put the energy into both with New Model learning and the challenges and opportunities of learning and driving a process of implementation? As consultants the future. Individual faculty could New Model implementation. Fur- for the American Academy of Fam- lead development for some aspect ther, we feel the development of ily Physicians (AAFP) Residency of the New Model consistent with a robust faculty development and Assistance Program (RAP), we their strengths, taking the residency evaluation system will serve as a believe residency programs should program through an organizational key support structure facilitating change process beginning with an the development of “champion” assessment of their existing sys- skills. Our hypothesis is that as tems of care. Group energy among residency programs begin to look (Fam Med 2007;39(4):284-7.) faculty will initiate and enhance at New Model changes and prepare readiness for change and eventual for implementation, the adoption of evolution toward the New Model. a faculty champion system within From the Department of Community and Fam- Larger organizational change tech- a program, supported by a strong ily Medicine, St Louis University (Dr Mengel); niques such as the “burning plat- faculty development and evaluation Department of Family Medicine, University of form” (crises that are engineered system, will encourage the adoption Washington (Dr Pauwels); and Department of Family Medicine, Mayo Clinic Arizona, Scotts- to force change), use of competing of this needed innovation. And, if dale, Ariz (Dr Frey). multidisciplinary teams, or formal lessons are widely communicated, Essays and Commentaries Vol. 39, No. 4 285 this effort can serve to assist other these concepts and the future model areas of growth for current faculty residency programs with change. of practice. Second, individual or the need to recruit new faculty. faculty expertise needs to be devel- Resources that might be tapped for Faculty Development oped, whether through supporting development include both internal The components of the New existing faculty members who are programs, which might include Model that will need faculty cham- identiﬁed with interests in these current faculty, regional experts, pions may be thought of in several areas or hiring new faculty who or community leaders and external ways. We propose the following can bring new skills to the program. programs such as the AAFP’s RAP areas based on work at our own Third, time for ongoing faculty de- and faculty development programs programs (Table 1). While not all velopment, both for individuals and offered by the Society of Teachers inclusive, this faculty champion for the group, is needed. Fourth, of Family Medicine (STFM) and model does provide coverage of additional resources, particularly the Association of Family Medicine the most important New Model ﬁnancial, but also including infor- Residency Directors (AFMRD). components and won’t outstrip fac- mation technology support and net- ulty resources in small-to-medium- working with others in the health Faculty Evaluation sized family medicine residency care system and the community, A fundamental element in the programs, where there are often are crucial. process of nurturing residency only four to six faculty members Planning for faculty development program faculty champions is on staff. is the ﬁrst step toward achieving feedback. Residency programs The challenges for residency this expertise, beginning with an will increasingly need to work as programs in developing these assessment of current levels of fac- high-performance teams as the champions among their faculty are ulty interest and skills using formal New Model metamorphosis oc- several. First, program leadership, tools. Then programs need to deﬁne curs. Each program must have in including not just the program a vision of what additional faculty place a strong faculty evaluation director but also the sponsoring skills are needed by examining the system, particularly critical during institutional ofﬁcials to whom the areas of championship, and per- times of change. Unfortunately, director reports, needs to embrace form a “gap analysis” to identify our observation as RAP consul- Table 1 Proposed New Model Faculty Champion Areas Champion Area Knowledge and Skills Required Practice Champion • Advanced access models • Group visit models • Multi-modal communications • Integration of enhanced patient education systems that are interactive and culturally competent Quality Champion • Integration of evidence-based approaches and decision support tools into point-of-care interaction • Development of mechanisms to perform and track outcomes analysis • Development and piloting of patient safety plans Community Champion • Cultural competency • Health advocacy • Development of community linkages • Community-oriented primary care (COPC) project development Chronic Care Model Champion • Development and integration of modules for the care of speciﬁc diseases and health issues into the residency practice • Support for patient self-management • Decision support for physicians • Delivery system design emphasizing a team approach • Clinical information systems • Utilizing community resources and health care organization Information Technology • Computer literacy Champion • Implementation of an electronic medical record • Use of other information technology systems into the practice and program 286 April 2007 Family Medicine tants is that such faculty evalua- champion skills in their faculty is the Family Medicine Residency tion systems are often inadequate coaching.15,16 Coaching is an orga- Review Committee in 2002.17 As or absent altogether. We feel the nized process designed to develop residency programs learn about development and implementation skills or enhance performance. new model implementation, lessons of a functional faculty evaluation Rather than focusing on individual should be shared at the annual RAP system is a necessary ﬁrst step for weaknesses, coaching focuses on workshop, the annual meetings of many programs. individual strengths and seeks to STFM and AFMRD, on listserves The purposes of the performance improve performance by further and discussion groups, and in pub- evaluation system are to (1) clarify developing those strengths. Once lications. We strongly encourage role expectations for each faculty, the program director ensures align- and challenge programs to not lose (2) provide a feedback process ment of individual strengths with any individual or organizational for individual performance, (3) the skills needed for the champion learning that takes place through promote volunteerism, (4) identify role for a particular component of this approach but to share it with training and development needs, the new model, the coaching pro- the rest of the discipline. and (5) encourage professional cess then involves the formulation growth that meets both individual of a clear plan with the faculty to Acknowledgments: Even though all three authors are current Residency Assistance Program (RAP) and organizational goals. The “360- develop those skills and prepare consultants, the contents of this article are the degree evaluation,” using behavior- the residency program for New responsibility of the authors and do not neces- ally anchored rating scales (BARS), Model learning and implementa- sarily reﬂect the ofﬁcial views of the American Academy of Family Physicians or the RAP. has become the standard methodol- tion. A positive approach is then ogy.14 The primary objective of the taken when interacting with the Corresponding Author: Address correspondence 360-degree evaluation is to pool faculty member, consistent with to Dr Mengel, St Louis University, Department of Community and Family Medicine, 1402 South feedback for the faculty member the individual’s personality style, Grand Boulevard, St Louis, MO 63104. 314-977- from all of their key customers. to stimulate the development of 8480. Fax: 314-977-5268. firstname.lastname@example.org. In a family medicine residency new skills and positively support program, these customers often the process as individual and or- REFERENCES include themselves (self-evalua- ganizational learning takes place. tion), their immediate supervisor Certain barriers to coaching, such 1. Martin JC, Avant RF, Bowman MA et al; Future of Family Medicine Project Lead- (program director), peers (other as the time required and the need ership Committee. The Future of Family faculty), residents, nurses, and to develop coaching skills in the Medicine: a collaborative project of the other support staff. program director, are important to family medicine community. Ann Fam Med 2004 Mar-Apr;2(suppl 1):S3-S32. To accelerate faculty learning consider prior to widespread imple- 2. Solberg LI, Hroscikoski MC, Sperl-Hillen and adoption of new model skills, mentation of the coaching role by JM, Harper P, Crabtree BF. 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