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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
                               • 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.
In a family medicine residency          new skills and positively support
program, these customers often          the process as individual and or-                       REFERENCES
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