zilongwang/ReadingBank huggingface dataset:
53 MATTERS RAISED BY COUNCILLORS a Cemetery Recruitment – Councillor Morrison had requested this item but an update had been provided earlier in the meeting. The Town Clerk added that due only two members attending the original meeting Personnel Committee is now rescheduled for Monday 17th September 2018. b Local Defibrillators – Councillor Mrs D Smith circulated information for members from the British Heart Foundation about funding opportunities and requirements on siting defibrillators in the community. She feels it is important that these devices are accessible in the Community, and is aware that the provision of defibrillators has been discussed previously, halted by suitable locations. Councillor Smith suggested moving forward and asking our Communities to suggest suitable locations. The Town Clerk added that a lot of organisations, for example the school, and local shops have them but not everyone is aware where the nearest device is located. The Town Clerk will post an appropriate page on the website. c Report from DMBC Rights of way - Councillor Ms Moate reported that she had attended the meeting and Bridleway 22 was discussed, a representative of DMBC provided a brief outline to the rest of the group. Councillor Moate added that from the information given at the time of the meeting it would appear that the provision of a gate would not have DMBC permission and she did not want Council money wasted on a gate that could be removed. Some questions were raised about this by Councillor Glynn and a discussion followed. d Report from SYP meeting with Chief Superintendent Morley - Councillor Mrs Rutherford updated members that the Chief Superintendent is aware of concerns that there are not enough officers in the community particularly with regard to elderly residents concerns and it is his intention to rectify this. A discussion followed and Councillor Rutherford added that it is planned to have a further meeting in two months. e Report from Parish Councils Joint Consultative Committee meeting - Councillor Rutherford advised that she attended and it was merely a recap on last year with no one attending to speak. 54 FINANCIAL MATTERS a Approval of Monthly Accounts for Payment The Town Clerk asked if there were any questions with the accounts and explained there were some additions to be authorised including payment to Travis Perkins for postcrete for the new goal posts of £81.07, Arco for refuse sacks, gloves PPE for £38.47, Council tax for Cemetery house £612.96 together with Daisy
THE LIST OF PURCHASING spare parts of E-35 downhole device Cədvəl A Name of material Unit of measure Quantity Main technical requirements (detailed) Appointment Standards Elastic sonde LLS CCC 2.739.007 (in repair of borehole device pieces 10 Type-4.839.026 СБ Temperature-150 C Pressure- 120 MPa Diameter-76 mm E-35/76 mm well device 1.QOST 26116-84 2. İSO-9001 Elastic LLS CCC 2.739.007 (in repair of borehole device E- pieces 3 Type- 4.839.026 СБ Temperature-150 c Pressure-120MPa Diameter-63 mm E-35/60 mm well device 1.QOST 2. İSO-9001 GL electroscheme (for borehole device E-35) pieces 3 Type-CCC 2.739.007 Temperature-150 C Pressure-120MPa Diameter-76 mm E-35 well device 1.QOST 26116-84 2. İSO-9001 GL electroscheme (for borehole device E-35) pieces 3 Type-CCC 2.739.007 Temperature-150 C Pressure-120MPa Diameter-63 mm E-35 well device 1.QOST 2. İSO-9001 Center electrode LL 4.839.026 СБ (for borehole device pieces 10 Type-E35-INT-GEN Temperature-150 C E-35/76 mm well device 1.QOST 26116-84 2. İSO-9001 Center electrode LL 4.839.060 СБ (for borehole device pieces 3 Type-Mini-INT-GEN Temperature-150 C E-35/60 mm well device 1.QOST 26116-84 2. İSO-9001
10.1 Special Triangles & their Properties Determine the indicated measure. 1. 2. 3. 4. Determine the missing angles. 5. ∠C = _____ 6. ∠C = _____ 7. ∠B = ____, ∠A = ____ 8. MO = MN, ∠N = _____ 9. ∠Q = _____ 10. ∠A = ____ Solve for x. Show work where necessary. 11. x = ____ 12. x = ____ 13. x = ____
DOCUMENT 7: OVERALL ASSESSMENT SHEET / RECOMMENDATIONS FOR INTERVIEW FOR THE POST OF: ___________________________ NAME AND REFERENCE NUMBER OF CANDIDATE: NOT RECOMMENDED FOR INTERVIEW (MARKS 0 – 20) POSSIBLE INTERVIEW (MARKS 21 – 30) RECOMMENDED FOR INTERVIEW (MARKS 31 – 40) TOTAL MARKS RANKING (1st/ 2nd/ 3rd etc.) CANDIDATES INTERVIEW PANEL
SKILLS AND ABILITIES to: TOTAL MARKS OUT OF 10 ANY COMMENTS: 2. Did the candidate demonstrate KNOWLEDGE in relation to: MARKS OUT OF 10 ANY COMMENTS: 3. Did the candidate demonstrate that they have a MINIMUM OF 3 YEAS PREVIOUS EXPERIENCE in: MARKS OUT OF 10 ANY COMMENTS: AREA OF EXPERTISE DOES CANDIDATE MEET THE CRITERIA YES NO 4. Does candidate have a 3RD OR POST GRADUATE QUALIFICATION in one of the following: TOTAL MARKS OUT OF 10 ANY COMMENTS:
SL.9-10.4 Present information, findings, and supporting evidence clearly, concisely, and logically such that listeners can follow the line of reasoning and the organization, development, substance, and are appropriate to purpose, audience, and task. CCL Standards: Language I know what this is asking and I can do this. This standard has familiar language, but I haven’t mastered it. I am not familiar with this standard. L.9-10.1 Demonstrate command of the conventions of standard English grammar and usage when writing or speaking. L.9-10.1.a Use parallel structure.
L.9-10.1.b Use various of phrases (noun, verb, adjectival, adverbial, participial, prepositional, absolute) and clauses (independent, dependent; noun, relative, adverbial) to convey specific meanings and add variety and interest to writing or presentations. L.9-10.2 Demonstrate command of the conventions of standard English capitalization, punctuation, and spelling when writing. L.9-10.2.a Use a semicolon (and perhaps a conjunctive adverb) to link two or more closely related independent clauses. L.9-10.2.c correctly. L.9-10.4.a Use context (e.g., the overall meaning of a sentence, paragraph, or text; a word’s position or function in a sentence) as a clue to the meaning of a word or phrase.
Hundert’s opinion further develops the idea that people rarely change (including Hundert). He faults himself “for not realizing his ambition before” (p. 196), considering Sedgewick’s background, personality, and popularity, as well as his “[ignorance] of history” (p. 196). Instruct student groups to read from “As soon as the clapping abated” to “I heard the din late into the night” (pp. 196–197) and answer the following question. How does Hundert feel about the outcome of the competition? Why? How do Hundert’s reactions develop a central idea of the text? Student responses should identify some or all of the following details: Hundert is tormented because only he knows the truth about Sedgewick. He describes the celebration as “an unbearable counterpart to the truth I knew” (p. 197) about Sedgewick. Perhaps doing “the right thing” isn’t always as easy as it sounds. Hundert expresses some understanding that everyone’s character (including his) has been relatively fixed when he berates himself for not realizing “the culmination I should long ago have seen” (p. 196). Instruct students to read the paragraph of “Yet, sure enough, my conviction soon began to wane” to “I spent the afternoon alone in a cove across the island” (p. 197) and answer the following question. How do Hundert’s thoughts about Sedgewick contribute to his interaction with other former students? Hundert is so caught up in not being accusatory about Sedgewick that it prevents him from enjoying his time with the other St. Benedict’s alumni. Instruct students to read the paragraph of text that starts “Needless to say, I resolved to avoid Sedgewick Bell for the remainder of my stay” (p. 197) and answer the following question. How do Hundert’s actions help develop your understanding of the meaning of spurned sovereign (p. 197)? Hundert rejected; the “castle tower” makes it sound like someone who was part of royalty, so “spurned sovereign” is a member of royalty who feels rejected.
“The boy had somehow got hold of me again.” (p. 193) Hundert won’t reveal Sedgewick’s cheating. Accurate “it was merely the sound … me from making my stand” (p. 193) and “We were guests now … to expose him would be a serious act indeed.” (p. 194) “Deepak Mehta merely looked at me, his eyes dark and resigned. Perhaps he too had just realized” (p. 194) Hundert wonders if others know that Sedgewick cheated. Unknown (Not yet revealed on reviewed text thus far. On p. 204) “’Who was Shutruk-Nahhunte?’” (p. 194) Hundert thinks Sedgewick won’t be able to answer this correctly and Deepak will win. Accurate “Deepak Mehta smiled, spoke the answer” (p. 195)
Distribute a copy of the Evidence Collection Tool to each student. This Tool will help students investigate the kind of relationship Hundert has always wanted to have with his students versus the kind of relationship he actually does have with them. Instruct students to on the interactions between Hundert and Sedgewick at the rally and interactions between Hundert and Deepak as they watch Sedgewick on television. Students listen. Instruct students to include details on the Evidence Collection Tool in the Key Details box. Details should include examples of the two interactions between Hundert and Sedgewick at the rally and between Hundert and Deepak at the end of the story. Analysis should explore the individual detail further. The connections box allows students to connect the details and better answer the focus question: How does the interaction between Deepak and Hundert develop your understanding of the relationship between Hundert and Sedgewick? Students complete the Evidence Collection Tool. See the Model Evidence Collection Tool at the end of this lesson. Instruct students to discuss their details, analysis and connections in pairs and prepare for a share out of connections during whole-class feedback. Students work in pairs to compare Evidence Collection Tools and prepare for whole-class feedback. Lead a brief full-class discussion of the tools. Activity 6: Quick Write 15% Instruct students to respond briefly in writing to the following prompt: How does the interaction between Hundert and Deepak develop your understanding of the relationship between Hundert and Bell? Remind students to use the Response Rubric and Checklist to guide their written response. Students listen and read the Quick Write prompt. Display the prompt for students to see or provide the prompt in hard copy. Consider eliciting some of the vocabulary words from this and the previous two lessons (11 and 12) that might be appropriate for students to use in their Quick Writes. Instruct students to incorporate
Project 10.1 Design Challenge Rubric Design Elements Weight 5 Points 4 Points 3 Points 2 Points 1-0 Points Total Freehand Sketching Produces accurate pictorial and sketches of the required design concepts. Is properly detailed for effective communication. Produces marginally sufficient freehand sketches of required design concepts. Is partially detailed for effective communication Produces marginally sufficient freehand sketches of required design concepts. Is marginally detailed for effective communication Produces freehand sketches that are difficult to visualize. Lacks details in sketches. Produces incomplete sketches. Does not present concept. Consideration of Alternatives Generates at three viable concepts. Selects most appropriate concept and clearly justifies the choice using the appropriate criteria. Generates three concepts. Selects an appropriate concept and is somewhat able to justify the choice using marginally acceptable criteria. Generates three concepts. Selects an appropriate concept, but cannot justify the choice. Generates three concepts. Selects one using inadequate criteria. Generates one concept. Design Requirements Fully meets design requirements. Meets most design requirements and supports the design function. most design requirements, but not enough to support the design function. Meets some requirements, but not enough to support the design function. Does not meet any requirements. Teamwork Both team members worked well together and Showed good team working Showed good team working Showed that understands team working Did not present any team working skills.
presents it. Interprets verification results. instructor. Presents clearly, but results are not interpreted well. instructor. Presents fairly well, but results are not interpreted well. Dimensions and Annotation Dimensions and annotates properly and clearly. Supplies most dimensions and annotations. Locates most dimensions and annotations them properly. Supplies most dimensions and annotations. Locates most dimensions, but does not annotate them properly. Omits many dimensions or annotations. Some mislabeling exists. Dimensions or annotations have not been leaving only defaults. Views Locates all appropriate views properly and clearly. Locate most views clearly or properly. Does not locate all appropriate views clearly or properly. Omits views needed for clarity. Includes inappropriate views. Incomplete drawing submitted.
12:15 – 1:10 Lunch (possible panel) Washington Ballroom 1:10 – 2:30 Session 2 Options Compelling Communication Katz III, Mohawk Valley Community College Requires 3 activity pages printed to work from (see website) Change Leadership: Designing and Implementing Pathways Dr. Kathleen Cleary, AVP Sinclair Community College Strategies and Resources for Implementing and Improving Effective Math Pathways Joan Zoellner, Rebecca Hartzler and Paula Talley Integrating Student Voices – how one college listened to and integrated students into the redesign process Erin Davison, Danielle Carnes and Jennifer Inslee Development of Career Communities at Sinclair Community College April Carpenter, Department Chair, Sinclair Community College Location Snoqualmie 2 Salon F Salon G Salon H Salon I 2:30 – 3:30 Team Time – Shared Learning / Takeaways / Action Planning Washington Ballroom 3:30 – 4:00 Closing Session Washington Ballroom
Patient Name and DOB Influenza Manufacturer/ Lot Number/ Expiration PCV13 Manufacturer/ Lot Number/ Expiration PPSV23 Manufacturer/ Lot Number/ Expiration HPV Manufacturer/ Lot Number/ Expiration Tdap Manufacturer/ Lot Number/ Expiration VZV Manufacturer/ Lot Number/ Expiration Other Manufacturer/ Lot Number/ Expiration NAME: DOB: VIS Edition & Date Given: NAME: DOB: VIS Edition & Date Given: NAME: DOB: VIS Edition & Date Given: NAME: DOB: VIS Edition & Date Given: NAME: DOB: VIS Edition & Date Given: Source: AMA. Practice transformation series: implementing a team-based adult immunization program. 2017.
Sample meeting agenda Insert your clinic name Quality, Efficiency and Satisfaction (QE&S) agenda The mission of our practice is to deliver high quality care with a personal touch, in an efficient, timely manner that is rewarding to patients and the entire care team. January 13, 2015 Meeting 7 am – 8 am Chair: Mary Recorder: Xavier Timekeeper: Rajan Agenda Item Allotted Time Check-in (share something from your personal life) 7:00 – 7:05 (share positive patient care experiences) 7:05 – 7:10 Check-back (review action steps from last meeting) Reason for discontinuing medications Nurses will add reason for discontinuing; if they don’t know they will ask Dr. Smith. Annual Wellness Visit form Julie and Mary will create a new form for Medicare patients to complete at check-in. Team will review the form for visual management capabilities (all abnormal responses visible at a glance). EHR template will be built to match. 7:10 – 7:20 New business Collaborative care and Xavier) Introductory script with patients Review of chronic diseases Review of pre-visit lab results As needed use of action plan 7:20 – 7:40 Education Sleep apnea (Greg) 7:40 – 7:55 Meeting debrief Assign action items and roles for next meeting 7:55 – 8:00 Source: AMA. Practice transformation series: team meetings. 2015.
Sample meeting minutes Insert clinic name Quality, Efficiency and Satisfaction (QE&S) meeting minutes Date: January 13, 2015 Location: Conference room A Time: 7am – 8 am Minutes prepared by: Xavier Chair: Mary Timekeeper: Rajan Attendees: Julie, Dr. Smith, Greg, Sally Agenda item Description Due Status Check-in Mary’s son finished his college applications last week. Complete Shout-out Rajan was able to order a patient’s overdue mammogram during a recent visit, catching early breast cancer. The patient wrote a letter thanking him for helping her schedule the appointment! Complete The team will continue to add the reason for discontinuing medications in patient charts. Nurses Started 1/6/15 Ongoing The Annual Wellness Visit form was modified to meet practice needs. It passed the team’s visual management review, and it will start being used after the meeting. IT is working on integrating the new format into the EHR. Feedback for continued improvements can be shared with Julie and Mary. and Mary 1/13/15 Adopted by all, ongoing New business Julie and Xavier presented the new collaborative care initiative. They shared the introductory script to guide communication with patients and gave an overview of the review process for chronic diseases and pre-visit lab results. The action plan will continue to be used for patients as needed. The target activation date is Monday, February 2nd. Julie and Xavier 2/2/15 Julie and Xavier will continue to work with Dr. Smith to develop. They will present at the team meeting on 1/27. Education Greg gave a briefing on apnea. The team learned about what symptoms patients might be experiencing, administering the Epworth sleepiness scale, when to involve the physician and other conditions often confused with sleep apnea. Greg 1/13/15 Complete Roles at next meeting Chair: Julie Recorder: Sally Timekeeper: Dr. Smith Attach documents shared with team at the meeting: Revised Annual Wellness Visit form Collaborative care update Sleep apnea education Source: AMA. Practice transformation series: team meetings. 2015.
Encourages me to develop my talents and skills. Strongly disagree Disagree Neither agree/disagree Agree Strongly agree N/A 1 2 3 4 5 I would recommend working for (insert name of immediate supervisor). Strongly disagree Disagree Neither agree/disagree Agree Strongly agree N/A 1 2 3 4 5 Overall, how satisfied are you with (insert name of immediate supervisor). Strongly disagree Disagree Neither agree/disagree Agree Strongly agree N/A 1 2 3 4 5 Reprinted from Mayo Clinic Proceedings, Vol. 90 Issue 4, Shanafelt, T., et al., Impact of Organizational Leadership on Physician Burnout and Satisfaction, Pages No. 432-440, Copyright (2015), with permission from Elsevier.
Appendix A Appendix B University Studies Courses with average section enrollment 10 and less Average (Fall Course Course Name 2015-Spring 2017) GERM 202 PSYC 270 GERM 102 FNS 101 HIST 394 FNS 480 HIST 393 FREN 101 FNS 304 HIST 395 ECON 438 ANTH 310 GST/PHIL 459 GERM 201 POLS 260 PHIL 211 SO W / FNS 386 PSYC 230 ECON 435 SPAN 315 Intermediate German II 3 Psych of Men & Masculinity 4 Beginning German II 5 Beginning Ojibwa Language 6 Interrogating the Vietnam War 6 First Nations Soc/Culture:F R 6 Wom, Colonial, Nat Mod SE Asia 7 Beginning French I 7 First Nations Literature 8 Modern India 8 Comparative Economic Systems 9 Gender Perspect 9 Philosophies of Mothering 9 Intermediate German I 9 Contemp Issues:Amer Politics 10 Contemporary Moral Problems 10 SW Prac/American Indian Family 10 Social Cognition 10 Development Economics 10 Voices of Hispanic Women 10
Prepare patients for the exam and medical procedures. Provide a gown and advise patients to undress as appropriate. Set up the exam room and prepare the patient for procedures such as skin biopsy, cryosurgery, etc. Introduce new patients to the practice. Some practices have created a “Welcome to Our Practice” pamphlet or folder to introduce new patients to physicians, and processes in the practice. Handoff Prepare the physician. In a “mini-huddle” with the physician, share the information you’ve learned during rooming, such as the patient’s goals for the visit, response to treatment initiated during the last visit and social/emotional history. For example, “The patient felt dizzy on the atenolol we started at the last visit and decided to stop it. In addition, her husband was recently diagnosed with Alzheimer’s disease. She is stressed and doesn’t think she can handle another medication at this time.” This handoff, taking no more than a minute, will help the physician best meet the patient’s needs. Source: AMA. Practice transformation series: implementing team-based care. 2015.
Additional Information What else should you measure? planning can increase productivity and capacity to care for more patients. If this is one of your goals, consider tracking your productivity visits/half day and/or relative value units (RVUs) using your practice management system. Sharing positive results is an opportunity to showcase your success. For additional information on how to implement quality improvement strategies in your practice, contact the AMA at . Sources for scales R, Hessler D, Rogers E, Dube K, Bodenheimer T, Grumbach K. Team structure and culture are associated with lower burnout in primary care. JABFM. 2014;27:229-238. Reuben DB, Knudsen J, Senelick W, Glazier E, Koretz BK. The Effect of a Physician Partner Program on Physician Efficiency and Patient Satisfaction. JAMA IM. 2014 Jul; 174(7):1190-1193.
COMMON DISEASE ABBREVIATIONS A-fib: atrial fibrillation DM: diabetes mellitus CHF: congestive failure CKD: chronic kidney disease COPD: chronic obstructive pulmonary disease CVA: cerebral vascular accident or stroke HTN: hypertension HOW OFTEN DO STABLE PATIENTS NEED TO BE SEEN BEFORE MEDICATION REFILLS ARE COMPLETED? Stable DM: 3 months Stable HTN: every 6 months Stable hyperlipidemia: every 6 months Stable thyroid disease: 6 months (or as stated in the provider’s note for all of the above) HOW OFTEN DO PATIENTS NEED TO BE SEEN IF NEW MEDICATIONS OR DOSE TITRATION IS NEEDED? Every 4-6 weeks unless otherwise noted in the clinician’s plan HOW OFTEN ARE BEHAVIORAL HEALTH MEDICATIONS REFILLED? Patients need to be seen every 3 months until patient is deemed “stable” on their medications Once stabilized, 6 months
Conducting a patient experience focus group A patient experience focus group can help your practice really engage in conversation with patients to hear what they have to say in their own words. After a focus group, you should come away with actionable ideas that can improve your practice. Feedback given in this forum can also be powerful when shared with staff, physicians and leadership. Below are tips for conducting a focus group, a sample protocol and examples of questions that can be used to spark dialog. Tips Focus groups should be small, approximately 8-12 people. Select participants using an unbiased approach. Incentivize participants if possible. Provide some refreshments. Circular seating is common and preferred in this setting. Consider using participant name tags. Focus groups are one-time sessions that should last approximately 90 minutes. A trained moderator should be present to conduct the focus group. Record the session. Sample protocol for a patient experience focus group The moderator should deliver an opening statement explaining the purpose of the focus group, how it will be conducted, the rules (i.e., no phones, respectful conversation) and what the results will be used for. Example introduction Moderator: “Welcome! Thank you all for participating in today’s focus group. We are here today to discuss the patient experience in this practice and receive critical feedback that will help us shape a new, comprehensive patient experience program. I will be your moderator today and guide conversation for the next 90 minutes. Before we get started, I would like to set some ground rules. I ask that you kindly turn off any electronic devices, be respectful to each other throughout the discussion, and remember, there are no right or wrong answers — everyone’s opinion is valued! Let’s get started by doing some brief introductions (participants can introduce themselves).” Example icebreaker Ask participants to share an experience they may have had in the practice (positive or negative). Other participants can be encouraged to share their experiences or build the discussion off the initial story. Example questions What could we do to improve your experience in the practice? What do you think patients value most when they go to the doctor? How do you feel the practice staff and physicians communicate with each other? With patients? How do you feel you were treated during your last experience with the practice? Has anyone had an experience with practice leadership? What was that like? Source: AMA. Practice transformation series: building a patient experience program. 2017.
Employee Engagement Survey This survey will help us determine how our employees feel about their work environment and where opportunities for improvement exist. Any additional feedback you would like to share is welcome. Thank you for your participation and feedback! Name (optional): Role: Team: Date of survey: To what extent do you agree or disagree with the following statements? Please circle your answer. 1. The practice I work for has a positive culture. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 2. I understand the strategic goals of the practice and how my work impacts these goals. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 3. I feel proud to work for this practice. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly 4. My supervisor is an effective communicator. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 5. Employees are involved in making decisions that affect them. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 6. Management about employee interests and well-being. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 7. I feel appreciated and valued as an employee. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly 8. My work environment supports teamwork. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 9. My team works well together and communicates effectively. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 10. My team motivates me to do the best work I can do. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 11. I have the resources and tools to successfully do my job. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 12. The amount of work required of me is reasonable. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree
Coach That’s fine. Let’s go over it together. A1C tells you how well you are controlling your diabetes. A1C tells you what your average blood sugar has been for the last three months. Just to make sure I was clear, can you tell me what your A1C measures? [Tells the information Mr. Newton doesn’t know, then asks to check understanding, also called “closing the loop”] Mr. Newton I think A1C is an average of my blood sugar over 3 months. Is that right? Coach Yes, that’s correct! Why do you think we care about your A1C number? [Finding out what Mr. Newton knows or doesn’t know] Mr. Newton I’m not sure. I think you said it shows something about my diabetes. Coach Yes! Your A1C number is another way to measure how your diabetes is doing. Can you tell me what your A1C number is? And do you know your goal? information and then asks to find out what Mr. Newton knows or doesn’t know] Mr. Newton I’m not sure. Coach Your A1C is 10 and your goal is seven. What do you think about that? [Asking about Mr. Newton’s motivation] Mr. Newton My A1C is too high. I don’t like that. It needs to be seven. Coach Yes, would you like to talk about how to bring it down to seven? [Asking permission] Mr. Newton Yes. Coach Do you know how to bring your A1C to seven? [Asking to assess Mr. Newton’s knowledge] Mr. Newton No, I don’t. Coach The three main options are healthy eating, physical activity and taking your medicines. Is there one of those you would like to work on? [Tells options then asks for Mr. Newton’s preference] Mr. Newton I think eating better. Coach we talk about that when we meet next week? [Asks permission for a future coaching meeting] Source: AMA. Practice transformation series: health coaching. 2016.
Measurement tool 4: Staff experience survey Step 1: Survey your staff Purpose: The purpose of this survey is to measure satisfaction to understand the staff experience as it relates to expanded rooming and discharge in the practice. Instructions: Each staff member in the practice should complete this survey at three time points: (1) at least one week before starting the new expanded rooming and discharge process, which will serve as baseline data; (2) 12 weeks after implementation; and (3) 24 weeks after implementation. Complete this survey to identify opportunities for performance improvement. The shaded gray cells have been included to guide you in transferring data through this multi-step tool and determining the value of your first time point. Staff Survey Staff name (optional): Date of Survey: Did you work with a physician during today’s clinic session to assist with documentation? Yes No How much do you agree or disagree with the following statement? Please circle your answer. 1. I feel that the work that I do improves the quality of patient care. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 2. My professional skills are used to the fullest at this clinic. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 3. The tasks that I am asked to do each day are manageable. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 4. People at all levels of our clinic give feedback to improve the way we do things. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree Answer the following only after the collaborative documentation process has been implemented. What do you like most about the expanded rooming and discharge protocols? How could we improve the expanded rooming and discharge protocols? Step 2: Calculate the professional satisfaction score for each staff member in the practice
Measurement tool 3: Patient experience survey Step 1: Survey your patients. Purpose: The purpose of this survey is to measure patient satisfaction and understand the patient experience with the panel management process. Instructions: Distribute this survey to patients at time points: (1) at least one week before starting the new panel management process, which will serve as baseline data; (2) 12 weeks after implementation and (3) 24 weeks after implementation. Administer the survey to all patients on the same day of the week each time (e.g., sample all patients with Tuesday appointments at each time point). Ask a member of the team to provide the survey to every patient after their visit with the provider and identify a place for patients to anonymously submit their completed survey. To obtain meaningful results, aim to collect 30 survey responses per time point. Use survey results to identify opportunities to improve performance. The shaded gray cells have been included to guide you in transferring data through this multi-step tool. Patient Survey Survey number (to be filled out by clinic staff): Date of Survey: How much do you agree or disagree with the following statements? Please circle your answer. 1. I feel good about my visit. 1 Strongly disagree 2 Disagree 3 Neutral 4 5 Strongly agree 2. I felt that my provider (physician, NP, or PA) was prepared for my visit. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 3. I felt that I received comprehensive care – that is, the care team covered all of my health-related needs. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 4. My care team spoke with me about preventive and chronic care needs today, such as 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree
patient-related, including staff messages. Physicians and clinical team members continued Type of message Why am I getting this in my inbasket? What do I do with the message? How do I get the message out of my inbasket? Refill authorizations Someone has started a refill encounter and routed it to the physician or appropriate team member. Follow your practice-specific protocols for medication refills. Complete refills per protocol and close the encounter. Mark the message done or route to the physician and then mark as done. Overdue encounters Encounters left open more than 72 Open the report to quickly see what needs to be completed to close the encounter. Click the hyperlink to be taken directly to the section that needs to be completed. Close the encounter. Open encounters This is an encounter you created that has not been closed yet. You may need to finish documentation; forgot to route or just forgot to close the encounter. It may be in someone else’s inbasket waiting to be completed. Double click to open the encounter, complete any required actions, and add any additional documentation if needed. Close the encounter. The message will auto retract once the inbasket refreshes. Physicians only Type of message Why am I getting this in my inbasket? What do I do with the message? How do I get the message out of my inbasket? CC’d charts Another physician or nurse sent you a copy of a visit encounter to review. Extended care team members, such as case managers, will send communications to this folder. Do not disregard this folder. Review the encounter. You can mark it done or go to the Length of Stay (LOS) and Follow Up section (or whatever similar section you have in your EHR) to respond. A note to the sender can be typed in that section. Co-sign notes RN or extended care team member has seen a patient and charged 99211. The note needs to be co-signed by a physician who was in the office at the time of the charged visit. Click co-sign note. If you use SmartPhrases, consider adding “ATTEST” or something similar. The message will be marked “done” after the note has been co-signed. Clinical team members only Type of message Why am I getting this in my inbasket? What do I do with the message? How do I get the message out of my inbasket?
Navigating the complexities of prior authorization This grid is an example of one health system’s prior authorization requirements for various imaging and other tests. In some instances, clinical decision support (CDS) can . Note: The tests listed here are not the only tests that require prior authorization; they are the tests known to require prior authorization with the insurance providers listed. Commercial providers, Medicaid HMO and out-of-state Blue Cross Blue Shield not listed here should be contacted for every high-dollar test in order to determine prior authorization requirements. Because clinical information is required for prior authorization, the patient and provider are responsible for beginning the prior authorization process. All generic insurance plan providers should be called to check on prior authorization requirements, as plans vary. PRIOR AUTHORIZATION REQUIREMENTS Priority Health (PH), PH Medicare & PH Medicaid BCBS / Medicare + Blue Blue Care Network United Healthcare Humana Cigna Aetna PPO McLaren PPO Molina Healthcare of MI Meridian Upper Peninsula Health Plan Tricare Prime RADIATION SERVICES CT/CTA X (even if secondary to auto, work comp or liability) X X X X X X X X (Anesthesia (when performed with radiology testing) X MRI X X X X X X X X (Anesthesia (when performed with radiology testing) X MRA X X X X X X X (Anesthesia (when performed with X
(insertion, replacement, upgrade) Resting transthoracic echocardiography X Transesophageal echocardiography X OTHER SERVICES Bone density X X Cardiac rehab X X X X X Occupational therapy X X (after eval & 1st 6 visits) X Outpatient surgical X Per plan/call Per plan/call Per plan/call Per plan/call X X X X X Pain procedures X X Physical therapy X X X X X (after eval & 1st 6 visits) X X Pulmonary rehab – initial service X X X X X X X study X X Per plan/call Per plan/call Per plan/call Per plan/call X X X Sleep follow-up X X X X X AUTHORIZATION METHODS Phone Ereferrals option 3 options 1,4,1,2 Alternate phone Pulm Rehab EviCore PT/OT Web United Healthcare Health Help Med Solutions
Guide to process mapping and redesign Feeling worn out at the end of the day? Does a day at the office seem chaotic and on the verge of disaster? Would an unexpected hiccup, such as a key staff member being out for the day, a computer glitch or a lab machine malfunction, cause the day to unravel? Process mapping is a simple Lean tool to help you and your team identify inefficient workflows or unnecessary variables in your daily work to head off disorganized and potentially disastrous situations before they arise. Process mapping can be accomplished in six steps: Step One: Pick a specific process or workflow to analyze and improve. Keep your choice manageable. For example, you may want to analyze patient lab report review and follow up, or coding and billing workflow. Step Two: Select a few people for a “task-oriented work group,” which should include someone from each function in the workflow. Step Three: Detail all the steps with a map of the current workflow on a flip chart or white board with sticky notes. Think about decision points, authorizations required to proceed, location changes for patients or staff, handoffs of responsibility, equipment required, communication among staff about progress, etc. Step Four: Look for steps in the workflow map that are unnecessary and could be eliminated. In the language of Lean, eliminate any steps that do not add value to the patient. Review the map with the following questions in mind: “Why are we doing this? What can we do differently to improve efficiency? Who can or should be doing this part of the process? Would a protocol or standing orders help?” Step Five: Map the process with modifications and test it on a scale for usability and refinement. Ideally, the work group has selected metrics to determine if the new workflow is actually better (and by how much) than the original. See examples of process maps below and here [Note for Klick: link to Lean process maps]. Step Six: Roll out the new process to the entire office. Select the next process for analysis and repeat the six steps! Figure 1. Sample process map Source: AMA. Practice transformation series: preparing your practice for change. 2015.
Any gaps in care that could be better understood with a registry 1. 2. 3. 4. 5. Existing or future quality improvement efforts that could benefit from the data gathered by a registry 1. 2. 3. 4. 5. How the registry will fit into your existing workflows Consider using a workflow map to guide your discussion. Responsibilities of your team members Administer training: Input information: Monitor: Report: Anticipated challenges to training, implementation and/or rollout of the registry 1. 2. 3. 4. 5. Metrics that be reported to payors and/or partners and may enhance revenue through quality bonus programs 1. 2. 3.
The CPhT should use the counting tray provided to obtain an accurate number of each pill form medication to be disposed The CPhT should document the approximate amount of liquid medication disposed of based on the container holding the medication Complete the “Drug Disposal Checklist” in SafeMed database (below) Teach Back of Discharge Materials for Driving Diagnosis (LPN) Assess Patient Understanding of Material In Disease Tool Kit –LPN Review availability and knowledge SafeMed Program and primary care phone numbers and whom to call if patient has RED or YELLOW ZONE symptoms If the patient has an established primary care provider, the participant should attempt to contact that provider for mild to moderate symptoms. If the patient cannot access the provider in a timely manner, the patient is instructed to call the SafeMed Program APN for mild to moderate symptoms. Assess patient understanding of condition-specific self-care recommendations for the driving diagnosis Ask patient to state as many self-management goals for their driving diagnoses, as they can Ask patient to state basic information about their disease process Good Fair Poor The patient/caregiver can state the majority of self-management goals for their disease process they are able to state a majority (more than 4 items) of the basic information about their disease process upon prompting The patient/caregiver can a couple of the self-management goals for their disease process they are able to a moderate amount (3 to 4 items) of basic information about their disease process upon prompting The patient/caregiver cannot state more than one self-management goal for their disease process cannot state more than one piece of basic information about their disease process upon prompting Document assessment of the patient’s comprehension of educational materials in SafeMed Database Teach-back Checklist (below)
□ Reading it in English □ Looking at pictures while someone explains it □ Reading it in Spanish □ Listening to someone explain new information □ Reading it in another language □ Other: ________________________ □ Looking at pictures with words What is the highest of school you have completed? □ Grades 6 to 8 □ Associates Degree □ Grades 9 to 12 □ Bachelors Degree □ GED □ Graduate Degree □ High School Diploma □ Other: ________________________ □ Some College □ Prefer not to say Comments: Does the patient have low health literacy*? Yes No *Yes is somewhat, often, or always on following question
INFORMAL CAREGIVER INFORMATION Carer/Care Representative: No Carer Available By ‘carer’ we mean someone you rely on to help with daily life, but is not paid to do so – meaning a family member, friend or relative. By designating a carer, you authorize this individual to be part of your care team and assist with implementing your care plan upon leaving the hospital, assist organizing follow up services as needed, and support ongoing communication of needs and concerns to your care team. Carer understands role on care team and accepts designation. YES NO *Add carer contact information if not already entered under alternative contact information. DEMOGRAPHIC INFORMATION Gender: □ Male □ Female □ Unknown Height: Weight: ________________ Race: □ American Indian/Alaskan Native □ White/Caucasian □ Asian □ Multi-Racial □ Black/African American □ Unknown □ Native Hawaiian/Pacific Islander Ethnicity: □ Hispanic/Latino □ Not Hispanic/Latino Marital Status: □ Single/Never Married □ Civil Union/Domestic Partnership □ Married □ Cohabitating with Partner □ Separated □ Other: ________________________ □ Divorced □ Prefer Not to Say □ Widowed Where are you living right now? □ Own house/Apartment □ Institutional setting, specify____________ □ With friend/relative □ Other: ________________ □ SRO/boarding home Does the patient have lack of social support at home Yes No
Clinician 1: Clinician 2: Clinician 3: … Clinician 10: Add clinician professional satisfaction scores (numerator) number of clinicians included (denominator) Calculate practice professional satisfaction scores (numerator divided by denominator) Data to include in Step 4 Step 4: your results Instructions: Use a charting tool to graph the professional satisfaction score for your practice before and after implementation. Your graph might look like the run chart below. Use this to discuss how you can improve the process with your team.
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Separate waste (rubbish or recyclable) Wrap broken glass in thick paper Always keep lids on bins Wash hands after handling bins or rubbish Pest Control Types of common pests found in food preparation areas: Rats Mice Cockroaches Flies Ants Weevils Prevent from coming into food preparation areas by: Checking incoming stock for pests or signs of pests such as gnawed packages or droppings – if a food item is delivered with signs of pests do not accept it Store food in sealed containers off the floor Remove packaging cartons such as cardboard Ensure bins lids are tight fitting and away from food Shut unscreened doors and windows Ensure safe use of pest control chemicals – keep away from food and pest control ensure food preparation areas and equipment are cleaned and sanitised Food Safety at all Stages Food hazards can at all stages. Anyone involved at any stage must follow safe food handling practices. Receiving Goods When good are delivered it is important to inspect immediately for: Signs of damage or deterioration Broken or damaged packaging Signs of pests Use by dates/best before dates o Use by dates - The date by which the food should be eaten and still be safe. Food may not be sold beyond its use by date, as it may not be safe to eat.