RESUMEN
INTRODUCTION: Stemming from an initiative launched at the University of California, San Francisco, School of Medicine's retreat in 2014, a group of 15 senior faculty and administrators convened to explicitly discuss strategies for creating an institutional culture of leadership. The group agreed to focus on improving a foundational skill involved in almost all leadership activities: running effective meetings. Meetings are necessary to advance institutional vision and growth. Moreover, meetings also can be detrimental if not run effectively, leading to lost productivity and meeting fatigue. METHODS: A working group developed and disseminated a workshop for learners, faculty, and administrators to create an institutional culture where meetings are interactive and transformational events. The resulting Meeting Optimization Program (MOP) is a 75- to 90-minute workshop that contains the key elements of effective meetings culled from existing literature and resources. MOP includes interactive discussion and a role-play to allow participants to practice effective meeting skills. The toolkit includes a facilitator guideline and a companion checklist of skills and resources. RESULTS: Working group members cofacilitated workshops for a variety of divisions across the campus. Participants rated the workshop highly for achieving its goal, for its overall effectiveness, and for the general format. Several participants became facilitators in a modified train-the-trainer model. Feedback highlighted the need for another iteration of the workshop focusing on facilitation. DISCUSSION: Creating change in complex systems inevitably involves meetings. Using MOP, institutions can empower their members with the tools to have effective meetings.
RESUMEN
INTRODUCTION: The Geriatric Resources for the Assessment and Care of Elders (GRACE) program has been shown to decrease acute care utilization and increase patient self-rated health in low-income seniors at community-based health centers. AIMS: To describe adaptation of the GRACE model to include adults of all ages (named Care Support) and to evaluate the process and impact of Care Support implementation at an urban academic medical center. SETTING: 152 high-risk patients (≥5 ED visits or ≥2 hospitalizations in the past 12 months) enrolled from four medical clinics from 4/29/2013 to 5/31/2014. PROGRAM DESCRIPTION: Patients received a comprehensive in-home assessment by a nurse practitioner/social worker (NP/SW) team, who then met with a larger interdisciplinary team to develop an individualized care plan. In consultation with the primary care team, standardized care protocols were activated to address relevant key issues as needed. PROGRAM EVALUATION: A process evaluation based on the Consolidated Framework for Implementation Research identified key adaptations of the original model, which included streamlining of standardized protocols, augmenting mental health interventions and performing some assessments in the clinic. A summative evaluation found a significant decline in the median number of ED visits (5.5 to 0, p = 0.015) and hospitalizations (5.5 to 0, p<0.001) 6 months before enrollment in Care Support compared to 6 months after enrollment. In addition, the percent of patients reporting better self-rated health increased from 31% at enrollment to 64% at 9 months (p = 0.002). Semi-structured interviews with Care Support team members identified patients with multiple, complex conditions; little community support; and mild anxiety as those who appeared to benefit the most from the program. DISCUSSION: It was feasible to implement GRACE/Care Support at an academic medical center by making adaptations based on local needs. Care Support patients experienced significant reductions in acute care utilization and significant improvements in self-rated health.