Practice Facilitator Core Training Glossary Terms and Acronyms

Accelerating Change Transformation Team (ACTT): ACTT was established on November 1, 2018. It is a change management program within the Alberta Medical Association (AMA), connected to AMA’s key focus on health care system leadership and partnership. ACTT is the result of a merger of three previous support programs (Practice Management Program; Toward Optimized Practice; PCN Program Management Office) and it was created to better integrate the support and change management services of those former programs. In its various forms, ACTT has supported practice management, clinical quality improvement, and health care transformation in Alberta for over 20 years.

ACTT Change Package: A change package is an evidence-informed collection of tools and resources that supports process improvement and behaviour change in a focus area by following the Sequence to Achieve Change.

ADKAR®: The Prosci ADKAR® Model is a popular change management framework used with groups. This simple framework centers on the fact that successful implementation of a new way of working is the result of facilitating the change at the individual level. The 5 elements of ADKAR are Awareness, Desire, Knowledge, Ability and Reinforcement.

Aim Statement: When making a change, an aim statement helps a team define what they are trying to improve, by how much and by when.

Balancing Measure: Determines the impact of a change on a separate part of the system (e.g. a side effect).

Change Agent: At its simplest, a change agent is someone who promotes and supports others to think and work differently. In our context, a change agent is a person who acts individually or collectively to influence, instigate, promote or enable a positive change for health care transformation.

Change Management: A collective term for all approaches to prepare, support and guide individuals, teams, and organizations in making changes.

Community Information Integration and Central Patient Attachment Registry (CII/CPAR): CII allows providers to send select patient information to Alberta Netcare including consult letters and information about patient visits to contribute to Community Encounter Digests (CEDs). CPAR identifies relationships between patients and their primary provider in Netcare.

Common Cause Variation: A variation in data that is caused by chance alone.

Continuity: Continuity of care reflects the patient’s experience of care over time as consistent, connected and coordinated. There are three aspects of continuity that work together: relational continuity, informational continuity, and management continuity.

Diffusion of Innovations: A change management approach or framework that was pioneered by Everett Rogers in the 1960s. It is a long-standing, vast body of literature about how, why and at what rate new ideas or behaviours spread within a population. It covers 5 adopter groups (Innovator, Early Adopter, Early Majority, Late Majority, Laggard) and 5 factors that influence the rate of change (Relative Advantage, Trialability, Observability, Compatibility, Complexity).

Electronic Medical Record (EMR): EMRs are electronic patient files that a physician or other provider uses instead of paper files stored on shelves.

Governance: The act of establishing and monitoring the long-term direction of an organization through policy.

Health Neighbourhood: The concept of an integrated health neighbourhood takes comprehensive team-based care in the Patient’s Medical Home further to include a network of providers and services outside the medical home. The medical home acts as a hub for coordinating care within the neighbourhood, including referrals to other health professionals, specialists, hospitals and home care, and to broader social and community supports, such as community-based mental health and addictions and social services.

Health Transformation Workforce (HTW): The Health Transformation Workforce includes Practice Facilitators and Physician Champions and is sometimes referred to as the PF/PC Dyad. They are individuals with the defined role and skill to work with clinics to help them with their incremental transformation toward a Patient’s Medical Home integrated with the Health Neighbourhood. A well-resourced and high functioning Health Transformation Workforce is critical to the success of Patient’s Medical Home transformation and is a shared objective across many organizations, including Primary Care Networks (PCNs).

High Impact Changes: Represent the main areas of focus that are considered most critical for a care team to work on to achieve optimal performance in a particular area. High impact changes repeat across ACTT change packages as the changes teams need to make are similar but need to be applied in a slightly different way or context.

Health Quality Council of Alberta (HQCA): The HQCA is a provincial agency that brings an objective perspective to Alberta’s health system, pursuing opportunities to improve patient safety and health service quality for Albertans.

Huddle: A huddle is a short, stand-up meeting, usually 10 minutes or less, that is typically used once at the start of each workday in a clinical setting.

Informational Continuity: The transfer of relevant patient information between multiple care providers and locations. Includes accumulated knowledge about the patient’s preferences, values, and context.

Management Continuity: The extent to which services delivered by different providers are timely and complementary such that care is experienced as connected and coherent.

Mental Model: The lens through with we make sense of what is happening around us. It is more than our beliefs and values and is dynamic in nature. Mental models determine what we pay attention to, what options and possibilities we consider, how we make sense of events and experiences, solve problems, make judgements and ultimately make decisions and act.

Model for Improvement: The model for improvement is a tool for accelerating improvement work. It is comprised of setting an aim statement, identifying measures, selecting changes to test, and testing those changes through PDSA or plan do study act cycles.

Outcome Measure: Determines performance of the system under study. It often relates directly to the aim of the project and offers evidence that changes are having an impact.

Panel: A group of patients for whom a primary provider(s) and team is responsible for providing comprehensive and longitudinal care. Paneled patients have a confirmed relationship with their primary care provider.

Panel Managers: Personnel staffed at the clinic who provide support for panel identification, maintenance and management processes.

Patient's Medical Home (PMH): The College of Family Physicians of Canada describes a patient's medical home as, “a family practice defined by its patients as the place they feel most comfortable - most at home - to present and discuss their personal and family health and medical concerns...” The Patient’s Medical Home model of primary care emphasizes the role of the family practice and family physicians in providing high-quality, comprehensive, compassionate, and timely care.

Physician Champions: Family physicians in Alberta, who successfully engage other members of the practicing community, health organizations, and the public. They are well-positioned to build awareness about provincial transformational initiatives, affect positive change, be the voice of primary care in the province, and create system level transformation.

Potentially Better Practices: Specific processes and practices that can be tested and implemented based on clinic context. They are typically derived from related literature, clinical practice guidelines, expert recommendations and provincial innovators.

Practice Facilitators: Practice Facilitators are specially trained individuals who work with community care practices to enable meaningful changes designed to improve patients’ outcomes and clinic processes. They help physicians and quality improvement teams develop the skills they need to implement and adapt evidence-based practices to the specific circumstance of their practice environment.

Primary Care: Primary care is the first place people go for most of their everyday health needs. It is comprised of all the services in your community that support the day-to-day health needs of you and your family through every stage of life. The term “primary healthcare” is often used interchangeably but refers more broadly to all services that play a part in health, such as income, housing, education, and environment.

Primary Care Network (PCN): A Primary Care Network is a joint venture between a group of primary care physicians (who form a non-profit corporation) and Alberta Health Services to coordinate service delivery through a network of physicians and other primary health care providers.

Primary Health Care Integration Network (PHCIN): The Primary Health Care Integration Network was established to improve health outcomes and patient/provider experiences, while addressing challenges in Alberta to reduce spending in healthcare. It works closely with key partners to support integration priorities as they are identified by primary care within the zones.

Process Measures: Captures whether an activity has been accomplished. Process measurements are those that capture the changes your quality improvement efforts make to the inputs or steps that contribute to system outcomes.

Provincial PCN Committee (PPCNC): The Provincial PCN Committee is responsible for determining high-level strategic direction for primary healthcare in the province. They set specific goals, objectives, and targets as well as endorsing large provincial initiatives for primary care and primary care networks.

Quality Improvement: A scientific approach which provides a robust structure, processes and tools to test and spread improvement.

Relational Continuity: The ongoing, trusting therapeutic relationship between a patient and a primary care physician and team, where the patient sees this primary care physician the majority of the time.

Run Chart: A graph of data collected over time.

Scale: Change has happened on a large scale and permeates across the province or system.

Sequence to Achieve Change (StAC): A stepwise change management approach that incorporates the Institute for Healthcare Improvement Model for Improvement. Adapted by ACTT from the Vermont Oxford Network’s Sequence to Achieve Change.

Shared Mental Model: Means that everyone on the team shares a similar lens. When mental models are misaligned, team effectiveness can be markedly impaired and often the team does not clearly understand why.

Spread: Change that spreads to more than one area, organization or population.

Tipping Point: Term from Diffusion of Innovations. This is the point at which an innovation reaches “critical mass”, meaning that enough people have adopted it so that it becomes “mainstream”.

Valley of Death: Term from Diffusion of Innovations. This is the “gap” where an innovation can fail to spread unless a different approach is taken to engage the early majority.