Duration: 1-2 Weeks Each nurse is onboarded as per the expectation in their own health system. In addition to local training, the university team provides ~ 6-8 hours of introduction to the IC4 processes. Orientation activities include:
- Nurse onboarding processes
- Primary care team introductions
- Coaching introduction
- Orientation didactics:
- Principles of Care Coordination
- Shared Plans of Care
- Care Coordination Processes and Process Management
- Resources, Coaching and the Collaborative
Duration: Initial 6 Months (~3 hours per week) Each nurse joints a cohort of other new care coordinators to attend weekly virtual didactics, weekly one-on-one virtual coaching sessions with an experienced and trained care coordination coach and monthly statewide team meetings with the full community of care coordinators.
- Process and quality improvement coaching
- Case-based consultations
- Resource playbook distribution
- High intensity didactics with topics including:
- A. Communication in Care Coordination
- Motivational Interviewing: The basics
- Navigating Sensitive Topics and Difficult Conversations
- Trauma Informed Care
- B. Population Health
- Health Equity and Bias
- Health Literacy Universal Design
- Quadruple Aim –Quality, Cost, Family and Team Satisfaction
- Social Determinants of Health – Beyond Medical Needs
- C. Professional Development
- Conflict management: De-escalation
- Quality Improvement: In day-to-day work
- Self-Care and Resilience: Boundaries and Ethics
- D. Family Needs
- Anticipating life transitions
- Childcare, education, community services
- Durable Medical Equipment and Supplies
- Family and Social support
- Goal setting: proactive, prioritized, lifecourse, strengths approach
- Medicaid Basics
- Medicaid HCBS waivers
- Taking actions
Longitudinal ~3 hours per month Upon completion of the 6-month curriculum, each care coordinator joins the ongoing learning collaborative as a community of practice. Activities include:
- Ad hoc and monthly coach case-based consultation
- Quality improvement reporting and planning
- Continuing education sessions
- Resource updates