Bedford's MOVE in Prevention News Feature Article
Building 2 Bedford VA
When MOVE!® Program Coordinator Joanne Maddock at the Edith Nourse Rogers Memorial Hospital (Bedford VA Medical Center [VAMC]) and her team set a goal of increasing the number of eligible Veterans in the MOVE!® program by 25 percent, they knew it would take a multi-faceted approach to achieve success.
“Challenges with staff knowledge of the MOVE!® program details, scheduling, and class logistics were identified as key areas for improvement,” she explains. “Plan-Do-Study-Act cycles were implemented to promote change. Then a multi-disciplinary team of clerks, instructors, clinicians, and Telehealth staff began working towards their new mov6 target: 6.7 percent by the end of June of 2013.”
Scheduling, Education
The first issue they tackled was the process for enrolling Veterans into MOVE!®. “Clinical staff were supposed to discuss MOVE!® details with eligible Veterans,” says Maddock, who is also the Health Promotion and Disease Prevention (HPDP) Program Manager at the facility. “But we learned that not all staff were familiar with the program and many were uncomfortable discussing weight with Veterans.” Additionally, clerical staffing shortages were contributing to delays in scheduling Veterans to attend MOVE!® orientation.
MOVE!® staff engaged primary care physicians and nurses, educating them about the MOVE!® Program philosophy and participation options. To facilitate discussions with Veterans about their weight, the facility’s Health Behavior Coordinator, Amy Bachand, provided health coaching, as needed, and offered the Moving Veterans to MOVE!® brochure, an excellent resource for empowering clinicians.
In turn, these newly educated primary care staff began to promote the program, and the local MOVE!® physician champion facilitated opportunities for Maddock to periodically talk with and inform staff. She also worked with the scheduling clerks and their supervisor to address the ongoing staffing shortages, and coordinate efforts to improve scheduling and communication with Veterans.
“We realized that program visibility and understanding were not where they needed to be“, Maddock adds. “So we increased the MOVE!® media presence with clinic flyers that outlined participation options, increased program advertising on Bedford’s Web site, and published a Telehealth article.”
Logistics
“As one way to augment our staff, I started calling Veterans to schedule the MOVE!® orientation. This provided an opportunity for me to answer questions that other staff often couldn’t,” Maddock explains. “When Veterans were unable to attend an orientation session, I would offer to discuss the program via telephone and mail the MOVE!® folder of materials and pedometer to the Veterans. We also started making appointment reminder calls to help keep Veterans engaged and ready to access MOVE!®.”
Because travel time and the expense of coming to and from the facility presented another obstacle to some otherwise willing participants, Maddock and her team began using Clinical Video Telehealth (CVT) to spread
MOVE!® to the hospitals’ community-based outpatient clinics (CBOCs). MOVE!® staff completed the required training, and the Telehealth staff provided the valuable technical and patient assistance needed to start broadcasting live classes. A final push of the home-based TeleMOVE! Program—using flyers, and staff education—also helped expand MOVE!® participation, as did providing program information for the Mental Health Services’ Chief and Specialty and Acute Care nurses.
Maddock says that another simple, but important program change involved room size and scheduling. “We moved the MOVE!® classes from Monday to Friday—to avoid frequent holidays—and into a larger classroom where we could accommodate more Veterans,” she says.
Big Improvements
The achievements have been both qualitative and quantitative, according to Maddock, and have exceeded the original goal for mov6 improvement. "We achieved 8.8 percent in Q3 of 2013, and were at 9.1 percent in Q3 2014. There was a 10-percent increase in MOVE!® orientation participation in FY13 from FY12," she explains. "We’re broadcasting classes to two CBOCs and have surpassed our goals there in terms of participating Veterans. MOVE!® participants say that they’re happier with the more consistent class schedule, the opportunity to attend classes closer to home in some cases, and the orientation scheduling process, and they appreciate the reminder phone calls that we’ve implemented." Medical clerks involved in MOVE!® scheduling report that they appreciate the improvements in staff support and timely coordination process that are now in place.
Over a year after re-tooling MOVE!®, the MOVE!® team is still striving to maintain the improvements and increase participation. "We continue to widely advertise and work with multi-disciplinary partners," Maddock notes. "We’ve added a monthly MOVE!® maintenance class and two new instructors to the program, and in addition to primary care, other service lines are encouraged to refer Veterans to the program. We plan to broadcast MOVE!® classes to our third CBOC when there is room for a group. All these things have helped to improve MOVE!® participation and care at our facility, and we continue to strive to meet Veterans’ needs regarding weight management."
