Throughout the module is a script, designated by the star icon, which can be used to introduce issues, ask reflective questions, prompt discussion, elicit feedback, and summarize important take-home messages. The script can be read or preferably paraphrased by the educator(s) facilitating the teaching sessions.

The World Health Organization has defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Bright Futures embraces this broad definition of health — one that includes not only prevention of morbidity and mortality, but also the achievement of a child’s full potential. In the Bright Futures concept of health, providing the capacity for healthy child development is as important as ameliorating illness or injury. Recognizing and acknowledging the strengths and resources of the child, family, and community are essential to promoting healthy growth and development.

To build that capacity, the Pediatrics in Practice curriculum focuses on six core concepts: Partnership, Communication, Health Promotion, Time Management, Education, and Advocacy. The curriculum also includes a companion module (Health) and videotape that present an overview of Pediatrics in Practice and the Bright Futures approach.

Today’s session is the first of two that comprise the Pediatrics in Practice Time Management module. In today's complex health care environment, time management skills have become indispensable tools for health promotion. Today's health professionals face intense pressures to provide health care for increasing numbers of children and their families, including many with complex medical and behavioral problems. The American Academy of Pediatrics, the Centers for Disease Control and Prevention, the U.S. Preventive Services Task Force, Bright Futures, and others recommend expanded health promotion and preventive services to meet these challenges. Yet, the average time for a pediatric health visit is only 14.2 minutes. In this session, we will discuss an approach or model for managing the limited time available, in order to accomplish as many goals as possible during the health visit.In today’s session, our objectives will be to:

• Learn the five-step Time Management Model to manage the health visit more efficiently. Acquire the knowledge and skills to prioritize goals for the health visit.
• Understand the role of collaboration and partnership when setting priorities for the health visit.

When we have completed the session, you should be able to answer the following questions:

• How can I deliver enhanced health promotion services in a timely manner consistent with the real-world demands of pediatric health care, including care for children with medically and socially complex needs? How do core concepts and skills such as building a partnership with the family improve the efficiency of providing health promotion services? Improve time management?
• How do interview questions improve the efficiency of the health visit?

Before we begin, I am going to distribute copies of the handout Initial Self-Assessment of Time Management. Take 2 or 3 minutes to think about how frequently you use some of these time management tools. (This exercise is for your own personal use; it will not be collected.)

Looking at your self-assessment, let’s talk about areas where we could become more time-efficient.

OR:

Looking at your self-assessment, what areas seem to be most challenging for you? Why?

Time management helps us to use time in the most effective and productive way possible. The Time Management Model consists of five essential steps:

1. Maximize time for health promotion (by minimizing documentation time). Clarify the health professional's goals for the visit. Identify the family's needs and concerns for the visit. Work with the family to prioritize goals for the visit.
2. Suggest other options for addressing unmet goals.

We are now going to apply this model step by step, based on the case of Jacob Downing and his mother, who have come to the clinic for Jacob’s 4 month visit.

The focus of this discussion is the implementation of each step of the model.

Step 1 of the Time Management Model is to maximize time for health promotion. This can be accomplished through a range of techniques, such as using checklists and standardized documentation forms. What strategies would you, as a pediatric provider, use to minimize the time spent documenting Jacob’s health visit in order to have more time to discuss the family’s health concerns?

Step 2 of the Time Management Model is to clarify the health professional's goals for the visit.

As professionals, we enter into each health visit with an agenda. We must become fully aware of our own goals, as well as the family’s goals, for a health encounter before attempting to set priorities for the health visit. Being fully aware of this agenda is a vital step in managing health visits efficiently. In addition to completing the physical exam and necessary screening and immunizations, what goals do you, as Jacob's pediatric provider, have for this 4 month health visit?

What healthy and safe habits do you think should be addressed at a 4 month health visit? What parent/infant interaction behaviors would you want this mother to know?

What aspects of the family relationships would be important to address?

This list appears to have a lot in common with a menu in a restaurant. There are many good things to choose from, but no way to have them all.

Bright Futures questions for parents also offer a "menu" from which the health professional can select the questions most appropriate for an individual child and family. Skillful use of these interview questions can help identify both the professional's and the family's goals for the health visit.

Step 3 of the model is to identify the family's needs or concerns for the visit.

Too often, pediatric providers hesitate to identify all of the family’s health concerns for fear of getting farther behind in their schedule (like Jacob’s provider in the case we just read). Identifying the family’s goals and concerns for the health visit is a vital step in managing health promotion efficiently. How can you, as a pediatric provider, identify what the mother’s goals might be for this visit?

Bright Futures materials offer a variety of open-ended and focused interview questions that are appropriate for each recommended health visit. These questions are designed to help elicit concerns and engage the family as active partners in the visit.

Now that we have identified some of the interview questions that might be particularly relevant for the Downing family, let's continue with the case. In Part 2, the health professional learns more about the family through skillful use of interview questions.

Based on what you have learned from the interview questions, what needs or concerns do you think Jacob’s mother has?

Now we have two menus — one for the health professional and one for the family. Step 4 of our model is to work with the family to prioritize goals for the visit. Differences in priorities between the health professional's and family's menus can create interactions that are ineffective, inefficient, and frustrating for both the health professional and the family. Collaborating with the family in choosing and prioritizing which items get addressed can make the visit more effective.

How would you go about developing a realistic agenda that meets Eileen’s and Jacob’s needs as well as your own priorities?

Identifying and prioritizing goals and reaching a common agenda are important steps. The fifth and final step in our Time Management Model is to suggest other options for addressing unmet goals. Be sure to validate all of the family’s goals, even those that could not be addressed during the health visit. What are some resources the health professional might use to deal with these unmet needs or concerns?

This teaching session was based on a five step model for managing time more efficiently during the health visit. In summary, these are the five steps:

• Maximize time for health promotion. Clarify the health professional's goals for the visit. Identify the family's needs and concerns for the visit. Work with the family to prioritize goals for the visit.
• Suggest other options for addressing unmet goals.

In today's session we’ve applied these steps to a case vignette as a practical way to build time management skills in the context of health encounters. Before we conclude, what questions remain about what we addressed today?

In clinical practice, this self-assessment can help you gauge your use of the time management techniques we’ve been discussing. This process of self-evaluation will help you remember to incorporate and actively practice these steps in health encounters with families. You might also find it helpful to list any barriers on the back of the self-assessment form.

What would you do differently if the mother's anger over being kept waiting so long presented a barrier to an effective visit?

Now that we have completed this session on Time Management, you should be able to answer the following questions:

How can I deliver enhanced health promotion services in a timely manner consistent with the real-world demands of pediatric health care, including care for children with medically and socially complex needs?

• Enhanced health promotion services can be delivered by incorporating the five steps of the Time Management Model:
  1. Maximize time for health promotion Clarify the health professional’s goals for the visit Identify the family’s needs and concerns for the visit Work with the family to prioritize goals for the visit
  2. Suggest other options for addressing unmet goals

How do core concepts and skills such as building a partnership with the family improve the efficiency of providing health promotion services? Improve time management?

• Partnership ensures that the highest-priority concerns for the child’s health are addressed in the time available, while lower-priority concerns are met through other methods (handouts, Internet resources, follow-up phone calls, referrals). When families and pediatric providers work together toward the same goals, mutual trust will develop and any differences of opinion can be resolved more quickly.
• An effective health partnership helps the family better prepare for the health visit by anticipating and providing the information needed (interval history, health habits, special concerns), thus minimizing the time required for the provider to gather this information.

How do interview questions improve the efficiency of the health visit?

• Interview questions help make the health visit more efficient by:
  • Guiding the family into a discussion about their child’s health and their health promotion needs. Facilitating the family’s meaningful participation in the health visit.
  • Guiding the pediatric provider in addressing age-specific pertinent health topics for the visit.

In the next session, we will use encounter forms and documentation forms to illustrate how such tools can enhance health promotion by minimizing the time needed to document the health visit.