When do practice coaches end engagement with a practice?

It depends on a number of factors.

Is there a right time to end the engagement with a practice? Practice coaches provide support based on a number of factors. Practice coaches and their supervisors must determine the dosage, frequency, and length of engagement based on these factors as well as the number of practices assigned to the practice coach’s portfolio. 
 
Ideally, a practice coach will have the option of returning to the practice after the practice has graduated from a project and has built internal capacity to conduct QI in a continuous and effective way. We have found that when a significant event occurs within the practice—such as physician champion or practice administrator departure, merger, or buy out—or implementation of a new electronic medical record or billing system, often we see their QI capacity begins to disintegrate, including a downward trend in their quality and process indicators. In those instances, it is very beneficial for the practice coach to be re-assigned during the time of transition to ensure that their QI capacity remains on track. For this reason, we recommend that the practice coaching program dashboard or registry include practices that have graduated from the practice coaching support.
 
We recommend that practice coaching programs determine graduation criteria for ending a coaching engagement. AHRQ’s Developing and Running a Practice Facilitation Program, A How-To Guide outlines stages of the engagement. In stage 6, Completion and Maintenance, the practice coach begins a phased withdrawal for the practice and increasingly transfers more of the coordinating functions to practice staff. This section of the guide includes examples of common activities in Stage 6. A practice QI capacity checklist also might be useful to develop and use with a practice so the practice knows what it will take to maintain their gains after the project is over. South Central Pennsylvania’s Team Maturity Assessment Tool is one example of how a practice coaching program determines the QI capacity of graduated practices.   
 
Compiled by Jen Powell, an AF4Q technical advisor working with the Improving Performance in Practice (IPIP) Technical Support Team.