Genetic Counseling Assistants: Success Stories on How We Can All Win - PDF document

9/17/2018 Genetic Counseling Assistants: Success Stories on How We Can All Win Roxanne Acquaro, MS, LCGC Sara Pirzadeh ‐ Miller, MS, CGC GCA Program Development Seriously…everyone wins! Roxanne Acquaro, MS LCGC Genetic Counseling Supervisor UPMC Children’s Hospital of Pittsburgh 1

9/17/2018 Disclosures • I have no COI or disclosures Learning Objectives • Differentiate the role of a genetic counselor from that of the genetic counselor assistant. • Discuss the evolution of the genetic counseling assistant position in a pediatric genetics program. • Outline some changes in service delivery models being utilized in our clinic as response to the GCA program. 2

9/17/2018 The Precipitating Factors • Our division was experiencing significant difficulty with: • Staffing (not only GC) • Waitlist • Insurance authorizations • Patient satisfaction • Job satisfaction Some solutions • Hire more staff – MDs – GCs – Authorization specialists • Create a new staff designation – Genetic Counseling Assistant 3

9/17/2018 Genetic Counseling Assistants • Actually not unheard of in the world of hospital administration. (COTA, PTA, CNA) • Establish roles • Submit justification • Conduct candidate search • Breathe a sigh of relief Job Description • Actual description developed by HR with guidance from multiple departments • Needed to be broad enough to be an umbrella for responsibilities across clinical and research applications • Finding the common GCA functions and setting reasonable expectations 4

9/17/2018 Justification for funding • FTE vs casual vs PT ask • Ratio ‐ is there a magic number • Recruitment asset – Job satisfaction – Pipeline • Metrics to measure success • Access • Patient Satisfaction • Efficiency Drawing the Lines • GCs wanted to carve out more time for: – Psychosocial assessment and support in the clinic setting – Teaching students – Deep dive into complex molecular results – Desk time to interface with families; quicker responses to phone calls and emails 5

9/17/2018 Drawing the Lines • GCAs could be trained to: – Call patients to do intake evaluation prior to visit – Assist genetic counselors by communicating normal test results to patients and physicians by phone and/or in writing. – Assist in maintaining departmental databases – Generate normal lab results letters – Create and update patient pedigrees – Assist with follow ‐ up on pending lab work and testing that has not been completed Candidate Selection • Revolving door? • Past experience? • Motivation/Goals? • Timing of departure? • Salary? 6

9/17/2018 Intentions • Structure program to address the initial metrics for justification: – Access – Patient Satisfaction – Efficiency Reality • It took us 6 months to begin working towards our initial goals. – Training, training, training – Staffing remained problematic requiring us to use GCAs to fill more immediate needs – Authorization and Administrative teams were creating bottle neck – Back log of work from “the dark times” 7

9/17/2018 Altruism • Genetic Counseling Programs are extremely competitive. • Applicants are frequently passed over if they have not had hands on experience/exposure. • Our new hires deserved an investment from the GC staff • Time in clinic • Ride alongs • References/ Proof reading Outcomes • Still a work in progress • Early Data suggests: We Actually All Won! Mostly… Maybe… I’m Pretty Sure… 8

9/17/2018 Outcomes • Access – Wait list ‐ still a thing – Bottle neck ‐ not a thing • Efficiency – Clinic time reduction 15% – No Show rate reduced 7% • Recruitment Asset – 6 new GCs – GCA will transition to FT GC in April Feedback “…being a GCA also allows me to synthesize material I learn in class and gives me the opportunity to apply it in a clinical setting. I expect that my work position will also ease my transition from graduate student to genetic counselor, since I will have had almost two years of experience doing many of the daily tasks that are expected of genetic counselors. “ ‐‐ Rebecca Clark, Class of 2019 http://pittgcprogram.blogspot.com/2017/11/genetic ‐ counseling ‐ assistant ‐ experience.html 9

9/17/2018 Future Direction • Patient Satisfaction – Student Thesis • Expansion – All new patient intakes – Time in the clinic – Consent documents Genetic Counseling Assistants: An Integral Part of the Evolving Service Delivery Model Sara Pirzadeh ‐ Miller, MS, CGC Assistant Director, Cancer Genetics UT Southwestern Medical Center Dallas/Fort Worth, TX 10

9/17/2018 Disclosures • Advisor: Invitae Genetic Counselor Advisory Board • Advisor: GeneMatters, LLC Objectives • Discuss the evolution of the GCA position in a cancer genetics program • Outline changes through program impact and service delivery models being utilized in clinic as response to GCA program • Expand on how to build GCAs into programs through data 11

9/17/2018 UTSW Cancer Genetics Program Annual Patient Volume 4500 4000 3500 3000 2500 2000 1500 1000 500 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 UTSW Cancer Genetics Program 12

9/17/2018 GCA: Beginnings Making the case • – Program needed increased efficiency – how best to accomplish? – Business plan/5 year vision – Presented options • more GCs hired, increase admin staff, concept of GCA, etc – Pros/cons of hiring GC, admin staff, GCA – Cost benefit of assistant – Who we would define as GCA • B.S. or B.A., good science background, resume that is prepared for grad school – Title designation: what to call? – Experience of other institutions – How much does your institution support your program? Recruiting • Getting the word out – Institution website ‐ Announcements/Job posting/ E ‐ blast to clients – Social media • Facebook • Twitter • LinkedIn – Networking/Word of Mouth – Contacting regional GC Program Directors 13

9/17/2018 Evolution of GCA • Ongoing case to hire more GCAs • Showed the 7:2 ratio yield 25% increase of new patients, with more growth dependent on lower ratio – this is working! J Genet Couns. 2017 Aug;26(4):716 ‐ 727. doi: 10.1007/s10897 ‐ 016 ‐ 0039 ‐ 6. Epub 2016 Nov 10. Program Impact – Mentorship for GCs (satisfy GC clinical ladder) – Increase in patient volume – GC workload efficiency – Implementation of alternate service delivery • GCA integration made these much more efficient– telephone, group sessions, telemedicine – CPRIT grant – assistant written into funding source • Roles: coordinate all patient workflow through state grant, screen patient lists for high ‐ risk that need GC consult/follow ‐ up, check results, construct basic letters, call out negative results 14

9/17/2018 Institutional Lessons Learned… High turnover rate due to GC program acceptance (of 12 GCAs, 11 • accepted on 1 st application) Rigorous training – primarily result disclosure • Major time commitment for helping mentor/prep for grad school • Now scheduling specific rotation time in our clinics (not just other specialty clinics) – Created a GCA curriculum for training – GCA education hour! • Has now become education for many more in our center and beyond – Mentorship has been a big plus to our GCs • Hiring GCAs that don’t want to be GCs? • Pro: longer stay – Con: inequivalent efficiency/production? – GC retention due to support staff • More Lessons Learned… • Over time and with larger GCA staff, altered coverage schedule and tasks – Instead of covering specific GC, now task ‐ based – Just started GCA calls to complete CGC questionnaire before GC appointment for all clinics • Give GCA ‘trainer’ experience – but not too much • The stronger the candidate, the efficiency increases!! • Exit surveys/feedback to elevate experience 15

9/17/2018 •High attrition rate •Develop SOPs and update as needed •First time hires •Evaluate your •Newly created positions responsibilities quarterly •Interviewing a candidate •Create self monitoring and who may tell you an end accountability date •Involve GCAs in hiring of peers Roles and Unique Position Responsibilities Elements Innovate Time Approaches Management •Look at workload and shift •Hire a diverse and organization complimentary group •Diversify use of GCA •Varied leave dates if possible •Group resources and identify •Determine if overtime is other depts who could use GCA optional •Create tiered mgmt./supervision within GCAs What makes genetics program desirable for hiring 16

9/17/2018 Genetic Counseling Assistants: An Integral Part of the Evolving Service Delivery Model • Purpose – To determine the efficacy of the GCA position as an integral piece of sustainable service deliver model within the field. – Explore the attitudes of expanding the field of genetic counseling into a tiered profession by incorporating GCAs. J Genet Couns. 2017 Aug;26(4):716 ‐ 727. doi: 10.1007/s10897 ‐ 016 ‐ 0039 ‐ 6. Epub 2016 Nov 10. Respondents and Surveys • Study was IRB approved by UT Southwestern • 4 surveys sent July 2015: – Program Directors with or without without GCA = 27% – Genetic Counselors = 79% – Genetic Counseling Assistants = 61% 17