6. Conducting Group Visits
After much planning and preparation, your first group visit is approaching!
We have a checklist of tasks to be completed before, during, and after group visit sessions. Feel free to add any other tasks you think of that will help your group visits run smoothly.
We hope you are excited to begin!
Read on for guidance on group facilitation, quality improvement, and patient retention.
Group Facilitation
Decide who will lead each portion of the group visit session. Be mindful of how much “airtime” staff and patients are getting. Facilitating groups effectively can take some practice. Your team will learn as you go and you can adapt your style based on your unique group of patients.
In general, facilitating diabetes groups involves:
Click on the plus signs below for tips on group facilitation.
General Tips
- At your first group visit, you might want to establish group norms, guidelines, or expectations. Consider writing them down where everyone can see or reviewing them at the beginning of future visits.
- Have various questions and discussion prompts prepared ahead of time. You might not use them all if people have a lot to share but better to be prepared.
- You can call on specific people to respond to a question if you notice they haven’t had a chance to talk.
- Designate a team member to take notes on things you want to follow up on after the session.
Tips for Virtual Visits
- Assign a team member to be the contact person for IT issues the day of the session.
- Choose the viewing option that allows you to see everyone at once (“gallery view”) rather than just the person who is currently speaking. That way you can notice people’s facial expressions, body language, etc.
- You might want to do something to indicate who staff members are. Edit how your name appears, use a background with your health center logo, or wear shirts with your health center logo.
- Consider additional group guidelines specific to the virtual setting.
- If some patients are attending group using their phone, think about how materials you show will appear on a small screen.
- Share materials with patients ahead of time. Number handouts that you will use during the session so they can be easily identified. Documents could be emailed, mailed, or picked up by the patient at the health center. Remind patients what materials they should have on hand for the upcoming session.
- Consider if there are other items you want to share with patients ahead of time (e.g., care package with healthy snacks, which could be used for practice reading nutrition labels; medical or diabetes self-care supplies).
“Our team really felt that the social support was one of the most impactful aspects of the group visit. This portion of the visit was facilitated by our Behavioral Health Consultant who did an amazing job of building rapport, balancing the different personalities and making sure everyone feels heard and validated.”
Quality Improvement
When you debrief as a team after each group visit session, discuss and take notes on what went well and what could be improved. We also recommend getting patient feedback about what they are enjoying, what could be improved, and what they would like to learn and do in future sessions. This could be done by a written survey, an informal discussion, or an anonymous suggestion box.
There are a number of quality improvement (QI) methods and tools your team could use to make adjustments to your program. The Model for Improvement is one approach, which allows you to take small pieces of a problem and quickly plan a change, try it out, see if it will work, and revise the plan based on what was learned. For example, you might be trying to improve patient recruitment, flow of group visit sessions, or patient attendance. Plan-Do-Study-Act (PDSA) is a “trial and learning” method to test potential solutions quickly to see how they work.
“Organizing our patients order to be seen helped the flow of the provider visits. We scheduled patients who were closest to goal first and those needing more assistance last.”
Patient Retention
Patient retention can be a challenge. Be prepared and understand that poor retention in health education and behavior change programs is the norm. Knowledge is power! Since you know ahead of time that retention could be an issue, you can be proactive and take steps to keep patients engaged.
What contributes to low retention?
Click on the plus sign below to see some ideas for how to keep patients engaged in your program.
Strategies for Patient Retention
- Make a great first impression. Communicate information and instructions clearly before the first visit. Respond quickly to any questions or concerns. Be prepared as a team to ensure the visit runs as smoothly as possible.
- Develop personal relationships. Make eye contact, smile, and call patients by name. Ask about family and life events not related to diabetes. Send birthday cards signed by the group visit team. If the health center is having a community event, invite the patients to participate.
- Empower patients. Build confidence by encouraging patients to set goals that are realistic and attainable—small steps to success. Remind patients of their strengths and past successes. For example, “You’re really good at tracking your walking and your diet. How did you learn that?”
- Emphasize benefits. Attrition happens when perceived costs outweigh anticipated benefits. Intrinsic motivation is key. Ask patients about their purpose and values in life. How does diabetes self-management align with these higher goals?
- Tailor your program. Ask patients what they would like to learn. Step into the patients’ shoes to see things through their eyes. Ask for feedback and be ready to make changes to help improve the group visit.
- Support autonomy. Treat patients as experts in their own diabetes self-management. Thank them for making the choice to participate in group visits. Encourage them to share their experiences and advice and to set their own goals. For example, “You decide what exercises you want to do: when, how, and with whom?”
- Remove barriers. Provide parking, transportation, and childcare if possible. When patients do not attend a visit, follow up and ask, “Is there anything we can do for you?”
- Communicate consistently. When patients enroll, ask for multiple forms of contact information. At the end of each visit, remind patients when the next visit will be and what you will be talking about. Set up a schedule for reminder calls, texts, or emails.
- Foster accountability. Emphasize group interaction so that patients feel like others in the group are counting on them to be there for each visit. Give “homework” between visits to help patients take ownership of their participation. Follow up with those who miss a visit.
- Make it fun. Plan educational activities, games, cooking lessons, dance parties, etc. Create opportunities for patients to talk and support each other. Celebrate milestones. Provide snacks and give away goody bags with items related to the topic of the session. Ask patients to help recruit new group members.
“I do think incentives helped… keep them coming back each month to see, kind of what they’d learn and then what they might receive in the mail for participating.”
Potential Roadblocks
Your team is having a hard time getting through everything you planned during the allotted time for the group visit so sessions have been going over time. What can you do to stay on schedule?
- Look at your agenda and consider if you can realistically complete all the activities you have planned while also leaving time for discussion. Prioritize the most relevant, engaging, or impactful activities, and do others if time allows.
- Discuss your workflow as a team and identify which parts of the group visit are slow or inefficient. Consider if any tasks could be done before or after the session or while another activity is going on. This is an opportunity to use PDSA!
- Use a timer or designate a team member who is not leading the group visit as the timekeeper to help the group stay on schedule.
- What else could you try?
You call a patient after they miss a session. They tell you they don’t think they are getting much benefit from the group visits. After 20 years of having diabetes, they feel like they already know most of what is being taught. How can you encourage the patient to stay engaged?
- Ask them what they are interested in learning and what kind of support they need for their diabetes self-management. If possible, describe how future sessions will incorporate these interests and needs.
- Highlight the benefits of the program. Emphasize how sharing their experience and advice is helpful to other group members. Talk about the long-term benefits of improving blood sugar control.
- Remind them of goals they set during previous sessions and the progress they have made and could continue to make. Remind them that their primary care provider thought it was a good option for them.
- What else could you try?
You follow up with a patient who has missed the last two sessions. They are reluctant to come back because think they are too far behind. How can you address the patient’s concerns and increase their chances of attending the next group visit session?
- Offer to share materials from the previous sessions with the patient or meet with them individually to review what was discussed.
- Tell them that they have been missed and emphasize how much their presence means to the group. Highlight any special strengths or experiences they bring that other group members appreciate.
- Explain what is planned for upcoming sessions and clarify that previous knowledge is not required to participate in any of these activities.
- What else could you try?