FACILITATOR SAY SCRIPTS - DUE 10/24/2018 - MTL Facilitate Workgroup

[lzim]

Hello Everyone,

Please find the new folder for working on our Facilitator SAY Scripts here: https://github.com/lzim/teampsd/tree/master/mtl_facilitate_workgroup/facilitator_say

s1 - Lindsey & David s2 - Lindsey & Andrew (or Tom) s3 - Lindsey & Andrew (or Tom) s4 - Lindsey & Jane s5 - Lindsey & Debbie s6 - Lindsey & Jane s7 - Lindsey & Jane s8 - Lindsey & Debbie s9 - Lindsey & Tom s10 - Lindsey & David s11 - Lindsey & Debbie s12 - Lindsey & David

[branscombj]

The Facilitator Say files for sessions 1 and 5-12 are ready for the co-facilitators above to run them on down the field (or to the next base - more relevant to what's on my tv right now). You will note that they were last revised prior to today's decisions and will need, among other things:

• To start with "We decided" when recapping what the DO from the end of the last session was;
• To follow the guidance on "we";
• To be written for MTL video for the immediate purpose (e.g. not include probing questions of participants).

[dlkibbe]

I have updated the say files for 1, 2, and 4. I will complete sessions 3 and 8 later this morning.

[dlkibbe]

I have updated the say files for 1, 2, and 4. I will complete sessions 3 and 8 later this morning.

[branscombj]

Thanks @dlkibbe! Per the divvying, I think you should prioritize finalizing 5, 8, 11 now, if all recent "say" work is updated in the rmd say files. OK by me to delete the old "liveguide" folder.

[lzim]

@branscombj @dlkibbe @TomRust @dlounsbu @staceypark

COMPLETE SCRIPTS POSTED BEFORE 8AM this WED 10/24! https://github.com/lzim/teampsd/tree/master/mtl_facilitate_workgroup/facilitator_say

Our 3 rehearsals are: 10/24 - Full timed trial run of each 30 minute exercise (demonstrate live)  in 12 session plan - finalize standardization of facilitator say scripts on GitHub (6 hours)

11/7 - Full timed trial run of the done/do for 12 session plan (3 hours); Practice 30 minute exercises of sessions 5-10 tailored to each module (MM, PSY, AGG, SP, CC) (3 hours)

11/14 - Full timed trial run of each 30 minute exercise (demonstrate live) in the 12 session plan (6 hours)

• s1 - Lindsey & David
• s2 - Lindsey & Tom (or Andrew)
• s3 - Lindsey & Tom (or Andrew)
• s4 - Lindsey & Jane
• s5 - Lindsey & Debbie
• s6 - Lindsey & Jane
• s7 - Lindsey & Jane
• s8 - Lindsey & Debbie
• s9 - Lindsey & Tom
• s10 - Lindsey & David
• s11 - Lindsey & Debbie
• s12 - Lindsey & David

[dlkibbe]

@lzim @branscombj @staceypark As a reminder, due to conference attendance, I will be on the call from approximately 2:00 - 4:00 pm at an airport.

[branscombj]

@TomRust @dlkibbe @dlounsbu - Put another way, we need to have in-session scripts (i.e., excluding Done/Do segments) finalized for rehearsal by tomorrow at 11am Eastern. Lindsey is co-facilitator for all sessions. David 1, 10, 12 Debbie 5, 8, 11 Jane 4, 6, 7 Tom 2, 3, 9 (if not Andrew 2, 3)

[branscombj]

@lzim @staceypark Do we have a fictitious or prototype MTL Menu results file to use for the video for Session 4? Would like to fill in the blanks for the video script. Thanks!

[lzim]

@staceypark we do have a demo version, we should use the one from the MTL Facilitate Pilot as it has SP in it.

Thanks!

[lzim]

@branscombj and @dlkibbe

• Please work to flesh out any missing experiments and clean up the language here: https://github.com/lzim/teampsd/blob/master/mtl_facilitate_workgroup/facilitator_say/model_details_say_scripts.md

@TomRust and @lzim will add the Measurement Based Stepped Care for Suicide Prevention examples

@staceypark will work to build out the demonstration worlds that we will use for the MTL Video shoot.

[branscombj]

Sorry to bug you @dlounsbu or @TomRust - could you help me?

3 questions - these are from MM but they apply to others too:

1. Is it correct that the polarity of Completing Rate -> True Missed Appointment Rate is +? If so, I’m not getting something. I’d think that more Completed Appts either means "completed by patients showing up", therefore directly reducing missed appts, or means more appointments passing by on the calendar, whether show or no-show, i.e. the denominator for Missed Appointment Rate, which would also reduce Missed Appt rate. What am I missing?
2. I remember (not crisply) the discussion of what “measured” vs “actual” time means; but it’s not made explicit in the “i” text and I’m having trouble explaining it in script.
3. Is the name of the next variable, Effect of Task Time on Missed Appointments, still correct after changing the prior variable to this Measured Vs Actual name? Note the heading in the “i” box of the 2nd variable below. Also note that in the text for that one, it refers to the meaning of the quantity as "provider fatigue" - the only time that part of the concept appears. Thanks! Jane

Variable label: Measured versus Actual Time "i" box heading: Measured versus Actual Time "i" box content: This represents the relative change in time available for other MM-related tasks consumed by overbooking patient visits. We assume that these "extra" appointments come at the expense of "other MM related tasks," such as , team coordination, patient reminder calls, chart review and other appointment prep, etc. It is constrained from going to zero, even if official appointment supply is zero.

variable label: Effect of Task Time on Missed Appointments “i” box heading: Effect of "Other MM Tasks Time" [sic] on Missed Appointments "i" box content: The deviation from the the base case missed appointment rate is controlled by an exponent that reflects how sensitive both patients and providers are to provider fatigue. The negative sign on the exponent indicates that this is inversely coded, i.e., decreasing time for other MM tasks (e.g., appointment prep, follow-up, reminder calls) increases the missed appointment rate. Patients start to experience this reduced quality by their next appointment, which occurs after the teams actual return visit interval. The effect is restricted from going below 1, as lower than official work hours do not influence providers or patients to come more regularly to their appointments.

[branscombj]

@staceypark could you get us the MTL menu referenced above when you get a chance please https://github.com/lzim/teampsd/issues/232#issuecomment-432680608 - Thanks!

[branscombj]

Morning team @lzim @dlkibbe @dlounsbu @TomRust Can anyone can help me with the 3 Questions above https://github.com/lzim/teampsd/issues/232#issuecomment-434050396 Thanks!

[TomRust]

Sorry @branscombj , I didn't see your questions.

1) "Completing Appointments" doesn't necessarily mean that both the provider and patient were at the appointment. You're right that it means "more appointments passing by on the calendar, whether show or no-show." The model takes what we know about the ratio of missed appointments to total appointments (the Missed Appointment %), and applies that ratio going into the future, regardless of how many appointments they have per week. We're assuming that the appointment rate is not influencing the % who no-show (it will affect the # who no-show (i.e., the Missed Appointment Rate), but not the %).

@TomRust - Got it!

2) The "relative change in time available for other MM-related tasks" is how much time the team loses for these "other tasks" when they start overbooking. It is the ratio of "Official Total Appointment Supply over the "Current Total Appointment Supply,"

@TomRust - Think I've got it! So "Official" = "Measured" and "Actual" = "Current"?

so as current hours increase (because they start working through lunch), then the ratio decreases. The tricky part about this is that the variable is not measured in hours, but as a ratio. Example, if they are a big team, with lots of hours, and they start overbooking 1 hour a week, the variable "Measured versus Actual Time" will decrease a tiny bit (to maybe 0.99 instead of 1). If a very small team started overbooking 1 hour per week, then we'd see a much larger drop in "Measured vs Actual Time"...maybe it would drop from 1 to 0.8 or 0.7. What we care about is the relative change in time available for non-patient-facing care delivery.

3) If "Effect of Task Time on Missed Appointments" is not immediately clear, then it's not correct. :) How about "Effect of Losing Non-Patient-Facing Care Delivery Time on Missed Appointments"? The Effect only applies when the team loses non-patient-facing time (there is no negative overtime, and even if there were, we assume it would not reduce the Missed Appointment %).

@TomRust - My question's more about the variation in the naming and defining of these variables, in their diagram labels, i-box headings, and descriptions in i-boxes. Now that I understand measured/official and actual/current, I can look back over all that and see what edits to suggest.

THANKS!

[staceypark]

@branscombj Here is a copy of the plots (the view we would walk through learners with): mtl_menu_demo_plots.pdf Here is a copy of the results in an excel sheet format: mtl_menu_demo_data.xlsx

@lzim Below are 5 copies of the survey, one for each module, that we can fill out with tailored responses to fit each module: https://is.gd/cc_demo https://is.gd/mm_demo https://is.gd/psy_demo https://is.gd/agg_demo https://is.gd/sp_demo

[lzim]

Thanks @tomrust and @staceypark!

[staceypark]

@dlounsbu How are the scripts coming along for sessions 11 & 12 tomorrow?

[branscombj]

@dlounsbu Please look at them and edit if you see things you want to improve. You can give them a time check as well.

[lzim]

Thanks @branscombj @dloundbu for moving these sessions forward!

[branscombj]

@lzim, @dlkibbe and I discussed the "Next are the dones and dos" edit, which I propose tweaking to say "Next is our Done/Do review" at both the beginning and end of each session, without naming the session.

So Session 1 begins, "I'm , I'm , and today we're modeling to learn... . We start and end each session by reviewing what we've done and what we will do next. Before this first session, we... . In today's session we will..."

• Session 1 in-session exercise ends "Thank you for modeling to learn... . Next is our Done/Do review."
• End of Session 1 Done/Do review starts: "Today we... For next time we will..." and goes into the 3 S's.
• Session 2 begins, "I'm , I'm , and today we're modeling to learn..." Next is our Done/Do Review."
• Session 2 Done/Do Review starts, "Before the session, we... . Today we will..."
• Session 2 In-session exercise ends: "Thank you for modeling to learn... . Next is our Done/Do Review."
• End of Session 2 Done/Do review starts: "Today we... . For next time we will..."

We could end each end-of-session Done/Do Review with simply, "Thank you for Modeling to Learn!"

[lzim]

These are great edits @brancombj and @dlkibbe!

Will one of you able to make these edits across the session scripts?

FYI @tomrust @dlounsbu @staceypark We can also try to incorporate them in any facilitator say scripts we are working with.

[dlkibbe]

@lzim I'm making the edits to the scripts today.

[branscombj]

@dlkibbe , I tweaked your edits per the following simplified (I think) pattern:

• I'm --- and I'm --- and today we're modeling to learn ---.
• As you can see in the done/do table of the Learner See Guide at mtl.how:
• Facilitators recite done, do and resources from table.
• After this session you will be able to:
• Facilitators read learning objectives.
• Let's get started:
• Facilitators go through in-session exercise steps 1-n.
• That’s it for modeling to learn ---. Next is our Done/Do Review:
• Facilitators recite done and do from the table, then go through Do Demo steps 1-n.
• Until next time, thank you for modeling to learn.

[dlkibbe]

@branscombj I finished the say file edits but want to get clear on the suggestions in your comment above compared to the agreed upon text from last Wednesday's call. I did not push say files 6-12 to the master as I wanted to clarify this discrepancy with you before doing so. Refer to your email to me with the yellow highlights and the Lucid notes. Thanks.

[branscombj]

@dlkibbe Sorry for the confusion! We didn't communicate very well between the live Lucid meeting discussion, Lucid notes, and our emails, github pull request comments, and github issue comments. You did the right thing, including revising language slightly from the Lucid notes to get rid of redundancies ("next", for example). I shortened further as described above.

[branscombj]

@lzim All of the standard transitional language for the facilitator say files has been pushed to master. @dlounsbu @TomRust When you have finished fleshing out experiments 1, 2 and 3 either in the 1.7 simUI test world or in the Model Details for Facilitator Say Scripts for your module, please ping @dlkibbe and me so we can import them into the Session 5-10 Say files for each of the modules. Thanks! p.s. We need to be careful with our tagging: I saw that a "dkibbe" was tagged who is not Debbie, and I accidentally tagged a not-David Lounsbury whose github username starts with dlo.

[branscombj]

@lzim @TomRust @dlounsbu @dlkibbe Still so many questions as I run sims. Running CC in 1.7 with the abc dataset Tom built/Stacey uploaded. Starting Rate in table is 3.82. Showing on widget is 31.94. Where does that number come from? When I run a BC, it doesn't drop from 31.94 to 3.82; it drops from 4.4 to 3.82. Where did the 4.4 come from? How would I know that choosing Use Team Data ON would mean decreasing Starting Rate by that smaller amount vs the huge one indicated by the widgets?

What numbers populate the widgets in default view, anyway?

[lzim]

@jamesrollins take a look at @branscombj’s post

[lzim]

Happy WEEKEND er'body :wave:

Two questions - I was going to start a work session, but I noticed there aren't any pull requests? I'm happy to review them as they come in over the weekend, rather than have a glut of things :ocean: next week as we get closer to the holiday.

• If there aren't any edits to merge with the Master via pull requests, are there instead updated experiments to review in the "demo_worlds"? @branscombj and my own testing has identified places where our allowable range and the dataset are unworkable together.

• We want to make sure we get on that with @TomRust and @jamesmrollins by COB Sunday or AM Monday if we can, since it requires work on the .mdl files and with DEV to fix. Are there others? Especially in MM, PSY, AGG or SP?

• Quick note on the "i" information - we'll keep that tracked in the Master Cross-Walk - Check-out System #208

• @jamesmrollins will take our GitHub work and add it to the MASTER CROSSWALK FILE FOR DEV on MONDAY

THANKS All! ☺️

@branscombj @branscombj @TomRust @dlounsbu @staceypark

[dlkibbe]

@lzim @branscombj my bad... I edited session 6 say file on the master. Not done yet... Today is my work day for MTL.

[branscombj]

@lzim and @dlkibbe Also fleshed out bc and exps in CC and MM, but ran into questions again, which I've posted - except one I only emailed to Tom - but I'll post that one too in case others can clear it up.

[staceypark]

@branscombj @dlkibbe @dlounsbu @TomRust @lzim Hi all, As folks are finishing up writing the SAY scripts, I wanted to add some general comments from across the modules:

1) Be consistent in level of detail and style used to walk through the story from basecase through experiment 3. 2) Refer/point to specific model variables that I can look for and pull up in the Results Dashboard to follow the story i.e. "We can see more patients" vs. "We can see more patients as evidenced by Appointment Supply" i.e. "Our baseline shows that we have more than 1000 MM patients in service, followed by PSY (about 300 patients), CC (about 260 patients)..." VS. "Looking at Patient in Service, our baseline..." 3) It helps visually for variable names to be capitalized when referenced. 4) You don't need to "guess" what number the lines are pointing to in the Results Dashboard. You can click on the "Table" view and it gives you exact numbers, that can be rounded to tell the story. 5) All instance of "RVI" spelled out should say "Return-to-clinic Visit Interval" not "Return Visit Interval" 6) All Question text should start as "How..." 7) Reference to and formatting of values should be consistent. Always reference units (appointments or patients; appointments/week or patients/week) I noticed some folks used "n=100" or "Appointment Supply (100 appointments)" or "100 appointments in Appointment Supply". We want it to all have the same look and feel. 8) There are some general copy edits to be made i.e. typos, missing words, missing punctuation, etc.

@branscombj and @dlkibbe Once all the systems stories are solidified, would you guys be willing to take a final pass at scripts for consistency, including the points above?

@lzim Tom is updating the SP module scripts to make them clearer and they'll be ready by 9AM pacific tomorrow.

[staceypark]

@branscombj @dlkibbe @dlounsbu @TomRust @lzim AGG Questions Basecase

1. Hypothesis: The script is written in a matter that makes it seem as if MM and PSY have the highest engagement time and account for the highest service proportions. However, based on the team data table in the sim, Adjunctive is next highest. This is confusing.
2. Findings: "Interestingly, patients receiving group services drops to about 100 patients at about 1.5 years into the simulation run." I'm not sure how/where you're seeing that?

[dlounsbu]

What I saw was that the engagement time was too long, based on evidence based practice. An evidence based dose of PSY would be delivered in 12 to 14 weeks.

When I change the Return Interval, Interesting things happened, including a reduced number of PSY patients.

I agree we can provide additional context and should clarify my thinking.

D

David Lounsbury Sent from my iPhone

On Nov 20, 2018, at 9:33 PM, Stacey Park notifications@github.com<mailto:notifications@github.com> wrote:

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1. Hypothesis: The script is written in a matter that makes it seem as if MM and PSY have the highest engagement time and account for the highest service proportions. However, based on the team data table in the sim, Adjunctive is next highest. This is confusing.
2. Findings: "Interestingly, patients receiving group services drops to about 100 patients at about 1.5 years into the simulation run." I'm not sure how/where you're seeing that?

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[dlounsbu]

I think we need to keep in mind that there are a multitude of possible experiments that teams can run. And running 3 or 4 quick experiments is all just a warm up exercise.

Also, I would argue that, especially in AGG, there may not be an obvious optimal strategy. But we can model to learn ....

David Lounsbury Sent from my iPhone

On Nov 20, 2018, at 9:33 PM, Stacey Park notifications@github.com<mailto:notifications@github.com> wrote:

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1. Hypothesis: The script is written in a matter that makes it seem as if MM and PSY have the highest engagement time and account for the highest service proportions. However, based on the team data table in the sim, Adjunctive is next highest. This is confusing.
2. Findings: "Interestingly, patients receiving group services drops to about 100 patients at about 1.5 years into the simulation run." I'm not sure how/where you're seeing that?

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[branscombj]

@staceypark @lzim @dlkibbe @dlounsbu @TomRust All- I finshed bc & exp1,2,3 for MM in the 1.7 TEST environment, MM Demo world. Please check it out before I transfer it to the Say script. Thanks!!

[dlounsbu]

@branscombj I have called up and read through, and compared all of your experiments in MM. Your Q,, H, F, and D text was very clear and corresponds with what I was able to see in the expanded output figures. I think this can be your final!

[branscombj]

Yaay!! Thanks, @dlounsbu! @staceypark I would love your 2nd opinion as you’re looking at all of them.

[TomRust]

@lzim @branscombj @dlkibbe @dlounsbu

I've been putting the final touches on the scripts for SP across all the SAY files, and am a bit confused. I thought we needed to be as explicit as possible with the SAY scripts -- putting in all the directions (eg, "click on...") and explanations for why we're finding the results that we see. The text explaining the hypothesis and findings for the SP experiments are paragraphs long.

Should I cut them down to match the length of the others? If so, then where should I save all that detail that we need to say in the video?

--TOM

[branscombj]

@TomRust - One response is to see if the content is fairly balanced for SP across each set of qhfd. Sometimes you can put a little more of the "thinking out loud" into the previous or next box, and that might make the delivery feel more balanced. If you're asking about making the text the same as for the other modules, I think it's good to head in that direction, but also know some are just more complex than others and may need a little more content. Yes to directional verbiage, navigation, etc, which may not be as well fleshed out in some of the others but I have it on my agenda to go through everything for that as much as I can. If you cut any material from the Session Say Scripts that you think is useful to hang onto for future reference, please put it in the Model Details Say Scripts. Those will also need to be built out for MTL Live with scripts for all the rest of each systems story and reveals that we're not using in MTL Video. Thank you!!

[TomRust]

Thanks, @branscombj!

One more question for the group, though @lzim @branscombj @dlkibbe @dlounsbu: I thought we were going to use the same set of experiments for PSY in MTL Video that we did with the TAS group from our MTL Facilitate Pilot. Is that not right? @staceypark: Didn't you paste in the QHDF text from the MTL Facilitate Pilot World?

[staceypark]

@branscombj MM is looking great!

@branscombj @lzim @dlkibbe @dlounsbu @TomRust I seem to remember something similar to what Tom is saying. I thought that was why we used the specific data set that we used with the TAS group?

Also, who is in charge of CC and what is the timeline for that one being finished?

[lzim]

Happy Thanksgiving!!

Yes, the TAS experiment is the one we wanted to use for PSY.

@tomrust @dlkibbe @branscombj @staceypark @dlounsbu

[lzim]

Good Morning Everyone! 😃

I hope it has been a very chill couple of days. I just wanted to check in with you all. I have to head to the airport tomorrow at 8:45M Pacific/11:45AM Eastern. I'll be in St. Louis at ~5PM Central Time. Anyone else arrive around then to share a car to the hotel or meet for dinner?

I'll be reviewing things on GitHub. But, I wanted to see if anyone prefers checking in by phone today or early tomorrow at 7AM Pacific/10AM Eastern?? Please let us all know if you do.

Things that I know need attention:

• Re-running CC, MM, PSY, AGG and SP in PROD - (Watch out there is both a MTL 1.7 TEST Issue #257 and a MTL 1.7 PROD issue #287)
• Are we prepared for the TAS PSY experiment?
• Update from @TomRust about the ranges on the sliders - e.g., CC discussed a bit in both TEST and PROD
• Review @jamesmrollins new Model Pop up "i" information file here: https://github.com/lzim/teampsd/tree/master/resources/master_crosswalk/info
• Get an update from @staceypark about mtl.how, cheatsheets, tt reports, .gifs, help info etc.
• Lindsey will be populating the session 4 menu examples today for use.

What am I missing ❓

@branscombj @dlkibbe @dlounsbu @TomRust @staceypark @jamesmrollins

[jamesmrollins]

I’m in. 😴

[dlkibbe]

I re-ran CC experiments in PROD, but did it in my individual world. I have 1 left to run and can re-run others. First, I was going to work on making the say file scripts for Q,H,F,D more uniform/same voice in response to @lzim comment from earlier. @branscombj @lzim @jamesmrollins @TomRust @staceypark @dlounsbu

[branscombj]

@lzim @dlkibbe @dlounsbu @TomRust @staceypark Debbie and I get in tomorrow at 6:25pm. I have rental car (full-size this time!). Let me know if you're commuting around then and want to ride with us. @lzim I'm up for dinner and if @dlkibbe is OK it's fine with me to go straight from the airport without checking in first. Am I getting that @dlounsbu prepared a different set of experiments for PSY than what you wanted to use, @lzim ? Do those need to be redone?

[dlounsbu]

@lzim @dlkibbe @dlounsbu @TomRust @staceypark

I do not arrive until 7:55pm. I would love to catch a ride to hotel with you, but understand if you do not want to wait around.

Regarding PSY and AGG, I prepared a set of PSY and a set of AGG experiments, using 1.7. Can they be edited to your liking, or is there something more that needs to be fixed?

[branscombj]

@lzim and @dlounsbu (& @dlkibbe @TomRust ) - I have been using the Blame function to compare what was pasted in to the Model Details Say Scripts file by Lindsey with what David developed and pasted in from his MTL1.7test work. It looks to me like basically the same course of experiments, except that David increased how much he moved a lever in exp 2 to show a larger effect; fleshed out the script with more detail; and worked up exp 3 which wasn't there. Was this not the set of experiments we did with TAS?

[lzim]

Actually, I was wondering about PSY because of @tomrust's question about it being different than the TAS. If it is not and matches the Model Details file, then don't worry about that :smile:

@dlkibbe and @branscombj why don't you text me when you land. I'll likely head to the hotel and try to find a good spot to grab a bite for dinner.

@dlounsbu Let us know when you arrive too, David. Probably, we'll try to eat before you get there.

What time do you arrive @TomRust ?