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Medical Practice Specialty Role Enhancement Program

2020

Revision April 2020

Medical Practice Specialty Role Enhancement Program 2020

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Tips for Success

Get a buddy – work with someone who has successfully completed the program before.

Thoroughly read all program requirements.

o Highlight important lines and areas of concern or interest.

o Set reminders for important dates in your Outlook Calendar or in a Planner.

Ask questions promptly (Supervisors and Outpatient Education Department can help).

Start documenting and gathering program requirements ASAP.

Use a binder to collect all the materials – this will become your portfolio.

o Use Section Titles for divider headings.

o Keep binder in an easy to access area.

o Bring binder with your to Staff Meetings/Committee Meetings.

Materials submitted with the application must be typed.

Stay neat and organized.

Save your work on your U-Drive.

Think outside the box for your project – what do you want to improve in your practice?

Think Positive – you can do this!

Ask for help! The Outpatient Education Department Team is hosting meetings to assist you in

the process and to support your journey.

“Success is no accident. It is hard work, perseverance, learning, studying, sacrifice and most of

all, love of what you are doing.” –Pele, World Cup Champion


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Table of Contents

Summary……………………………………………………………………………….....4

Purpose & Criteria……………………………………………………………......4

Objectives…………………………………………………………………….......5

Process and Timeline………………………………………………………..…....5

Qualifications……………………………………………………………….….....5

Expectations……………………………………………………………………....6

Review Panel………………………………………………………………………….......7

Requirements to Participate…………………………………………………………..…...7

Technologist I……………………..……………………………….....8

Technologist II……………………………………………..………...11

Technologist III………………………………………..……………..13

Forms……………………………………………………………………………………....15

Summary of Forms by Level……………………………………………………....16

Letter of Intent……………………………………………………………………..17

Supervisor Validation Form for Intent to Apply…………………………….….....18

Supervisor Validation Form for Portfolio Submission………...…………….….....19

Staff Meeting Attendance Form…………………………………………………...20

Education Hours…………………………………………………………………...21

Education Tracking Form….……………………………………………....22

Education Verification Form………………………………………………23

Project Report……………………………………………………………………...24

Evidence Based Practice Report Form…………………………………….28

Quality Improvement Project Report Form………………………………..31

Lean Process Improvement Project Report Form………………………….34

Enhanced Clinical Leadership Role………………………………………………..37

Community Service Evaluation Form……………………………………...39

Super User Webinar Attendance …………………………………………..40

Leadership Role Point Evaluation Form…………………………………...41

Monthly Leadership Point Journal…………………………………………42

Final Checklist for Technologist Enhancement Program Portfolio…………………..…….44


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Summary

Purpose and Criteria

Welcome to the MaineGeneral Technologist Enhancement Program!

The purpose of the Technologist (Tech) Enhancement Program is to provide opportunities for the

Tech to advance his or her clinical, professional, interpersonal, and leadership abilities by enriching

personal job satisfaction, improving professional confidence, and developing a culture of learning. This

program guides the exceptional Tech to elevate his or her role in the practice. Participants committed to

achieving the program’s goals will not only advance in the Tech role, but will be seen by others as

respected leaders, positive peer mentors and valued employees of the organization.

The Tech Enhancement Program has three distinct levels. The first level includes requirements

for national certification and MaineGeneral Health’s Technologist job description. This level establishes

a baseline for all candidates. Eligibility and achievement qualifications for the second and third levels

are detailed in the program requirements section.

The structured process will support the Supervisor’s ability to oversee the participant’s

performance, promote effective program management, and provide program sustainability. The program

participation date starts on July 1, 2020. The Technologist Enhancement Program is a model of

professional advancement, personal achievement, and recognition of the important role of the Tech in

providing excellent patient care at MaineGeneral. The Review Panel will evaluate the program’s

effectiveness on an ongoing basis.

Job Titles included in this program are:

o Urology Technologist

o Dermatology Technologist

o Orthopedic Technologist

o Ophthalmic Assistant

Please read this packet carefully to ensure all requirements are understood.


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Objectives

Recognize and reward Techs for excellent performance, leadership and clinical practice by:

o Enhancing professional and personal growth through learning opportunities and projects,

o Promoting leadership development within applicants in the practice and beyond,

o Enhancing professional satisfaction by seeking new opportunities to grow, and

o Creating a learning environment that promotes a high level of quality patient and family

care.

Provide an opportunity for continued professional growth.

Process and Timeline

There are two important timelines to understand in applying for this program. They will be

referenced throughout this document.

Application Year: Wednesday July 1, 2020 – Wednesday June 30, 2021

Benefit Year: Thursday July 1, 2021 – Thursday June 30, 2022

The first step is to submit the Letter of Intent Form (page 17) to your supervisor, who will serve

as your initial resource. The Letter of Intent Form, signed by your supervisor, must be submitted to the

Outpatient Education Department no later than 4pm on July 1st, 2020 along with the formal Letter of

Intent written by the applicant and the Supervisor Validation Form for Intent to Apply. Documents

submitted after the due date will not be accepted. They can be delivered in person or scanned via email

to Karen Dostie, Thayer Campus, Terrace Level, and Office 0247. You can contact Karen Dostie and

Elizabeth Kingsbury via email or phone. Faxing is not an option.

Each applicant will prepare a portfolio throughout the application year to track evidence of all

the requirements. This portfolio will become the application that will be evaluated by the Review Panel.

Qualifications

Basic program qualifications must be met prior to submitting a Letter of Intent. These basic

qualifications are as follows:

1. The most recent annual performance appraisal score must meet or exceed a score of 3.5 for

the Technologist II candidate and a score of 4 for Technologist III candidate.

2. Candidate with “less than satisfactory” annual performance appraisal does not qualify.


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3. Candidate with any documented Disciplinary Actions within the year prior to applying –

such as a Notice of Concern, a Formal Warning OR any documented feedback, such as

Performance Discussion – does not qualify.

4. Must be employed as a Technologist at MaineGeneral for at least 1 year for Technologist

Level II and a minimum of 2 years for Technologist Level III.

These qualifications must be maintained: (1) in the 12 months prior to application, (2) during the

application year and (3) during the benefit year. If any of these are not maintained, the Technologist

will not receive (or will stop receiving) incentive pay, as outlined below.

Expectations:

1. Portfolio must include all evidence of program completion (described in the following sections).

2. Portfolio must be neat and organized – portfolio must follow the order outlined in the final

checklist available on page 44.

3. Portfolio must be submitted to Karen Dostie no later than 4PM, June 11, 2021 (Friday).

4. The Review Panel will review Portfolios by Friday, June 18, 2021.

5. The Review Panel will notify applicants by JULY 1, 2021.

6. Successful completion of Technologist II: incentive bonus of $1.00/hr over base pay.

7. Successful completion of Technologist III: incentive bonus of $2.00/hr over base pay.

8. Given that the Enhancement program is beyond normal job duties, it may be necessary to devote

time outside the workday toward completing some requirements.

9. Applicants must apply and submit requirements of participation to be reviewed annually to

retain an Advanced Tech level (including II and III). This wage increase is an incentive

bonus, paid as an hourly differential. Applications will be reviewed annually. If the

requirements for the Advanced Level are not submitted annually, the Tech will no longer

receive the incentive benefit.


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Review Panel

Purpose: The purpose of the Review Panel is to evaluate Portfolios and to recommend advancement if

the applicant meets all the criteria outlined in this packet.

Membership Chair: The Director of Outpatient Education will appoint the Review Panel Chair. The

Chair is a non-voting member of the Review Panel.

Membership: The Chair will appoint Review Panel members, which will include a combination of

administrative/service line directors, managers and Outpatient Education staff.

Specialty Clinics – at least 3 members

Outpatient Education Department – 3 members

Tenure of the Panel members is 1-2 years, minimally. Members may be re-appointed. If vacancies occur

during the year, the Chair will appoint a new member for the remainder of the Fiscal Year. Ad hoc

members will be invited to participate as needed in order to accomplish the purpose of the Panel.

Meetings: Meetings will be held at least once per year, or as needed, to accomplish the review and

approval of applications.

Requirements to Participate

Carefully read each requirement

To advance to a higher level, the applicant must provide evidence of achievement for

Technologist level I. For example, a Tech applying for Level III must demonstrate that s/he has met the

requirements of Level I and Level II – as well as III. Requirements for attaining and maintaining levels

are described in this section.

Pay special attention to the requirements and evidence forms in each category. These must be

included in the application. Any missing evidence will automatically disqualify an applicant.

Resources are available to assist in application development. These include your supervisor and

the Outpatient Education Department.


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Tech I

Technologist

Level I

(Tech I)


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PLEASE NOTE: You do not need to apply for level I as there is no financial incentive. This

level is a baseline for program applicants to apply for higher levels.

Successfully complete Technologist training/educational program.

Achieve and/or maintain technologist certification, as described on page 10, relevant to the

Clinical Area where the technologist is employed. This can include:

o Urology Technologist

o Dermatology Technologist

o Orthopedic Technologist

o Ophthalmic Assistant

Complete required competencies specific to your practice. This includes annual departmental

competencies and any new competencies that come up throughout the year.

Demonstrate MGH Values and Standards and meet all requirements of the Tech job description.

Maintain active Basic Life Support (BLS) certification for positions requiring certification (see

list on page 10).

Attend 75% of Staff Meetings.


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Technologist by Role Certifying Organization BLS Requirement (per MGH Job Descriptions)

Urology Technologist Society of Urological Nurses and

Associates: CUA Certified Urology

Associate

Preferred

Dermatology Technologist Association of Certified Dermatology

Techs

Required

Orthopedic Technologist National Board for Certification for

Orthopedic Technologists Inc.

Preferred

Ophthalmic Assistant Certified as an Ophthalmic Assistant

(COA) by the Joint Commission on

Allied Health Personnel in

Ophthalmology (JCAHPO)

Required


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Technologist II

Technologist

Level II

(Tech II)


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To achieve and/or maintain the Technologist II level, the applicant must submit documentation

supporting the following criteria annually:

Achieve and maintain all Technologist I criteria.

o Complete Technologist educational program

o Achieve and maintain certification

o Complete initial and ongoing competencies

o Demonstrate MGH Values and Standards

Must be employed as a Technologist at MGH for at least 1 year and work a minimum of 1,248

hours in the year prior to applying.

Must also maintain a minimum of 1,248 hours within both the Application and Benefit years.

This is roughly an average of 24 hours per week.

No documented Disciplinary Action within the year prior to applying and within both the

Application and Benefit years.

Complete 16 Education hours.

o Education can include, but is not limited to: both MGH and non-MGH hosted courses,

webinars, conferences, Lean training, BLS certification, college courses relevant to your

work and skills testing, etc.

o Renewing your BLS certification counts for 4 education hours if required for the position.

Lead an Evidence-Based Practice, Efficiency or Quality Improvement Project that: (1) applies to

practice-based goals that impact the provision of high quality patient care and (2) is approved by

applicant’s supervisor. See page 23 for more details.


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TECH III

Technologist

Level III

(Tech III)


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To achieve and/or maintain the Technologist III level, the applicant must submit documentation

supporting the following criteria annually:

Maintain all requirements of Technologist I and II.

o Complete Technologist educational program

o Achieve and maintain certification

o Complete initial and ongoing competencies

o Demonstrate MGH Values and Standards

o Must be employed as a Technologist at MGH for at least 2 years.

o Work a minimum of 1,248 hours within both the Application and Benefit years. This is

an average of 24 hours per week.

o No documented Disciplinary Action within both the Application and Benefit years.

Complete 24 Education hours.

Lead an Evidence-Based Practice, Efficiency or Quality Improvement Project that: (1) applies to

practice-based goals that impact the provision of high quality patient care and (2) is approved by

applicant’s supervisor. See page 23 for more details.

Serve in an Enhanced Clinical Leadership Role during the application year. Applicant must gain

50 points. There are a number of ways to meet this requirement, and these are described on page

38.


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Section Title:

Forms


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Summary of Forms by Level

The following forms must be submitted in a portfolio to the Technologist Enhancement Review Panel

for approval:

Technologist Level I:

Do not need to apply

BLS certification card/document if required by job description

Technologist certification document

Complete competency based orientation

LEVELS II AND III MUST SUBMIT: (1) LETTER OF INTENT, (2) LETTER OF INTENT FORM

AND (3) SUPERVISOR VALIDATION FORM FOR INTENT TO APPLY BY JULY 1, 2020. THE

REST OF THE FORMS LISTED BELOW ARE DUE WITH THE PORTFOLIO ON JUNE 11, 2021.

Technologist Level II:

Evidence of completed competency based orientation tool

Supervisor Validation Form for Portfolio Submission

Staff Meeting Attendance Tracking Form

Education Tracking Form

o Education Verification Form(s) as appropriate

Appropriate Project Report Form



Technologist Level III:

Evidence of completed competency based orientation tool




o Education Verification Form(s) as appropriate


Leadership Point Evaluation Form

o Community Service Evaluation Form as appropriate

o Super User Webinar Attendance Form as appropriate

Monthly Leadership Point Journal



Copies of these forms are on the subsequent pages.


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Technologist Enhancement Program

Letter of Intent Form

NAME: ______________________________________________

PRACTICE/DEPARTMENT: __________________________________________

Level applying for:

Technologist II

Technologist III

Letter of Intent Form, Letter of Intent and Supervisor Validation Form for Intent to Apply must be

submitted to the Review Panel Chair no later than 4PM on JULY 1, 2020.

Signed Forms will not be accepted after the due date and time.

Present this form, the Letter of Intent and the Supervisor Validation Form for Intent to Apply

(p.17) to:

Karen Dostie, [email protected], 872-1654

_______________________________ _________________

Applicant Signature Date

_______________________________ ________________

Supervisor Signature Date

mailto:[email protected]


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Supervisor Validation Form for Intent to Apply

This form is due on July 1, 2020 with the applicant’s Letter of Intent

NAME: ______________________ DEPARTMENT: _________________

Date of Hire at MaineGeneral Health: .

Hours worked in the prior fiscal year (July 1, 2019 - June 30, 2020) ________. Must have

worked a minimum of 1,248 hours in the year prior to application.

To qualify for program, the Technologist must have achieved the following prior to applying:

Employed as a Technologist at MaineGeneral for 1 year for Level II

and 2 years for Level III. Y/N ___

Technologist II: Annual Appraisal Score of 3.5 or greater. Y/N ___

Technologist III: Annual Appraisal Score of 4.0 or greater. Y/N ___

Completed orientation and ongoing competencies. Y/N ___

BLS certification current. (if preferred or required on job description) Y/N ___

Technologists certification current or able to

acquire certification during application year. Y/N ___

Possesses the knowledge, skills, and attitude to contribute

to a high performing team. Y/N ___

Demonstrates MGH’s Values and Standards. Y/N ___

Demonstrates Excellent Teamwork. Y/N ___

Demonstrates ability to Problem Solve. Y/N ___

Demonstrates Excellent Communication Skills. Y/N ___

Was there any documented Disciplinary Action

within the prior fiscal year? Y/N ___

_______________________________ _________________



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This form is due with the Applicant’s portfolio on June 11, 2021

NAME: ______________________ DEPARTMENT: _________________

Date of Hire at Maine General Health: .

Amount of hours worked during the Application Year . Must have worked a

minimum of 1,248 hours.

To qualify for program, the Technologist must have achieved the following during the Application

year:

Technologist II: Annual Appraisal Score of 3.5 or greater. Y/N ___

Technologist III: Annual Appraisal Score of 4.0 or greater. Y/N ___

Completed annual Clinical Skills Fair or department competency update Y/N ___

Attended 75% of Staff Meetings. Y/N ___

BLS certification current. ( if preferred or required on job description) Y/N ___

Technologist certification current. Y/N ___

Possesses the knowledge, skills, and attitude to contribute

to a high performing team. Y/N ___

Consistently participates in team huddles. Y/N ___

Demonstrates MGH’s Values and Standards. Y/N ___

Demonstrates Excellent Teamwork. Y/N ___

Demonstrates ability to Problem Solve. Y/N ___

Demonstrates Excellent Communication Skills. Y/N ___

Was there any documented Disciplinary Action

within the application year? Y/N ___

_______________________________ _________________



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Applicant’s Name: ________________________________

List all scheduled staff

meetings

Check dates attended Supervisor Signature


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Education Hours

Instructions:

All documented Education must be relevant to the Technologist role.

Evidence of Education completed must be attached or placed behind the Education Tracking

Form on page 21. Examples of evidence documents are described below under “Methods of

Evidence.”

Examples of education include: any of the courses offered by the MaineGeneral Outpatient

Education Department (courses such as Professionalism, Excellence in Office Practice, Preceptor

Course, Patient Engagement, BLS, etc.), college courses, webinars and conferences. Any

education that you complete to maintain your Certification counts toward your Enhancement

Program.

Methods of Evidence

1. Certificates

2. College credit hours – transcript must be submitted with a grade of B or better.

3. CEU Transcript

4. Webinar certificates

If you complete an educational program and you do not receive a certificate stating the number of hours

awarded, you must fill out the Education Verification Form for that program. This must be done for each

educational program you participate in if you do not receive a certificate stating the hours awarded.

NOTE: College credit hours are calculated as 1 hour per credit per week. For example, a 3-credit course

that runs for 15 weeks will earn you 45 Education Hours.


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Fill this form out to track your Education Hours throughout the year.

Applicant’s Name: _____________________________

Total Number of Education Hours: __________ hours.

Educational Event Date # of hours

completed

Describe how this event applies to your

work:

Supervisor or Instructor Signature:


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Education Verification Form

Directions: The Education Verification Form must be filled out for all educational sessions and

conferences for which a Certificate of Completion was not provided and/or does not state the number of

hours awarded. For example: if the applicant attended 3 educational sessions where a Certificate of

Completion was not provided, then 3 Education Verification Forms must be submitted.

Title of the Educational Program:

Organization Providing Training:

Total number of hours completed:

Brief description of the education presented and how it applies to your work:

Supervisor or Instructor Signature:


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Project Report

For levels II and III, the applicant must complete a Project that: (1) applies to practice-based goals which

impact the provision of high quality patient care and (2) is approved by applicant’s supervisor. The

applicant can lead the project independently or collaborate with 1 other applicant to co-lead the project.

The applicant is responsible for working with their practice leadership to identify a project that meets

these requirements.

The Project must fall into one of these categories:

Evidence Based Practice

Quality Improvement

Lean Process Improvement

To ensure all requirements are met, please thoroughly review the descriptions, project requirements and

forms for each category. The Review Panel will use a rubric to evaluate your Project Report. The rubric

can be found on the Outpatient Education website. Please reference this as you develop your project

goals and write the final report.

Description of Each Category:

An evidence based practice (EBP) project incorporates research to improve care provided within your

department. This type of project covers a specific sequence of steps, which are described in the

“Requirements” section below. These steps lead you through a research project with the ultimate goal of

guiding clinical care in your department. The EBP project integrates patient preference, practitioner

knowledge, clinical experiences, clinical expertise, and reliable sources of academic information

(Cullen, et al, 2018).

An EBP project requires buy-in and support from many members of the practice including clinical

support staff, medical staff, nursing leadership and administrative leadership. This project requires many

steps and collaboration with a number of key groups – therefore, you will also receive leadership hours

if you select this type of project. This is described in detail below.

A quality improvement initiative is aimed at improving patient care, outcomes, patient experience

and/or staff satisfaction/retention within your department. QI uses systematic processes to monitor and

achieve outcomes – such as the Plan-Do-Check-Act (PDCA) cycle. If your quality improvement project

requires you to lead or participate in a Committee, you can count the committee meeting hours toward

your leadership hours.


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A Lean process improvement project focuses on solving everyday problems, eliminating waste and

improving the patient/customer experience. The focus here is to implement an idea that is intended to

improve outcomes for the “customer” by improving at least one of the following:

1. Effectiveness: the level at which the output/product/service meet the customer’s needs.

2. Efficiency: the ability to be effective at the lowest cost.

3. Adaptability: the ability to remain effective and efficient in the face of change.

Examples:

EBP: implementing an evidence-based screening in collaboration with your medical staff, improving a

problem identified by a patient, adhering to a national/organizational initiative, updating practice based

on new evidence in collaboration with Medical Staff, etc.

QI: improving cancer screening rates, improving collection of clinical data and use of that data (i.e. the

rooming process or new patient intake), enhancing care for patients with chronic conditions, etc.

Lean Process Improvement: decreasing wait time, improving communication of patient data across your

practice or between specialties, organizing and standardizing practice workflows to improve patient

safety, improving orientation processes to ensure staff competence, etc.

Requirements for your Report:

Evidence Based Practice:

Check in monthly with a member of the OPED team for assistance with the EBP Process.


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Complete online Evidence Based Practice Modules – on the Outpatient Education Sharepoint

Site (this counts for 3.5 Education Hours).

It is recommended that you develop a Project Leadership Committee within your practice to

guide the work (developing and leading a committee is worth Leadership Points for Level III.

See grid on page 38).

Follow these steps, as outlined in your training:

o Identify a problem and create a PICOT question (you will learn about this in a training

you will complete online).

o Search for the best evidence (conduct a literature review). MaineGeneral has a Library

Site with resources for you to do this. Gather current available evidence from reputable

online resources.

o Propose an intervention/investigation based on observations and findings in the literature.

Gain approval from the key stakeholders in your practice – patients, medical staff,

supervisor, clinical support staff, administrator, etc.

o Define SMART goals and measurements.

o Seek Institutional Review Board (IRB) approval or waiver – based on the project.

(Seeking IRB approval is worth Leadership Points for Level III. See the grid on page 36).

o After approval is gained, implement your plan.

o Evaluate the outcome – what does your data tell you?

o Report your findings in your final portfolio.

If you publish or present your work, you will gain leadership points – see the grid on page 36 for

details. Provide evidence of your publication or presentation.


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Submit the EBP Project Report Form and follow the Rubric to ensure all requirements are met.

Reference: Cullen, L., et al. (2018). Evidence-based practice in action: Comprehensive strategies, tools and tips from the

University of Iowa Hospitals and Clinics. Indianapolis, IN: Sigma Theta Tau International.

Quality Improvement:

Identify your SMART (specific, measureable, achievable, relevant and timely) goal – it may be a

pre-established quality goal, or something new that you would like to work on. Work with your

supervisor to identify an area that would be beneficial to your patients/practice/staff.

Work with key stakeholders in your department – this may include administration, medical staff,

clinical support staff, etc.

Create your project plan and gather baseline data.

Implement your PDCA cycle (see image above).

Assess the outcome and determine if you met your goal, or if you need to reassess. Continue the

PDCA cycle as appropriate.

Submit the Quality Improvement Project Report Form and follow the Rubric to ensure all

requirements are met.

Lean Process Improvement:

It is strongly recommended that you attend Lean Yellow Belt Training and/or the Daily

Management Workshop.

Submit a Lean Support Request on the Lean Process Improvement Site (MGHConnect >

Excellence at Work > Lean Process Improvement > Lean Support Request > New Item) – in

collaboration with your supervisor.

Use tools recommended by the Lean Process Improvement Team to assess the current state,

collect data, implement your project and evaluate the outcome(s) – this could include the Daily

Management Board, spaghetti diagrams, run charts, development of standard work, etc.

Submit the Lean Process Improvement Project Report Form and follow the Rubric to ensure all

requirements are met.


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Evidence-Based Practice Project Report Form

Project Name:

Phase 1: Plan your Project

Purpose: (Describe and state your PICOT Question = Population, Intervention, Comparison, Outcome,

Time)

Literature Review/Appraisal of Evidence: (Provide a summary of the evidence you found. Attach a

reference sheet in APA format)

Describe your proposed intervention and next steps (include your SMART goal(s))


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Phase 2: Implement and Track your Project

Describe the Implementation Plan

Phase 3: Describe the Results

Provide Data & Lessons Learned (You may attach any tables or tracking sheets for your data. Provide a

description of the data and what it means for your practice. Did the data surprise you and your team?

Did it lead you to implement a new practice or method? Did it effect positive change? Did it benefit your

patients? Did it impact patient safety or experience? Please maintain patient confidentiality and do not

submit any patient identifiers in your Portfolio. You can assign titles such as Patient 1, Patient 2, etc.)


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Summarize how you shared the results of your project

Supervisor Signature:


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Quality Improvement Project Report Form

Project Name:

Purpose:

SMART Goal(s):

Background:

Plan: (describe baseline data, need for change and how you intend to reach the goal defined above)


32

Do: (describe how you implemented the plan and collected data)

Check: (report the data and lessons learned)


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Act: (describe how you took further action based on what you learned – described how you spread your

plan across your department if indicated or made adjustments to the plan and repeated the cycle.)



34

Lean Process Improvement Project Report Form

Project Name:

Purpose:

SMART Goal(s):

Describe the problem that was identified:

Describe key process changes made during this project:

Describe standard work or other tools developed:


35

Describe key lessons learned:

Describe barriers experienced during the project:

Describe any concerns for implementation:

Describe your results– did you meet your SMART goal?

If yes – please include (1) Results AND (2) maintenance plan below.


36

If no – please include (1) Results AND (2) Lessons learned.

Describe positive outcomes of the project (for example: improved patient outcomes, improved staff

satisfaction, financial savings, time savings, enhanced workflow, etc).



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Enhanced Clinical Leadership Role

The Applicant must demonstrate the ability to lead by: inspiring peers to engage in practice success,

motivating peers as a role model, and using your leadership skills to maintain excellence.

There are many ways the Applicant can meet the Enhanced Clinical Leadership Requirements. These

are defined below with the assigned points. A Tech Level III Applicant must achieve 50 points. Points

must be logged on the Leadership Point Evaluation Form and described in the Monthly Leadership

Points Journal. It is the applicant’s responsibility to gain approval from their supervisor for any role

outside the practice. The Supervisor verifies hours done by signing the Leadership Point Evaluation

Form.

Role Definition Points Associates degree

related to the role

Successfully completed a related Associates Degree

Program.

15 points

Technologist Program Successfully completed a Technologist Program. 7 points

Preceptor One-on-one training with a new staff or student. Must have

completed Preceptor Course within the last 3 years. Please

submit a certificate from the course.

1 point per hour

Instructor for an

Outpatient Education

Department Course

You must observe the course, study and be approved by your

Supervisor and the Outpatient Education team. Must teach

the selected course at least 2 times during the application

year.

0.5 points per hour

of observation

2 points per hour of

teaching

EMR-Super User Appointed by your Supervisor. Demonstrate mastery of

accurate workflows within TouchWorks (i.e. HMP,

Rooming, Patient Education, Medication List Maintenance,

etc.) and train peers. Attend 75% of Super User webinars and

share information with your team. Attendance must be

tracked on page 39.

1 point per hour

Compliance Champion Selected and trained to be part of the MaineGeneral Joint

Commission Mock Rounding Team OR complete online

training to conduct this in your practice. Contact the

Outpatient Education Team.

1 point per hour

Gemba Leader Attend Daily Management Training. Identify and define

goal. Lead the work in your practice. Speaking at Gemba

rounds does not count as leadership unless it is a project you

are the lead on.

1 point per hour

Yellow/Green Belt Assisting in Gemba rounds or fulfilling other Yellow/Green

Belt duties as requested by the Lean Process Improvement

team.

1 point per hour

Clinical Skills Trainer This can include BLS, or any clinical competency that the

applicant is proficient with (i.e. specific skills to the

position). For BLS or FIT Testing, you have to be an

approved instructor – contact the Outpatient Education

Team. For clinical skills, you must complete train-the-trainer

with the Outpatient Education Team and be signed off.

2 points per hour of

training the first

time you conduct

training.


38

1 point per hour

each time you train

thereafter.

Policy Development Participating or leading a committee to develop a

department-specific or organization wide policy.

1 point per hour if

you lead the

committee.

0.5 points per hour

if you are a

participant in the

committee.

Publishing or Presenting Participating in a team that is publishing an article in a

scholarly journal or participating in a professional

presentation (i.e. at a Conference). This includes a podium

presentation and/or a poster presentation.

8 points per

publication or

presentation

Community Service Participating in a community service organization that helps

people in our area (food pantry, habitat for humanity,

tutoring, etc.). Must fill out the community service

evaluation form with Site Supervisor Signature.

1 point per hour

for a maximum of

10 hours

Committee Participation Within MaineGeneral, or external committee that is relevant

to the role of Technologist (i.e participating on a school

board for a Technologist program, participating in a

workgroup to develop a new EHR process, etc). This

includes work in a committee for an extended period of time,

not attendance at one meeting.

1 point per hour if

you lead the

committee.

0.5 points per hour

if you are a

participant in the

committee.

Teaching Hired teacher in a certified Technologist program 2 points per hour of

teaching

IRB approval Seeking IRB approval is part of completing an Evidence

Based Practice Project. It consists of describing your project

and gaining approval to conduct research or chart reviews.

2 points

Clinically Competent in

Multiple Specialties

Has demonstrated and been signed off on clinical

competencies for multiple areas. Must work at least 2 shifts

per month in each area and complete annual competency

updates in each area within the application year to qualify.

(i.e. if you complete the requirements for 3 areas of practice,

you will receive points for 2)

5 points for each

specialty beyond

your primary

position. Need to

submit a copy of

completed

competency with

leadership forms.

Award Winner Receive an Award such as; Great Catch Award or EMME

Award. Provide a copy of the Award in your portfolio.

5 points

Award Nominee Nominated for an Award such as; Great Catch Award or

EMME Award. Provide a copy of the nomination in your

portfolio.

2.5 points per

nomination


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Community Service Evaluation Form

Total Points Earned: _______

Name of Agency Date & Hour Site Supervisor Signature & Title

Example: Muskie Center 02/07/2020 – 2 hours Jane Doe – Activity Coordinator

Supervisor Signature: _________________________


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Super User Webinar Attendance Form

Meeting Date & Time Attended – Y/N? Supervisor Signature

Example: 8/18/2019, 12p Y Joan Doe



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Leadership Point Evaluation Form

Total Points Earned: _______

Leadership Role Date Hours & Points

Example: Preceptor 5/11/2020 2 hours



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Monthly Leadership Point Journal

Directions: At the end of each month, please write at least 1 paragraph about what you did to fulfill your

Leadership Points during the month. Your journal should be written in a professional tone, free of typos

and without grammatical errors. If you are out for an extended period of time or did not gain Leadership

Points in a month, simply write “Nothing to report.”

July

August

September

October

November


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December

January

February

March

April

May

June


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Final Checklist for Technologist Enhancement Program Portfolio – 2020-2021

Included? Document Title

Proof of Technologist Certification (specific to your specialty) copy only, not

your actual certificate

Proof of Competency Booklet (or – if you started prior to booklets being

available – work with your manager to provide evidence of competency based

orientation).

Proof of BLS Certification, if required by job - copy only, not your actual

certificate




NOTE: If you are using college credit hours, you also need to send us proof of

successful course completion (such as a transcript showing B or higher) and a

brief description of how this applies to your current work. The number of

credits the course is worth is the number of credits you will receive weekly

while taking the course. For example, a 3-credit course that runs for 15 weeks

will earn you 45 Education Hours.

Education Certificates of Attendance

NOTE: If certificates were not provided, fill out the Education Verification

Form for each educational session with a Supervisor Signature. Certificates

should make it clear how many hours were achieved.


NOTE: the rubric is available online if you want to see how your project will

be approved/denied.

Optional: Materials from your project that you would like the Review Panel to

see! For example – educational materials, data, etc. We would love to see your

work.

Enhanced Clinical Leadership Forms (for Level 3).

REQUIRED: Leadership Point Evaluation Form & Monthly Leadership Point

Journal

MAY INCLUDE: Community Service Evaluation Form, Super User

Attendance Form (if you participated in either of these roles, you must provide

the completed forms), copy of competencies for multiple specialties.

NOTE: If you are counting preceptor hours, you need to have attended the

Preceptor course within the last 3 years. Provide a certificate.


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