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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
BLS certification card/document if required by job description
Technologist certification document
Technologist Level III:
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
Leadership Point Evaluation Form
o Community Service Evaluation Form as appropriate
o Super User Webinar Attendance Form as appropriate
Monthly Leadership Point Journal
BLS certification card/document if required by job description
Technologist certification document
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
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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 ___
_______________________________ _________________
Supervisor Signature Date
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Supervisor Validation Form for Portfolio Submission
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 ___
_______________________________ _________________
Supervisor Signature Date
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Staff Meeting Attendance Tracking Form
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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Education Tracking Form
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)
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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.)
Supervisor Signature:
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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:
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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.
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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).
Supervisor Signature:
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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.
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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
Supervisor Signature: _________________________
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Leadership Point Evaluation Form
Total Points Earned: _______
Leadership Role Date Hours & Points
Example: Preceptor 5/11/2020 2 hours
Supervisor Signature: _________________________
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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
Supervisor Validation Form for Portfolio Submission
Staff Meeting Attendance Tracking Form
Education Tracking Form
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.
Appropriate Project Report Form
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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