Observations on the benefits of team-based care and making the transition to it
Why Team-Based Care? Over the past several years a lot has been written and done around team-based care. A few of the reasons for this increased focus include: the changing healthcare industry landscape; the shift to value-based care; Quadruple Aim goals (raising population health, improving patient experience, reducing waste/cost, and enhancing care team well-being); the rise of the empowered consumer along with increased expectations regarding access, efficiency and high reliability; provider burnout; and the looming physician shortage.
All of these contribute to the need for greater coordination, collaboration, and connection among providers with the patient at the center. “Health care is becoming more complex and as a result we need to be able to rely on trusted partners to keep us informed, share their expertise, provide emotional support and a sense of “we know what you are going through,” Kathy Hardesty, RN, vice president and senior clinical executive with Navvis Healthcare.
Wherever you are on the journey from “working alone together” to a high-functioning, integrated care team, I hope you will find something helpful in the information that follows. As the saying goes, none of us is as smart as all of us and with this article I share comments from my colleagues at MEDI Leadership and individual practice members with whom we’ve worked.
Team-based care benefits all involved—patients, families and care team members as well. In team-based care, physicians, nurse practitioners, physician assistants, nurses, medical assistants, dietitians, social workers and others function as an integrated team, jointly customizing care to a patient’s individual needs. Patients actively participate in establishing and managing their care goals and all team members help support them in achieving their goals.
“From the patient’s perspective, medicine has always been team-based care. It has never been the patient interacting solely with a physician. Coordination is what has been lacking,” said Brent Wallace, MD, the former chief medical officer of Intermountain Healthcare in Salt Lake City, Utah, and now a fellow MEDI Leadership coach.
He continued, “To provide cost-efficient, effective care in today’s environment, we need to utilize all members of the team to provide care. Primary care physicians often do things we don’t need physicians to do. We can provide higher quality, cost-effective, better care through a team approach.”
Patients have long complained about the lack of coordination and communication between caregivers. John Anderson, MD, MEDI Leadership colleague and former chief medical officer with Baylor University Health and CHI, commented: “Over the years, the most consistent patient concern is around communication. Patients may ask, or certainly think, ‘Do you people ever talk to each other?’ We need to ask ourselves, ‘Is there redundancy or any disconnect in our communication?’ The ability to communicate effectively in real time, speaking with one voice, is key.”
Another perspective was offered by Debra Harrison, RN, a MEDI Leadership colleague and former chief nursing officer for the Mayo Clinic in Jacksonville, Fla. “I believe it increases a patient’s trust and confidence to see care team members working together. More minds are better than one. We come at it from different perspectives and working together helps us to think synergistically.”
Mitchell Stucky, MD, a family practice physician with Parkview Physicians Group in Ft. Wayne, Ind., has been using a team-based care model for the past seven years. Of his experience, he said, “Patients see that we truly work together. These are OUR patients; we are one team, one mind.”
There are definite benefits for care team members in the model as well. Shannon Tranquill, nurse practitioner in Dr. Stucky’s office, added: “We lean on and help each other. We support each other around our patients’ goals and care plans. It is much less fragmented than in the past. We learn from each other, share our knowledge and experience, respond promptly to each other when there are questions or concerns, and work in the best interests of our patients. I really appreciate a physician partner who wants me to learn and contribute positively to the practice. Team-based care also helps with provider burnout and promotes high levels of work satisfaction.”
Dr. Stucky agrees, “In my 35 years of practice, I have worked in solo, group practice, with advanced provider professionals (APPs) who, in the early days, saw overflow patients, and in this integrated team-based model. This is by far the most rewarding way to practice.”
Dr. Anderson notes physicians’ orientation to doing everything themselves. “Our traditional physician training reinforced working independently and that all decisions needed to go through us. Everyone wins when we shift to a more efficient, effective team-based approach,” he said.
Streamlining Processes and Workflows
Collaborating to streamline processes and workflows is a key step in implementing team-based care. Dr. Anderson said, “We need to ask ourselves what we want team-based care to feel like for our patients. It needs to be team-based through the eyes of patients and their families, not what we call a ‘team’ or simply conducting team huddles. We tend to design around our perception rather than engaging the voice of the customer.”
By redesigning the experience to best meet patient needs, we can eliminate unnecessary steps and add value. Dr. Stucky recalls, “We sat down together and got on the same page about processes, workflows, and protocols. We came together as a team with a goal to do what’s best for our patients.”
Nurse practitioner Lisa Foldesi in Dr. Stucky’s office added, “As we watch what each other does, we become more aware of places to help each other, to reduce steps, eliminate duplication.”
Another suggestion from our panel is to test new processes/workflows in a controlled environment before they are released in a larger context and to build in monitoring capabilities. Process flow maps, simulation, re-enactment, and video are valuable tools in identifying process and workflow opportunities.
Guiding Principles for Effective Team-Based Care
Highly effective team-based care requires more than streamlining processes and conducting huddles. It requires clear roles and responsibilities and building a high-performance, collaborative team.
“Identifying roles and responsibilities is just the start. The true functioning of a team comes through building trust and learning each other’s work styles. It takes effort and time,” Dr. Wallace said.
Dr. Anderson agrees, “The hard work is under the surface; building trust and staying connected so patients will see and experience the team as working together effectively on behalf of the patient.”
So, how do you go about building a high-performance team? My colleagues and I have the pleasure of coaching and helping healthcare leaders across the country build high-performance teams. We recommend having a coach or facilitator assist with team-building to help accelerate the team’s evolution to a state of interdependence, characterized by trust, shared responsibility, collaborative decision-making and commitment. Below are some suggestions:
- Establish a shared vision, purpose. Why team-based care? What are our goals and key success measures?
- Identify and develop a strong leader.
- Establish a foundation of trust. Get to know each other as people and professionals. Better understand individual and collective strengths.
- Develop the right culture (“What do we want it to be like around here?”). Establish agreements for how team members will work together.
- Help clarify roles and responsibilities, with a goal of having team members practice at the highest level of their role (within relevant state, the scope of practice and licensure requirements).
- “Upsell” each other to patients. Introduce team members. Ensure that the person answering the phone helps patients with immediate access to advanced practice providers (not “extenders” or “mid-levels”).
- Facilitate effective communication (open, transparent, timely); establish team huddles. Listen actively. Manage conflict constructively. Develop methods to support information sharing within the team.
- Foster accountability and commitment.
- Establish, monitor and regularly communicate progress toward shared goals, key measures. Celebrate successes and collaborate to continuously improve.
- Include administrative team members such as practice managers and front desk staff, who are key parts of a strong overall team.
- Keep learning—individually and collectively; learn from and share with each other.
Some of the common challenges encountered when implementing team-based care include a lack of clarity around the meaning of “team-based care;” unclear responsibilities; and that it is a fundamentally different way of working. Physicians’ training teaches them to be high-functioning individuals. Providing care as a team is a big shift, practically and behaviorally, that shouldn’t be underestimated.
“We’ve been in a historically hierarchical model. Using terms like ‘my practice,’ ‘my patient’ or ‘mid-levels,’ needs to change,” said Dr. Anderson.
Other common challenges are not getting patient input and resistance to change, in general.
Final Advice/Tips for Successfully Transitioning to Team-Based Care
Dr. Stucky suggested, “Focus on being one team. We each bring different skill sets and perspectives that together help us provide better care and a better experience for our patients. We have a lot of informal communication and emphasize with our patients that we work as a team.”
Nurse practitioner Lisa Foldesi from his office added, “Come to it with an open mind about what APPs can bring to the practice. They aren’t looking to take patients from physicians. They are looking to partner to help the patients and provide great care as part of a team.”
To learn more about team-based care, consult the Institute for Healthcare Improvement (www.ihi.org) or the National Center for Interprofessional Practice and Education (https://nexusipe.org).
Wishing you success on your team-based care journey. MEDI Leadership offers team coaching to focus on team development and alignment specifically around leading transformational change within your medical group, hospital or health system.
*Excerpt originally published in collaboration with the St. Louis Metropolitan Medical Society