Why should we pursue team care in health care? Is it to prevent physician burnout — or is it to support population health?
The answer, of course, is: Yes, it’s both.
Team care can help doctors succeed in their profession and give them back the work-life balance needed to have a successful home life as well. And the more patients know about this, the better.
What is team care? It's a way to redesign a physician's office staffing that provides additional support to help the physician — and can include an extended team of various professionals to provide additional services, including pharmacists to reconcile medications, case managers to help reduce readmissions, and behavioral health providers to manage psychosocial issues.
Some may say: Wait, won't this simply increase the cost of delivering care at a time when many practices are barely surviving financially? It might, if nothing else changes. Let's look at what changes if we do it right.
Benefits of team care. It's become common now for primary care physicians (PCPs) to see under 20 patients a day. There was a time, not so long ago, that PCPs saw 30 patients a day. And at the end of that day, they did not face an evening tethered to their keyboard at home catching up on visit notes and overflowing in-baskets. But times have changed. In the "good old days," chart notes were handwritten (OK, scrawled) or dictated, prescription refills required five seconds for a quick flick of a signature, medication reconciliation was less complex (fewer meds), preventive and chronic care gaps were not identified, attestation did not exist — and prior authorizations, when requested, were rare.
Hard to believe that was the case for most physicians 15 years ago. Back then, we didn't need a full team to support us. Well, times have changed for most docs. There are a few adventurous souls pursuing direct primary care, getting by with minimal staff, and loving it. Of course, they are seeing far fewer patients. It's OK. It works for them.
For the rest of us, we benefit a lot from the support. And we can afford it if we use our team effectively.
How does a team win? A team wins when all:
- know which game they are playing
- understand their position on the team
- have practiced and can execute all the plays and
- can adapt quickly to changing conditions.
It's not too different from any team sport. But it's a team sport. We can't play alone anymore, thinking that, as the physician, it's our job to:
- hike the ball
- drop back to pass, and then
- catch the ball downfield
It's impossible. (If you don't like football, that's OK. Pick any team sport and use the same analogy.)
How all workers are involved. In team care in a physician's office, all workers have their position and know what they are supposed to do in each play.
- The call center staff plans the appointments with protocols and ensures all billing info is collected before the patient is scheduled.
- A nurse reviews the schedule and charts a day ahead to ensure any care gaps are identified and prepped.
- The receptionist greets the patient and gets the visit process started, according to in-office protocols specific for each visit type.
- Medical assistants "room the patient" and ensure any information the doctor needs is available before the doctor enters the room.
- The physician is called to the room when the patient is fully prepared, so as not to waste time in the exam room on things other than giving full attention to the patient.
- The medical assistant stays in the room with the physician and the patient, acting as a scribe to minimize keyboarding for physicians.
- The physician reviews and approves the note and pending orders before leaving the room.
- The medical assistant stays with the patient, ensuring all questions are answered and appointments scheduled.
- Between patient encounters, the physician sits with support staff to answer questions and keep the in-basket messages to a minimum.
It takes practice. Doctors may look at the list above and think it looks like a lot; maybe it's too hard to get all this going. Like anything new, getting started isn't easy. But considering that the alternative is continuing to suffer with the existing model, or likely seeing it get worse, the effort is worth the pain.
Committing to the process is the way to win with team care. A doctor and his or her team will make mistakes at first, but as long as they learn from each mistake and stay committed to continuous improvement, they will succeed.
And how will success be identified? As people stick with this, things get better. Pretty soon doctors are not going home exhausted at the end of the day, with hours of keyboard time still ahead. Their waiting room starts to look empty, but productivity is increasing. Everyone on the team is smiling, even high-fiving at the end of a busy day.
Quality and patient satisfaction scores go up, as does a doctor's income. Physicians won't miss as many significant events with family and friends, as they did in the past.
Paul F. DeChant, M.D., is deputy chief health officer with Simpler Healthcare/IBM Watson Health in California. He provides executive coaching and thought leadership on preventing physician burnout. During his tenure as CEO of the Sutter Gould Medical Foundation, it achieved Consumer Reports' highest overall rating of 170 medical groups in California for two years in a row, while physician satisfaction rose to the 87th percentile. This piece appeared on PaulDeChantMD.com and is used by permission.
Last Modified: September 5, 2017, 6:41 am