You’ve Bought into the Concept of Team-Based Care. Now, How Do You Go About Building the Care Team?

Teams, as a healthcare intervention strategy, have been highly correlated with quality improvement, demonstrating a stronger impact than other interventions such as clinician education

“A ‘high-performance’ work team refers to a group of goal-focused individuals with specialized expertise and complementary skills who collaborate, innovate and produce consistently superior results. The group relentlessly pursues performance excellence through shared goals, shared leadership, collaboration, open communication, clear role expectations and group operating rules, early conflict resolution, and a strong sense of accountability and trust among its members.” (Society for Human Resource Management, 2015)

As I thought about the subject of this week’s post, the definition put forth by SHRM resonated. Maybe that shouldn’t come as a surprise. We’re in the midst of re-engineering the healthcare delivery value chain and re-architecting many of its programs and processes. Looking across industries at the application of – and the impact upon – organizational performance of teams, is well-timed and makes good sense. Environmental trends, health policy, and clinical evidence all support the adoption of care teams as a building block of high-functioning primary care. In fact, teams, as a healthcare intervention strategy, have been highly correlated with quality improvement, demonstrating a stronger impact than other interventions such as clinician education. (Shojana KG, 2006)

If you’ve embraced the concept of team-based care as an interventional strategy and an operating mechanism, the natural next question becomes: what does, or what should the care team look like? Before you can answer this question, the Institute for Healthcare Improvement (IHI) argues that you must understand the types of services your clinic provides, or intends to provide. You also have to decide who is going to be involved in delivering those services. In other words, you start by gauging supply and projecting demand. After you’ve married supply to demand, you’ll be less arbitrary in your approach. Instead, you’ll be better positioned to configure care teams within the context of your clinic and its resources. You will also be able to better identify and address any potential gaps. (Institute for Healthcare Improvement, 2016)

In order to provide one example, I’ve included a depiction below of a standard care team configuration. In past practice, we used this configuration as a flexible model, one that could be scaled-up or scaled-down based upon the needs of the individual clinic and its patient panel. The model consisted of a core team, as well as an extended team that worked across settings and supported specialized or non-standard inquiries, outreach, and core team care delivery initiatives.   

Once you’ve configured your care teams, it’s time to map resources to discrete responsibilities. By establishing clear roles and attaching expectations, and subsequently identifying how each supports clinical quality improvement as well as practice objectives, care team members will be “mission-aligned,” aware of their contribution, and presumably, empowered to organically improve “the system” with the benefit of continuous feedback.

IHI highlights a number of instructive guidelines associated with the concept of continuous improvement and care team performance optimization. The first, managing work away from the provider who is recognized to be the constraint or bottleneck. On some level, this is simultaneously obvious and yet something of an epiphany. Other guidelines include working to cross-train staff to incorporate flex, systematizing operations and reducing practice variation, ensuring team members are working to the height of their licensure, and formalizing team communication. In a previous blog article, my colleague Dr. Jacquelyn Hunt discussed the role that communication can play, specifically focusing on the practice of team huddles.

Another issue that providers frequently have to tackle as they are moving to team-based care and evaluating communication channels and practices relates to co-location. The traditional model locates physicians and other providers in private offices. Communication often suffers, requiring deliberate searches and, too regularly, the dreaded practice of messaging via the EHR. Co-location, however, facilitates richer, synchronous verbal dialogue with faster turnaround. And if executed properly, can provide answers to telephonic messages from patients in real-time, increasing the service quality and reducing the volume of (also dreaded) EHR phone notes. I am aware of multiple examples in which providers have enthusiastically surrendered their private offices in the interest of more effective team communication.

Ultimately, providers are measuring their performance – and being compensated – according to some algorithm that is rooted in the triple aim of population health improvement, cost reduction, and patient experience. And while there’s no silver bullet, no one path to achieving those goals, there is evidence suggesting that the implementation of care teams can support and accelerate your effort.

To read more about the impact of team-based care on clinical practice, I have included several links to journal articles that you may find interesting:

Additionally, I would suggest visiting IHI’s website which will prove to be a fantastic resource on a great number of topics, including team-based care.

J. Siemienczuk, MD