In healthcare one of the key issues we often have to address is fragmentation.
When we deliver care, often we do it in silos with little or no incentive to work with other disciplines. Much of this behavior is driven by how we pay for services; however, it is becoming increasingly clear that collaboration and working in teams is one answer to many of the problems plaguing us in healthcare.
Imagine this scenario:
You present to your primary care provider with a complaint. One piece of your complaint involves the primary care provider referring you to another provider. These two providers work closely with you addressing your healthcare needs, but when you ask if they are talking to each other, the answer might be no. They may both have copious notes on what was said and what was done with you, but even these notes may not be shared. You might find yourself being the “in between” for these providers communicating their respective message back and forth as needed. Further, you find that you are spending a substantial amount of time driving between offices, setting up different appointments and missing work. While you may be satisfied with the health outcome, the process has been a challenging one for you.
Unfortunately for many in our healthcare system, this is a common occurrence.
The notion of team based care is a powerful one and in some ways could help mitigate the challenges as seen in the scenario above. While not all services can integrate, where providers may share the same space, many healthcare services could if just given the opportunity and incentive to integrate. And, just because providers share the same space does not make them a team.
In a well thought out piece in JAMA, Drs. Grumbach and Bodenheimer describe the use of teams in primary care to improve practice:
“In health care settings, individuals from different disciplines come together to care for patients. Although these groups of health care personnel are generally called teams, they need to earn true team status by demonstrating teamwork. Developing health care teams requires attention to 2 central questions: who is on the team and how do team members work together?”
According to the authors, high performing or “cohesive” teams possess 5 key characteristics.
1) Clear goals with measurable outcomes;
2) Clinical and administrative systems;
3) Division of labor;
4) Training of all team members; and,
5) Effective communication.
What is interesting about these 5 key characteristics is that they often take time to develop. In the hustle and bustle of healthcare, it is hard to take a step back and to “rework” your system to accommodate a new line of service. Developing teams not only requires an operation change to facilitate better team based care, but it also requires an attitudinal change or cultural shift where providers start to think of themselves as a team rather than just an individual.
And this is a hard to change to make.
When one examines the research on team based care it’s pretty clear that greater cohesiveness in the team is associated with better clinical outcomes. In addition, patients seem to like the team based care better as patient satisfaction is higher.
In all our discussions on healthcare redesign and payment reform, we must begin to think of how we can start to move healthcare towards team based care. We must consider how working together, collaboratively, can improve lives and ultimately start to bend the healthcare cost curve. We also need to consider who are the members of the team that we need in place to truly meet the healthcare needs of our community.
Healthcare is a team sport, and the patient needs to be the one calling the plays. Let’s work towards developing more cohesive teams in all our reform efforts.