Is team-based care new? Does it need to be physician-led? What benefits can this care model bring? How to ensure high quality with a team comprising physicians, nurse practitioners, administrators and others?
Well, team-based care is not new. Its origins could be traced to sources including the Chronic Care Model in the 1990s. It is a strategic redistribution of work among members of a practice team. By involving other staff in patient care, it frees up the physician to focus his time and attention on the patient. At the same time, other team members are kept abreast on the patient’s health history and status with the objective of handling care coordination, treatment
All members of the team are essential and just as important. But strong reasons exist for physician leadership. We speak with HIMSS President & CEO Stephen Lieber and he answers a few questions about physician-led team based care.
Stephen, the complexity of modern healthcare is demanding – more than ever – effective healthcare provider teams. What is the advantage of physician-led team-based care?
SL: First, I think it is important to emphasise the importance of multi-disciplinary teams, regardless of who leads the team. There are many aspects to care: clinical, administrative, technical, to name a few and there are different components to each of those. For example, the clinical component is made up of medicine, nursing, and numerous therapies. It is important that all of these components are valued participants on the care team.
With any team, there does need to be one who has the ultimate authority to make decisions, based upon the input from the other team members. The physician is the traditional care leader in virtually all parts of the world usually due to educational, experiential and regulatory environments. The challenge for physicians though is typically the amount of time asthey have to give to a single patient is very limited so the physician team leader should rely greatly on the more frequent patient monitoring that typically is performed by nursing.
Finally, technology is bringing new dimensions to patient care and providing care teams with new information never before available. This is another component that is now part of the care environment. Again, the knowledge and skills that are more typically found in the physician community reinforce the role of physician as the team leader; but the caution about time is worth repeating. Someone, perhaps a patient advocate, with sufficient time to compile all inputs needs to be involved to ensure the patient receives the best care.
How does team-based care look like to you now?
SL: The physician as the “captain of the ship” is the dominant model and for good reason. Typically, it is the physician who has the breadth of knowledge and the regulatory authority to perform this role.
In some parts of the world — US, Northern Europe, Australia and a few other areas — there is a very sufficient role and scope of practice for nursing that provides great value to the patient and to help ensure quality of care. Also, therapists relevant to the patient’s condition are also key players. This is the typical model with nursing being the clinical discipline where there is the greatest variety around the world as there are countries who have not adopted the necessary nursing education and training for these professionals to contribute in the way they do elsewhere.
Generally, team-based care is operating satisfactorily but the rise of technology is challenging this traditional model.
How do you think it will evolve over the next 5 – 10 years?
SL: The change in the next 5-10 years will be the rise of the clinical informaticist as a key team member. The collection, analysis, and utilisation of data to guide patient care is becoming more important now and will only increase in importance over the next number of years.
The growth of information is so great that no one can possibly know and retain all of the new clinical information that is coming out daily. The use of clinical analytics to develop personally-designed care will also increase the importance of an informaticist on the care team.
As a healthcare leader yourself, what are the key principles to uphold in developing effective teams? Elaborate briefly on each.
SL: 1. Be fact based: We need to ensure that care is based upon science in that we now know more about patients (genetic sequencing) and disease and how the two interact differently among patients. One treatment protocol may work for one patient while it is a different protocol for another patient with a similar condition.
2. Value all input: Sometimes it is the verbal interaction between nurse and patient, family member and patient or other interactions that can give the team the best insight as to what is going on with the patient; don’t ignore input.
3. Ensure clarity of roles: Everyone has a role and clarity as to what that role is will avoid an aspect of care not being handled or conflict between team members with different understandings as to who is responsible for something.follow-through, administration, documentation and post-visit care.
Regional thought leaders also weigh in on Physician-Led Team-based Care. This is what they say:
As healthcare gets more complex and patients live longer with more co-morbidities, it’s become evident that no one single medical practitioner can provide the gamut of care needed.
EMRs are the foundational units for providing good high quality care in that they can capture discrete data elements that can be analysed and acted upon for cycles of improvements.
Physicians who can navigate the complex world of medical knowledge and who can tailor for the specific needs of their patients need to be guided by the input of their fellow medical colleagues, nurses and allied health professionals. Medical IT can bridge that communication gap in a multi-disciplinary team and can even value add by bringing relevant information to the forefront.
Adj. A/Prof. Gamaliel Tan, Chief Medical Informatics Officer; Head, Orthopaedics, Jurong Health Services, Singapore
The American Medical Association defines the term “physician-led” in the context of team-based care as the consistent use by a physician of the leadership knowledge, skills and expertise necessary to identify, engage and elicit from each team member the unique set of contributions needed to help patients achieve their care goals.
It has been decades that Healthcare IT has continuously evolved and now is proving its benefits on efficient patient flow, lean processes, and most of all safer and higher level of care for our patients.
At this stage, technologies can integrate practice units and care facilities altogether across geography and be able to help care providers to have care solution(s) planned and provided at the point of care as well as the outcome(s) predicted for each patient.
At this stage, having multispecialty, multi professionals working “collaboratively in a blameless way” would be considered as a crucial step to move forward that would open up everyone to speak while physician leaders shall then use their knowledge & expertise together with their leadership skills for the team. Great teamwork that plans to achieve measurable goal(s) for each of their patients.
Dr. Korpong Rookkapan, Hospital Director, Paknampo Hospital, Thailand
The patient-centered medical home (PCMH) is a team based health care delivery set of principles led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults."
As one of the key founders of PCMH, IBM has played a significant role in the PCMH principles and many of its employees are part of this initiative. The medical homes allow better access to health care, increase satisfaction with care, and improve health all at a lower cost. At the core of the PCMH is the patient’s personal, comprehensive, long-term relationship with his or her primary care physician (PCP).
Patients with a PCP will incur about a third less healthcare expenditure and will have 19% lower mortality. They are 7% more likely to stop smoking and 12% less likely to be obese. Thus, PCMH’s team-based care places the PCP at the forefront as the physician’s role drives quantifiable health improvements across patient populations. Rather than being just a resource for episodic care, the PCP-led care team assumes proactive prevention, wellness, and chronic illness care, becoming the patient’s confidant, coordinator and advisor for all aspects of healthcare.
Farhana Nakhooda, Healthcare and Social Services Director, IBM Asia Pacific, Industry Academy Member
China started embracing private healthcare delivery as a welcomed addition to the legacy public healthcare institutions. One of the differential factors for our organization is to offer a distinguished multidisciplinary team-based model of care to our patients and clients supported by technology.
Clinician-led service planning demands a relentless drive to make our cared communities much healthier based on the value of care offered. Such model requires iterative consultation and creative co-design and co-management of care amongst our clinicians and patients.
There is a need for innovation to achieve excellent care through integrated care delivery model, and how individual and community outcomes are enmeshed. We hope that provider and patient relationships can be preserved at the same time as the health of much larger groups is advanced.
Dr. Francis Qiu, Chief Medical Information Officer, Jiahui International Hospital, China
The positive outcomes of physician-led team care are clear in our Code Purple program where pre-critical patient onditions are proactively defined and monitored. Once established criteria are fulfilled, the code is activated. This reduced the number of Code Blue calls and subsequent mortality rates from 57% to 13%. Additionally, the average cost of care is lower by 20% and the lengths of stay are shortened by 13%.
The formation of the Brain Attack Team to respond to acute strokes has resulted in the time to response and imaging to steadily decrease from double to single digit minutes. This has increased the number of rtPA eligible patients to fall within the optimal time window of administration.
At the Asian Cancer Institute, the multidisciplinary teams of physicians, nurses and counselors are designed around the patient. This has brought down the fallout rate for treatment and subsequent follow up. Expanding team based care evidently is the way forward.
Dr. Juan Antonio G. Javellana, MD, Director of Medical Informatics, Asian Hospital and Medical Center, Philippines
To cope with the ever-increasing burden on, and demand for, healthcare services new approaches are required that will increase the productivity of healthcare providers without an increase in administrative burden.
Team-based care provides unique opportunities to reduce non-essential tasks and duplication of work through a model that promotes greater engagement of patients with all their care-givers to accomplish shared goals.
Essential in such an approach is the availability of an ICT system that allows all stakeholders to securely access and effectively use the information being generated, which has a user-centric design and organises all the work for team members in an intuitive way. In recognition of the growing role patients play in the delivery of their own care, such a system must also allow the patient to be fully engaged, informed and integrated in all applicable care team activities.
The Agfa Healthcare Engage Suite provides a platform for (physician led) team-based care that supports care management and access to patient health information beyond hospital walls, for patients and care providers alike. It offers features and functionality for care coordination and integrated care, enabling each stakeholder to prepare, follow and monitor the patient’s care through greater collaboration and communication, as part of a team-based care environment.
Matthew Koch, Imaging IT Product Manager ASPAC, Agfa HealthCare
Physicians will continue to experience pressure to become more efficient while improving the delivery of patient care.
The reality is, they can’t do it alone.
A team-based care approach provides a foundation for better communication among physicians, nurses, and other care team members.
That’s where Spok comes in. The Spok Care Connect® platform improves care team communication and allows delivery of critical information quickly to clinicians on the device of their choice. One Spok customer reduced formal complaints regarding a lack of communication by 75 percent. Another customer was able to cut the amount of time it takes to initiate a code by half.
Spok’s patient-centric messaging capabilities allow physicians and nurses to get the information they need when they need it, allowing more effective collaboration among care team members.
Hemant Goel, President, Spok
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