Changing the Culture

 

Team-Based Care – Part III

For health care organizations to successfully implement any type of team-based approach to patient care there are some things to consider. The culture will have to change to encourage adoption of this new approach and patients, just as physicians, will need to change.

In a field where every position already feels they are working as hard as they can, being passionate about new responsibilities can be difficult.

 As work is pushed down from one team member to another, the recipient may feel taken advantage of and the contributor may be reluctant to “let go.” Both parties may be anxious about the new responsibilities they are being asked to assume. But the idea of team-based care is for each person to perform at the highest level their education will allow.

Creating a Coordinated Team

The key to success is to approach care as a coordinated team. Meet to discuss patient care before and/or after visits. Have group discussions frequently throughout the day. Review the appointment schedule as a team to plan for patients who may need extra attention, and promote a culture where each individual is focused on the same goal—higher quality patient care.

Doctors may initially be reluctant to surrender duties to someone else since they are ultimately responsible for the patient’s treatment plan. Primary care physicians complete over 21,000 hours of education and clinical training over an 11-year period. Physicians may be fearful that a team member with less training may not have the necessary skills to properly diagnose and treat patients; therefore these docs fail to relinquish responsibilities.

To be successful with this culture shift, clear instructions and communication is crucial. Ease physician concerns by planning for the appropriate level of physician involvement, and continue to involve doctors in coordination of care while delegating tasks to others. For example, while a diabetic patient may need to be evaluated frequently, they may not need to see the doctor as long as their test results and vital signs are within acceptable ranges.

Overcoming Negative Patient Perceptions

The biggest hurdle that team-based care faces may be patients' perceptions. A 2012 Blue Shield of California Foundation survey of more than 1,000 low-income people revealed that the majority of respondents prefer to be seen by a doctor. However, about one in four respondents already had team-based care and 94% of those respondents were happy with their care. Of those who are not currently receiving team-based care, 81% said they are willing to try it.

To overcome possible negative perceptions, here are a few things to highlight to patients that may help them adapt to a team approach:

  • Educate your patients about the team-care philosophy and introduce them to the team
  • Promote the skills and special training of mid-level providers and nurses to develop a greater appreciation of the positive influence they bring to the team
  • Assure patients that physicians are still involved in the coordination of their care and the team member with the greatest skills to treat the current need will be providing care at that time
  • Remind patients that you value their time so using a team approach alleviates the potential for long wait times and increases the ability to make timely appointments
  • Encourage visits with mid-level providers in the office as an alternative to emergency room visits

     

I leave you with a quote from Frances Hesselbein, “Culture does not change because we desire to change it. Culture changes when the organization is transformed: the culture reflects the realities of people working together every day.”  Keep challenging the status quo!

 

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Topics: Population Health, Patient Care, Hospital Management

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