by Holly Hayes
In a message to all physicians posted on the American Medical News website this week, Ardis Dee Hoven, MD, chair of the American Medical Association (AMA) Board of Trustees said, “When physicians, hospitals, nurses, technicians, patient advocates and others collaborate, they can help prevent costly hospital admissions and keep patients from cycling between nursing homes and hospitals.” Her message, “Quality care follows when health professionals collaborate,” discusses the role of medical homes and Accountable Care Organizations (ACOs) in integrating and coordinating teamwork between physicians and health care professionals to provide comprehensive care for patients.
The most common example of a community-based team approach is the medical home, where collaborative teams of physicians, nurse practitioners and/or physician assistants provide office, hospital and home care. These teams make extensive use of telephone and e-mail consultations and electronic medical records.
The medical home model emphasizes consultation rather than referral, and successful medical home patients have greater care coordination, reduced hospitalizations and, ultimately, reduced costs.
As in hospital and clinical settings, community-based collaborations depend heavily on communication (both among team members and with patients) and patient compliance — much harder to accomplish in the “real world.” Clearly, EMR systems play a key role in any community-based medical team approach.
In his first major public address, Donald M. Berwick, MD, head of the Centers for Medicare & Medicaid Services, announced goals for CMS and specifically called for more community-based collaborations — in the form of interdisciplinary accountable care organizations.
ACOs, which were named in the Patient Protection and Affordable Care Act, aim to integrate and coordinate the work of teams of physicians and health care professionals as a way of providing comprehensive care for patients.
More recently, the AMA has urged Dr. Berwick and the FTC to make clear that small and solo physician practices can collaborate around health information technology and quality improvement initiatives that make joint negotiation of fees necessary and justifiable, without incurring the sort of organizational costs that make it necessary for physicians to turn to hospitals.
Much is currently being written about teamwork and collaboration in the medical setting. Bob Wachter, MD, posted an article on his blog this week titled “Teamwork Training in Healthcare: More Than Just Kumbaya” that says:
In this week’s issue of JAMA, (Julia) Neily (RN, MSN, MPH) and colleagues report the results of a teamwork training program implemented in 74 VA facilities. They found that the intervention (not just teamwork training, but more on this later) was associated with a 50% reduction in post-operative mortality, when compared to a contemporaneous control group of 34 facilities that had not yet implemented this training. While the raw mortality reduction is impressive, the finding… (there were 0.5 fewer deaths for every 1000 procedures) makes the results all the more convincing.
We are still learning the best ways to teach teamwork: there is good team training and not-so-good team training. Some of the lessons we learned from our experience were: a) everybody needs to participate; nobody can be allowed to opt out (some ORs now require that surgeons and the other members of OR crews participate in teamwork training to maintain their staff privileges, and their hospitals shut down their ORs for a day to allow the training to be conducted with full participation); b) the training must be intensely multidisciplinary (i.e., you need to get docs, nurses, pharmacists, and others sitting together, working through clinical scenarios – teaching teamwork to separated cohorts of physicians or nurses is a perversion of the concept); c) the use of high-tech simulation can help by amping up the drama, but it isn’t crucial; d) leadership endorsement and support of the program is essential; and e) while there are many companies that can be brought in to help design and implement teamwork training programs (many of them staffed by former or active pilots), programs need to be localized and delivered, at least in part, by folks known and respected by the staff, not by outside consultants. Moreover, we learned that a single training program of 4-8 hours, while helpful, won’t have lasting impact unless it is followed by ongoing efforts to reinforce the lessons and the tools. The initial training is like a vaccination; the effect erodes if it isn’t followed by the appropriate boosters.
We have written about the application of conflict resolution techniques in healthcare and about the need for conflict engagement specialists to work with healthcare teams to improve patient care. We welcome your thoughts on this timely topic.
Holly Hayes is a mediator at Karl Bayer, Dispute Resolution Expert where she focuses on mediation of health care disputes. Holly holds a B.A. from Southern Methodist University and a Masters in Health Administration from Duke University. She can be reached at holly@karlbayer.com.
