How to Expand Team-Based Care

Coordinate Expertise for Better Outcomes

No single physician can be an expert in all aspects of care, especially when patients have complex health conditions.

Complex care is common. A typical primary care doctor coordinates with 229 other physicians.[1] Patients on Medicare visit at least two primary care doctors and five specialists every year.[2]

In the hospital, patients often have more than one condition. Many illnesses involve more than one body part. An example is amyotrophic lateral sclerosis (ALS), a neuromuscular condition that affects the ability to move. Patients reach the point they cannot walk, speak, swallow, or breathe. A neurologist is usually the primary physician. Neurologists are experts on the brain but not physical therapy exercises, speech, swallowing, or the lungs. This type of complexity applies to many conditions.

Hospitals can overcome this problem by assembling the right team and facilitating communication.

Benefits of Team-Based Care

Research shows patient satisfaction improves significantly when a multidisciplinary team gives care.[3]

And satisfaction is not the only benefit. Team-based care models save money. They lower readmissions, improve outcomes, and increase efficiency.[4],[5] They can also reduce physician burnout because many share the mental load.[6]

How to Launch a Team-Care Model

All it takes to launch a team is members of 2 professions working together,[7] but consider aiming for more. Comprehensive models have a stronger impact on satisfaction scores.[3]

Teams can include:

• Physicians from different specialties

• Nurse practitioners

• Physician assistants

• Pharmacists

• Nurses

• Medical assistants

• Therapists (physical, occupational, speech, and respiratory)

• Social workers and care coordinators

• Behavioral health professionals and spiritual care providers

Steps to Expand Team Care Beyond Multidisciplinary Rounds

Bringing all team members together for daily rounds is a great start. If you want to take team-based care beyond a single activity like rounds, follow these steps:

1. Get buy-in. Financial and cultural support from leadership at all levels is critical to success.

2. Create a change team.[8] Assemble clinical representatives and leaders to spearhead action steps.

3. Define goals and identify opportunities. Ask what the team will accomplish. Where are team members already working together? Where could they expand collaboration?

4. Design the team. Who will be on the team? Who will lead it? How will the team work together?

1. Consider a primary team and an extended team. The primary team is closest to the patient's daily care. It may include the primary provider, nurse, and medical assistant. The extended team includes specialists and therapists who see the patient less often but should be available for questions.

2. Evaluate your physical layout. Can the primary team members work in the same location to maximize communication and efficiency?

3. Investigate communication systems. How will the team communicate? How often will they meet?

5. Start small. Launch your new care model with a pilot team to allow you to work out issues on a small scale.

6. Track outcomes. Measurable outcomes let you know if the team is accomplishing its goals or if you need to adjust.[7]

Clarity is Crucial.

Teams can get complex. In the intensive care unit, you may have an intensivist managing IV medication to raise blood pressure and a surgeon managing wounds and blood transfusions. If the kidneys get involved, a nephrologist has the final say on fluids, electrolytes, and certain medications.

Get clear. Have a system so nursing staff knows who to notify for problems and when.

Taking Full Advantage of the Knowledge in the Room

With a high-functioning multidisciplinary team, patients have access to many experts. Multidisciplinary rounds and care conference meetings are great opportunities to ask questions. Encouraging patient participation in the team also improves outcomes.[8]

To take full advantage, have patients take notes and write down questions throughout the day. Use rounds as a time to answer them and to teach. With team care, this might happen naturally. Studies show doctors working in multidisciplinary models are more likely to teach patients regularly.[9]

Providing reliable educational materials is especially helpful if patients forget questions. No matter how many questions the team covers during rounds, more will pop up. Augment bedside teaching with accurate printed materials patients can reference later.

References:

[1] Pham HH, O’Malley AS, Bach PB, Saiontz-Martinez C, Schrag D. Primary care physicians’ links to other physicians through Medicare patients: the scope of care coordination. Ann Intern Med. 2009;150(4):236-242. doi:10.7326/0003-4819-150-4-200902170-00004

[2] Bodenheimer T. Coordinating care--a perilous journey through the health care system. N Engl J Med. 2008;358(10):1064-1071. doi:10.1056/NEJMhpr0706165

[3] Will KK, Johnson ML, Lamb G. Team-based care and patient satisfaction in the hospital setting: A systematic review. J Patient Cent Res Rev. 2019;6(2):158-171. doi:10.17294/2330-0698.1695

[4] Brindis R, Rodgers GP, Handberg EM. President’s page: team-based care: a solution for our health care delivery challenges. J Am Coll Cardiol. 2011;57(9):1123-1125. doi:10.1016/j.jacc.2011.02.003

[5] Team-Based Care Can Add Value, Improve Outcomes in Pandemic Response. American Hospital Association. Accessed September 16, 2023. https://www.aha.org/aha-center-health-innovation-market-scan/2020-10-27-team-based-care-can-add-value-improve-outcomes

[6] Smith CD, American College of Physicians, Balatbat C, et al. Implementing optimal team-based care to reduce clinician burnout. NAM Perspect. 2018;8(9). doi:10.31478/201809c

[7] Mitchell P, Wynia M, Golden R, et al. Core principles & values of effective team-based health care. Washington, DC: Institute of Medicine; [Accessed September 13, 2021]. Published October 2012. https://nam.edu/wp-content/uploads/2015/06/VSRT-Team-Based-Care-Principles-Values.pdf. [Google Scholar]

[8] Sinsky C, Rajcevich E. Team-Based Care: Improve Patient Care and Team Engagement Through Collaboration and Streamlined Processes. AMA STEPS Forward. October 7, 2015. Accessed September 15, 2023. https://edhub.ama-assn.org/steps-forward/module/2702513

[9] Brindis R, Rodgers GP, Handberg EM. President’s page: team-based care: a solution for our health care delivery challenges. J Am Coll Cardiol. 2011;57(9):1123-1125. doi:10.1016/j.jacc.2011.02.003