Improving Chronic Illness Care
Improving Chronic Illness Care

Two: Teams

“Patients reap the benefits of more eyes and ears, the insights of different bodies of knowledge, and a wider range of skills. Thus team care has generally been embraced by most as a criterion for high quality care.”
- Ed Wagner, BMJ, February 2000

The health care team needs to organize itself to deliver effective clinical care and to continuously monitor and improve quality of care. Understanding how your team operates to meet both these needs is critical to improving patient outcomes. The team is more than the clinical staff; non-clinical staff can play an important role. From the two-person office to the ten-person multi-specialty group, collaborative team functioning needs to be a priority to be better prepared for patient care. A prepared team is critical to fostering productive interactions between patients and the care team.

In the article, “Putting Population-Based Care Into Practice: Real Option or Rhetoric?” Stephen Taplin and colleagues say that the mere existence of a core group, working together in a clinic for a number of years, does not automatically ensure nor indicate that the group functions as a team.  To do so, the team must establish and share a common vision and learn to problem-solve by communicating in ways that maximize the strengths of each member.  This effort requires strong leadership and encouragement.  Team members should be assigned roles that are in sync with individual areas of strength or interest. 
 
Team Roles
Some essential team roles include: meeting organization; long-term strategizing; maintaining a shared vision; and strong cheerleading to keep the team focused on its mission and goals in the face of inevitable resistance to change.

Tom Bodenheimer, MD, notes in his conversations with California physicians that many of them worry that their staff cannot perform both the clinical and self-management support functions necessary to effective patient care.  Consequently, the physician takes on all roles and responsibilities.  This is not a sustainable strategy as the burden of chronic illness increases. 

Bodenheimer emphasizes the need to delegate work to all staff, clinical and non-clinical. Non-physician staff are more likely to adhere to protocols than physicians, and so should be employed to do more of those care processes.  For example, nursing staff can conduct simple screenings.  Chart preparation and information gathering for the visit can be delegated to office staff, and medical assistants can conduct clinical and behavioral assessments to prepare for clinical review.  Broadening staff roles and creating a more cohesive care team reinforces the concept of team-based care, and thereby increases both patient and team satisfaction.  

Finally, Taplin, et al, suggest looking beyond providers for prospective team members. Certain skills have been shown to be helpful to team functioning, and should be considered when choosing team members.  For example:  Is this person a team player, an excellent listener, a good communicator, and a problem solver?  Is this person creative, innovative and/or enthusiastic?  Finally, choose people who see the need for improvement and who want to participate in and support the process. 
 
Additional Team Members
Round out your team with staff members from the clinic or from administrative branches who can be helpful toward achieving your aims. Possibilities include front office staff, case manager, health educator, medical assistant, pharmacist, and information system staff.

Characteristics of High Functioning Teams
Steven Shortell, MD conducted an analysis of practices participating in learning collaboratives. He found that high performing teams had similar chararcteristics. Some of the common threads include:
  • all members have clear roles and feel committed to patient care;
  • team members' strengths are utilized across a variety of skills;
  • team leadership is motivating versus top-down;
  • professional siloes are broken down.

For more about high functioning teams, read the Shortell article and related editorial response: