In a recent Vizient webcast about successful practice transformation in ambulatory care delivery, I was asked, “How does the patient know when they’ve experienced true team-based care?” It was a great question and, quite frankly, I had to think about it. I could provide a textbook definition, but could I accurately describe what it looks like to the patient?
Coincidentally, at the time of the webcast I was being treated for a fractured wrist. My injury required surgery, followed by physical therapy along with a host of other services. Looking down at my wrist I thought ‘I’ve got this’! I explained, “It feels complete when I (as a patient) am at the center of care, and all disciplines work in concert and at the top of their license for the best possible outcome.” If we compare it to an IndyCar race, the best outcome is winning the race.
Continuing with the race car analogy, traditionally the driver is the most recognizable figure on the team, similar to the doctor in a health care setting, but neither of them stands alone in success or failure. There’s also a pit crew, made up of top professionals within their areas of expertise, working as one unit to support the work of the driver to help them win. Each member of the pit crew has a specific role and they perform their work at the height of their training and ability. So, in reality, the driver cannot finish the race, much less win it, unless there is a coordinated, harmonious relationship with the pit crew.
Team-based care is also the best and most efficient way to deliver quality care to patients. Doctors, nurses and other health care providers working outside their scope or not at the top of their license causes inefficiencies at best and errors at its worst. Teams that are inefficient experience frustration which can be translated to the patient whether it’s overt or subtle. Patients don’t feel they are being cared for, they want to win the race but need the team. Patient safety can be the fallout.
After initial stabilization of my fracture in the emergency department, I was instructed to follow up with an orthopedic surgeon in his office. I groaned inwardly knowing I would have to start with scheduling, and hope the physician could see me in what I deemed a reasonable amount of time. I was prepared to tell my story to a multitude of people because I was pretty sure that no one on the team bothered to read my health record, much less work together in an efficient and patient-centered manner.
Little did I know I was about to the get the full experience of the doctor’s pit crew and experience team care at is finest. From scheduling and surgery to physical therapy and beyond, the entire health care pit crew worked together and at the top of their license to expedite my care, making me feel like I was part of a process that focused on my well-being.
Every patient deserves to receive the right care, at the right time, by the right person. Part of that care is also considering the psycho-social, environmental and dietary issues of the patient. Care must be moved from simply being episodic to holistic. This means using everyone within the health care team to address all the moving parts that make up a highly valued race car like the human body and mind. This is done by incorporating health coaches, educators, dieticians, nurses, clinical pharmacists and mental health specialists – to name a few – working in conjunction with the doctor or advanced practice provider to win the race.
While my experience should be the norm, it is most likely not. In my case, without each health care pit crew member working at top of his or her license and in communication with the doctor/driver, I would have been frustrated with my care and would not have achieved the outcome I did. Thanks to the team approach, I won the race.
So, how does the team approach to care feel? It feels seamless, empowering, enlightened and victorious. Just like being in the winner’s circle after the race.
About the author. As senior director for Transforming Clinical Practice Initiative (TCPI) advisory services at Vizient, Colleen Oldham leads a team of quality improvement advisors as they work with clinicians to prepare them for success in the value-based care payment landscape. She also serves on the Vizient TCPI leadership team, creating strategies to ensure delivery of TCPI’s programmatic objectives. Oldham possesses 25 years of experience as a registered nurse which serves as the foundation for her diverse clinical and operational leadership background. She has led both large-scale and growing community-based programs, fueled by a passion to meet the needs of the changing health care landscape.
Editor’s note: Tomas Villanueva, DO, MBA, FACPE, SFHM, associate vice president, clinical resources, TCPI, contributed to this blog.