High-functioning team-based health care models have the ability to change the healthcare landscape, particularly with regard to clinician well-being, according to a report published by the National Academy of Medicine.1

Researchers from a number of physician groups studied the concept of team-based health care, assessing what factors create a successful team, defining team-based health care, and examining successful existing models of effective team-based care.

Cynthia D. Smith, MD, FACP, vice president of clinical programs at the American College of Physicians, and colleagues from the National Academy of Medicine, the American Medical Association, and the American College of Surgeons, among others, identified 4 key characteristics that lead to successful research: (1) a clear and compelling purpose or goal, (2) an enabling social structure that facilitates teamwork, (3) a supportive organizational context, and (4) expert teamwork coaching.

The investigators defined team-based care as “…the promotion of health services to individuals, families, and/or their communities by at least 2 health [professionals] who work collaboratively with patients and their caregivers — to the extent preferred by each patient — to accomplish shared goals within and across settings to achieve coordinated, high quality care.” Dr Smith and colleagues noted that there is “growing recognition” of the importance of team-based health care.

Successful implementation of team-based health care has positive widespread effects, not only on patients but on the clinicians providing care. Although further research is needed to fully understand the effects of team-based care on clinician well-being, multiple studies have identified connections between “measures of high quality teamwork and measures of clinician well-being and resilience.”2-7 For example, a longitudinal study of interprofessional teams working in intensive care settings concluded that “addressing clinician emotional exhaustion is an important prerequisite to effective team-based care and patient safety.”2

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Dr Smith and colleagues caution, however, that “it is important to note that optimizing team-based care is by no means a panacea and may require a baseline level of clinician well-being and a positive team culture to be most effective.”1

The researchers identified 5 barriers to effective teamwork, and suggested possible solutions.

  • Barrier: Regulatory barriers, requirements and legal implications for personnel, and state variations in licensure
    • Solution: State-level advocacy to better align licensing and regulation of clinicians with concepts and standards of team-based care.
  • Barrier: Lack of uniform educational requirements and standards of care
    • Solution: Collaboration with education and organizational experts to prioritize training, continuing education, and the development of best practices.
  • Barrier: Payment systems are not designed to offset costs associated with forming and sustaining clinical teams
    • Solution: Advocate for changes in the payment system to align incentives with team-based care.
  • Barrier: CMS regulations and documentation guidelines do not allow all team members to meaningfully participate
    • Solution: Work with CMS to modernize documentation guidelines.
  • Barrier: Lack of support for clinical teams from outdated workflows and electronic health record (EHR) structure
    • Solution: Re-imagine EHR operability and workflows based on successful team-based care models.

“Team-based care…presents a unique opportunity to achieve key aims of a high-quality health system,” the researchers concluded. “Successful teams have the capacity to improve patient outcomes, the efficiency of care, and the satisfaction and well-being of health care clinicians.”

References

  1. Smith CD, Balabat C, Corbridge S, et al. Implementing optimal team-based care to reduce clinician burnout [published online September 17, 2018]. Nat Acad Med. doi:10.31478/201809c
  2. Welp A, Manser T. Integrating teamwork, clinician occupational well-being, and patient safety — development of a conceptual framework based on a systematic review. BMC Health Serv Res. 2016;16:281.
  3. Dehn RW, Brock DM, Keller AO, Hooker RS, Mittman D. Commentaries on health services research. J Am Acad Phys Asst. 2015;28(6). doi:10.1097/01.JAA.0000465232.59384.6f
  4. Willard-Grace R, Hessler D, Rogers E, Dube K, Bodenheimer T, Grumbach K. Team structure and culture are associated with lower burnout in primary care. J Am Board Fam Med. 2014;27(2):229-238.
  5. Day AL, Sibley A, Scott N, Tallon JM, Ackroyd-Stolarz S. Workplace risks and stressors as predictors of burnout: the moderating impact of job control and team efficacy. Canadian J Admin Sci. 2009;26(1):7-22
  6. So TTC, West  MA, Dawson JF. Team-based working and employee well-being: a cross-culutral comparison of United Kingdom and Hong Kong health services. Eur J Work Organizational Psych. 2011;3:305-325.
  7. Stout S, Zallman L, Arsenault L, Sayah A, Hacker K. Developing high-functioning teams: factors associated with operating as a “real team” and implications for patient-centered medical home development. Inquiry. 2017;54:46958017707296.