How to Use Team-Based Care to Improve the Patient Experience

What drives the need for team-based care?

Team-based care has become a popular healthcare goal in the wake of the industry’s transition to value-based care models. Given the cost-cutting and outcomes-based goals in many value-based care models, industry experts assert that teamwork between various providers is essential.

The focus on patients with chronic illness or other complex health needs has also given rise to the idea of team-based care. These patients see a number of providers, including primary care physicians, specialists, pharmacists, and the litany of nurses and physician assistants who may be practicing in those facilities.

Teamwork between these entities increases the quality of healthcare, reduces repetitious tests, and addresses incongruities in care, which can ultimately lead to better health outcomes.

Team-based care may also be a potential tool for reducing physician burnout, an industry-wide epidemic that impacts 83 percent of hospitals.

As providers face more administrative duties – in part because of the shift to value-based care – they must lean on their care team members to deliver patient care and to code key elements, according to Tarek Elsawy, MD, FACP, the president and CEO of Reliant Medical Group.

“We’re telling providers to code stuff they don’t really understand,” Elsawy said at Xtelligent Healthcare Media’s second annual Value-Based Care Summit in 2017. “Make sure you capture risk scores. Make sure you check all the boxes for meaningful use. Make sure you do all this stuff for your local hospital and physician group measures. Have a great day. By the way, try to do a good job taking care of patients.”

“The more non-value-adding work you ask providers to do, the more and more they become disengaged,” he added.

Team-based care can spread this burden. Between granting medical assistants more coding responsibility to leaning on advance practice practitioners to deliver certain elements of care, teams can ensure quality patient care while also easing the burden off of clinicians.

How to implement team-based care

Carrying out team-based care will require a considerable culture shift at most healthcare organizations. Successful team-based care approaches promote equality between different team-members, strong written and verbal communication, and patient-centeredness. Meeting those ends is no easy feat, especially in a traditionally paternalistic healthcare industry that has long fostered power hierarchies.

Organizations must begin by defining the roles of different care team members, ensuring that each individual feels valued and as though she is using her skills at the highest capacity. In recognizing the unique perspectives that each clinician brings to the table, organizational leaders can begin to address power hierarchies and foster a more egalitarian team environment.

Organization leaders should also create processes for sharing both written and verbal information about the patient, ensuring that each care team member has all of the data needed to make informed care decisions.

Finally, organization leaders should define the identity of the care team and emphasize that identity with patients. This will ensure the patient knows she is being treated by a team.

“Within high functioning, patient-centered team-based care models, patients have a multifaceted relationship with the team as a whole,” according to researchers from the Agency for Healthcare Research and Quality (AHRQ). “In this model, patients feel known and cared for by the whole team over time. Developing the identity of the provider team, so that the team looks and feels like a coherent entity to patients, is an important stepping stone for building smooth and continuous team relationships with patients.”

Care team members can accomplish this by being explicit about all of the teamwork taking place and explaining the specific roles of different team members.

As noted above, meeting these ends requires a significant culture change at most healthcare organizations. At Reliant Medical Group, clinical leaders implemented team-based care by creating shared working spaces that enabled and emphasized teamwork.

“What really makes team-based care work is the concept of co-location,” Elsawy explained. “When you’re collocated, the level of isolation goes way down. People love when you can walk down the hallway and ask the infectious disease expert who knows about this, or a dietitian who really knows about that.”

Clinician leaders should also note the role patients and their family caregivers play as members of the care team. Using shared decision-making and patient education, clinicians can integrate patients into treatment decisions. This will tap the patient as the expert on her own care and lifestyle preferences that must be considered before ordering certain therapies.

How does team-based care impact the patient experience?

Team-based care not only rewires how clinicians work together. It also changes the way the patient experiences care, and usually in a good way.

For one, patients who think their care team works well together tend to report better experiences and feel safer, research has shown. Experts from patient experience and healthcare consultant Press Ganey revealed that patients perceive their care as higher quality when they perceive their providers as all working well together.

That trend has played out in practice, as well. At Reliant Medical Group, 90 percent of patients ranked their experiences as very good following implementation of team-based colocation, compared to only 81 percent who said the same prior to the team-based care push.

What’s more, team-based care has yielded positive care outcomes, which is also good news for the patient. At Reliant, colocation resulted in better quality care scores and better blood pressure control for patients.

Some evidence indicates that team-based care makes providers happier or less stressed, which in turn can result in better relationships with patients and potentially lower rates of physician burnout. Although evidence is currently limited, researchers at NAM say team-based care may be one key solution to physician burnout.

“The existing evidence demonstrates a generally positive association between team-based care and clinician well-being,” the NAM researchers wrote.

Reducing physician burnout can improve the quality of care patients receive because their physicians will be less tired, more attuned to patient needs, and able to create better relationships with patients.

However, some industry experts may maintain that team-based care is more trouble than it’s worth, stating that it creates more work for physicians who must overlook the team. Leaning on advance practice practitioners, for example, will require a physician to sign off on certain treatment plans.

This conflict suggests a need for judicious team-based care, the NAM authors said, emphasizing shared goals between team members, mutual trust, clear roles, effective communication, and measurable processes and outcomes as core pillars.

As the healthcare industry continues to embrace value-based care, it will be essential for organizations to restructure to meet care goals. No longer can individual clinicians go it alone. They must form relationships with their peers and establish strong, team-based care. In doing so, providers can support better clinical outcomes while supporting an overall better patient experience.