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Dr. Tina Bettin DNP, MSN, RN, FNP-BC, APNP
OBJECTIVES Describe concepts related to team-based care & give
examples of the concepts in practice.
Discuss the impact of team-based care on quality outcomes.
Recognize ways to keep team-based care patient-centered
Apply this information to professional practice
“Team-based health care is the provision of health services to individuals, families, and/or their communities by at least two health providers 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.” Naylor MD, Coburn KD, Kurtzman ET, et al. Inter-professional team-based primary care for chronically ill adults: State of the Science. Unpublished white paper presented at the ABIM Foundation meeting to Advance Team-Based Care for the Chronically Ill in Ambulatory Settings. Philadelphia, PA; March 24-25, 2010.
THEDACARE’S PRINCIPLES Mission
ThedaCare’s mission is to improve the health of our communities.
Vision Our vision is to always set and deliver the highest standard of
health care performance in measurable and visible ways so our customers are confident they are making the right decision in choosing us.
Values Our values are the internal compasses that guide our day-to-
day decisions. They are the glue that holds the organization together.
NEW LONDON CALL GROUP
POPULATION SERVED Rural population
Portion is in a federal designated Health Professional Shortage Area (HPSA)
Providers serve as PCPs for 13,000 individuals
98% Caucasian
89% HS diploma ( than WI average)
16% Bachelor’s or higher ( than WI average)
POPULATION SERVED Median Income $48,000
19% Persons age 65 & older (WI average 14%)
11.2% families below poverty level
17% of children considered in poverty
42% children eligible for free/reduced lunch
27% of children in single parent homes
24% binge drinking
32% BMI above 30
THE BEGINNING Initially 1 MD & 1 NP in 1995
Culture was started—patient-focused; on-call & hospital responsibilities for NP
2000-2001 expanded; 3 MDs & 3 NPs (1 male); worked in teams of 2
2002 expanded; 5 MDs & 3 NPs
Interviewing included questions on team concepts, interactions with NPs & PAs; change concepts
CLINICAL TEAM MAKE UP Providers: 7 MDs, 6 APRNs & 3 PAs-all but 1 PCPs
Manager & 2 supervisors
Practice Associates
Patient Service Representatives
Triage (11 nurses; 5.8 FTEs)
Cell Leads
Disease Management (1 PT RN) Medical records, coding, laboratory & radiology
TEAMS New London Business Pod Team
NL, Manawa & Weyauwega
Teams within the team
Providers have 1-2 practice associates
Hallway placement or outlying clinic placement
2 providers per hallway with 3 practice associates 1 provider w/2 & 1 provider w/1
1 Cell lead per 2 hallways
Floating Patient Service Representatives (PSRs)
PERSONAL VALUES OF TEAM MEMBERS Honesty-transparency; critical to improvement &
maintaining mutual trust
Discipline-seeking & sharing new ideas
Creativity-excited to tackle new & emerging problems
Humility-recognize differences in training; individuals are human & will make mistakes
Curiosity-reflection; continuous improvement Mitchell P, Wynia M, Golden R, et al. Core principles & values of effective team-based health care. Discussion Paper, Institute of Medicine; October 2012. www.iom.edu
THEDACARE VALUES ThedaCare values are:
Focus on the customer – their needs are our top priority
Have a thirst for learning– continuously seek out ways to do our work better
Be courageous– challenge each other’s ideas to come up with the best thinking and solutions
Love your work– let your passion show every day
TEAM-BASED CARE CONCEPTS CONCEPT EXAMPLE
Shared goals work to establish shared
goals that reflect patient & family priorities.
Mission statement
ThedaCare’s mission is to improve the health of our communities.
“Lori” developed in 2010
Transparency of goals with staff
Goal directed problem list
Patient as part of LEAN team
Shared Goals-continued Across the board, just as they preach, ThedaCare is
patient-centered. Lori (the patient) is a word that's heard and seen all over the hospital. Lori is their patient and their true north. She has a face and a name and is a real person. On each floor, on each board there is a picture of Lori. Every project, mission, and objective actually connects back to Lori. Lori is why ThedaCare wants to build healthy communities
McGuinness D, More Evidence That ThedaCare Rocks. The Lean Post. October 9, 2013
TEAM-BASED CARE CONCEPTS CONCEPT EXAMPLE
Clear roles Clear expectations of team
members functions, responsibilities & accountabilities thereby optimizing team’s efficiency & take advantage of divisions of labor
All providers as paneled PCPs
Rooming standards for practice associates
All practice associates certified
MA schedule
Scheduling PSR
TEAM-BASED CARE CONCEPTS CONCEPT EXAMPLE
Mutual Trust Earn each other’s trust,
create a shared interest in teammates & their protection resulting in shared achievement
3 practice associates working as a team
Call rotation
Outlying clinics coverage for providers & staff
Community Health Assessment Team (CHAT)
Rural Health Initiative
Mental health
Obesity
TEAM-BASED CARE CONCEPTS CONCEPT EXAMPLE
Effective Communication Consistent channels for
transparent communication which are used by all team members
Daily huddles
Weekly provider meetings
Staff meetings
Leadership updates
Monthly CEO memos
Common calendars
Charter communications
TEAM-BASED CARE CONCEPTS CONCEPT EXAMPLE
Measurable Processes & Outcomes Implements feedback
mechanisms to track & improve performance/outcomes
Monthly provider updates on quality data
Tracking boards
Annual metrics—target set by Senior leadership
“True North” metrics
Wisconsin Collaborative for Healthcare Quality (WCHQ)
TEAM-BASED CARE CONCEPTS CONCEPT EXAMPLE
Adaptability Adjust strategies based on
environmental information & reallocation of resources
Altering course of team in response to changing conditions
Use of NP for hospitalist
Central Command
Providing care for patients in clinic when scheduled provider is in an urgent situation
LEAN
Changing reimbursement from production to quality
TEAM-BASED CARE CONCEPTS CONCEPT EXAMPLE
Backup Behavior
Ability to anticipate other’s needs
Ability to shift workload among members to achieve balance
Refill protocol-triage
Protime protocol-protime nurse
Strep & urine protocols
MDs & APCs seen as equals
Procedure set up book
“Secret sauce” for time off
Collegiality among providers
TEAM-BASED CARE CONCEPTS CONCEPT EXAMPLE
Team/collective Orientation Belief of team’s goals over
individual member’s goals
Health maintenance alerts addressed by all who contact patient
Patient treated like provider is PCP, even when not
Disease management RN
CHAT
Community service
Women’s Health Day
Mission of Hope
TEAM-BASED CARE CONCEPTS CONCEPT EXAMPLE
Mutual performance monitoring Ability to develop common
understandings of team environment & apply appropriate task strategies in order to accurately monitor teammate performance
PDPs for staff
Provider reviews
Twice yearly provider/employee surveys
Skills check off list
Models for providers
Interactive Employee Education data base & electronic data base for performance (Halogen)
TEAM-BASED CARE CONCEPTS CONCEPT EXAMPLE
Team Leadership Ability to direct & coordinate
activities of team members
Assess performance of team
Assign tasks
Motivate
Establish positive atmosphere
Lead projects—A-3; value streams; PDSA; SBAR
Monitor/track outcomes
Thank you cards
Challenges-w/in business pods and between pods
Volunteer opportunities
PATIENT OUTCOMES ThedaCare is repeat top performer in WCHQ
New London business pod is usually in the top 2 performers within system annually
September 2014-CMS reported Bellin-ThedaCare HealthCare Partners were ranked #1 out of the 23 Pioneer Affordable Care Organizations (ACOs); quality score 94.11; lowest cost; measured on 33 factors
TEAM SATISFACTION Overall very good
Bi-annual reviews over 3.0 on 4 point scale by both staff & providers
Sought after clinical rotation site for future providers and staff
Advancement of individuals w/in organization
Workload distributed
Staff turnover is 3%, less than state & national average
TEAM SATISFACTION Public recognition helps
ACO Pioneer-top performer
Top 100 Most Wired Healthcare Organizations for over 10 years
National Rural Health Association-TCMC-NL Top 20 CAH in country in area of financial stability x 2
VHA Sustainability Excellence Award –efforts to recycle single-use plastics
CHALLENGES Maintaining culture as clinic expands
Complacency—minimal; team challenges help; staff turnover <3% (less than state & national average)
Changing roles with ACA
Change itself
Payment still mostly production based
CELEBRATIONS Team challenges
Breakfast served by the providers
T-shirt days
Picnics
Team lunches/dinners
Celebration/Appreciation cards
ThedaCare Follies
Fall Fest for Families
COMMUNITY GARDENS
Questions?
REFERENCES
*American Hospital Association. Workforce roles in a redesigned primary care model. Executive summary. September 2011.
*Bendix J. Building a team-based medical practice. Medical Economics. September 10, 2013. http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/accountable (accessed on May 9, 2015)
*Bettin, T, Personal Experiences
*Gruman J, What does team-based care mean for patients? Center for Advancing Health. January 8, 2014. http://www.cfah.org/blog/2013/what-does-team-based care mean for patients (accessed May 9, 2015)
*Hupke C, Team-based care: Optimizing primary care for patients & providers. Safety first blog, IHI. http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx? (accessed May 8, 2015).
*Institute of Medicine (US); Olsen LA, Saunders RS, McGinnis JM, editors. Patients charting the course: Citizen engagement & the learning health system: Workshop summary. Washington DC: National Academies Press; 2011.
REFERENCES
*King H, Battles J, Baker D, Alonso A, Salas E, Webster J, Toomey L, & Salisbury M, TeamSTEPPS: Team strategies & tools to enhance performance & patient safety. http://www.ncbi.nlm.nih.gov/books/NBK43686/ (accessed May 9, 2015)
*McGuinness D, More Evidence That ThedaCare Rocks. The Lean Post. October 9, 2013.
*Mitchell P, Wynia M, Golden R, et al. Core principles & values of effective team-based health care. Discussion Paper, Institute of Medicine; October 2012. www.iom.edu
*Naylor MD, Coburn KD, Kurtzman ET, et al. Inter-professional team-based primary care for chronically ill adults: State of the Science. Unpublished white paper presented at the ABIM Foundation meeting to Advance Team-Based Care for the Chronically Ill in Ambulatory Settings. Philadelphia, PA; March 24-25, 2010.
*Patient-Centered Primary Care Collaborative. Team-based care: A critical element of primary care transformation. Population Health Management. February 2013.
REFERENCES
*Quinn T, Bringing a management model to healthcare: Team-based care. http://www.forbes.com/sites/groupthink/2014/12/09/bringing -a-management-model-to-healthcare (accessed May 9, 2015).
*Rodak S, 5 core principles of team-based healthcare. Becker’s Hospital Review. October 4, 2012. http://www.beckerhospitalreview.com/strategic-planning/5-core-principles-of-team-based-care (accessed May 8, 2015).
*Toussaint J, & Gerard R, On the mend. Cambridge, MA. Lean Enterprise Institute, 2010.
*Wynia MK, Von Kohom I, Mitchell PH. Challenges at the intersection of team-based & patient-centered healthcare. JAMA 2012; 308(13): 1327-8. (accessed May 8, 2015)
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