Creating Effective Practice Teams
Creating Effective Practice Teams
Nancy Jaeckels
Institute for Clinical Systems Improvement
January 28, 2010
Nancy Jaeckels
Institute for Clinical Systems Improvement
January 28, 2010© 2010 Institute for Clinical Systems Improvement
Collaborative Care ModelCollaborative Care Model
Collaborative care starts with a team focus To meet health care home criteria, a
successful team and a culture that supports team approach is needed
The question isn’t if teams have value but whether we acknowledge the fact and become better team players
Collaborative care starts with a team focus To meet health care home criteria, a
successful team and a culture that supports team approach is needed
The question isn’t if teams have value but whether we acknowledge the fact and become better team players
General team characteristics/definition
General team characteristics/definition
Two or more individuals Have individual purpose, specific role, specific
tasks and knowledge and skills but…. Consist of interdependency Identify themselves as a team Differ from a small group in that teams take
collective action towards a common goal that can only be reached through task interdependency
Two or more individuals Have individual purpose, specific role, specific
tasks and knowledge and skills but…. Consist of interdependency Identify themselves as a team Differ from a small group in that teams take
collective action towards a common goal that can only be reached through task interdependency
Who’s on the team?Who’s on the team?
Everyone who touches the process is a member of the team
Receptionist Medical assistants/nurses Providers Lab/x-ray Care manager others
Everyone who touches the process is a member of the team
Receptionist Medical assistants/nurses Providers Lab/x-ray Care manager others
Integration of culture and good team characteristics
Integration of culture and good team characteristics
Goal is more important than the role– Need shared vision at the team level – New attitudes
Leadership Need right people in the right role - redefined
roles Good communication techniques Standardized care New structures/processes
Goal is more important than the role– Need shared vision at the team level – New attitudes
Leadership Need right people in the right role - redefined
roles Good communication techniques Standardized care New structures/processes
Leadership and culture to support
Leadership and culture to support
Leadership needs to set the culture and the “new attitudes” towards team-based care
Leadership also sets the vision and reinforces the common goal the team is working towards– Is your leadership bought in and understanding health
care home concepts?
– Are they involved in the meetings that set a vision and goals for this work so they can talk that talk?
Leadership needs to set the culture and the “new attitudes” towards team-based care
Leadership also sets the vision and reinforces the common goal the team is working towards– Is your leadership bought in and understanding health
care home concepts?
– Are they involved in the meetings that set a vision and goals for this work so they can talk that talk?
Right people in the right roleRight people in the right role
Collaborative care teams need to have the right people in the right role
Don’t force people into work they don’t want to do
Be specific and clear on roles and expectations Find your catalyst and use people’s strengths to
give you the best team
Collaborative care teams need to have the right people in the right role
Don’t force people into work they don’t want to do
Be specific and clear on roles and expectations Find your catalyst and use people’s strengths to
give you the best team
Redefining rolesRedefining roles
Redefine as needed in the redesigned work flows (use care team analysis worksheet)
Use team members to highest skill Use team members to fullest licensure Cross train and have contingency plans for
team member absence Identify change champions and use them
Redefine as needed in the redesigned work flows (use care team analysis worksheet)
Use team members to highest skill Use team members to fullest licensure Cross train and have contingency plans for
team member absence Identify change champions and use them
Building an effective team through measurement and
communication
Building an effective team through measurement and
communication Need to define goals as a team Report on progress along the way Share data Need communication plan
– Bulletin boards– Team huddles– Multi-messaging media
Lack of communication results in “stories”
Need to define goals as a team Report on progress along the way Share data Need communication plan
– Bulletin boards– Team huddles– Multi-messaging media
Lack of communication results in “stories”
Building an effective team through measurement and
communication
Building an effective team through measurement and
communication Communicate as a team as well as the larger
staff/office– Scheduled time to close the office and update and
involve all staff This shows commitment, value, and engagement by
leadership
– Team huddles - daily Short term issues Quick trouble-shooting Plan for the day or tweaks needed Feedback on how it is going
Communicate as a team as well as the larger staff/office– Scheduled time to close the office and update and
involve all staff This shows commitment, value, and engagement by
leadership
– Team huddles - daily Short term issues Quick trouble-shooting Plan for the day or tweaks needed Feedback on how it is going
Don’t forget the patientsDon’t forget the patients
Involve the patients in your health care home
Communication 2-ways– Sharing of information in patient friendly form– Asking for and receiving information
Engagement– Self-management support– Relationship/care management/contacts at
home and office
Involve the patients in your health care home
Communication 2-ways– Sharing of information in patient friendly form– Asking for and receiving information
Engagement– Self-management support– Relationship/care management/contacts at
home and office
StandardizationStandardization
“….it would take a primary care doctor 18 hours per day to provide all the recommended preventive and chronic care services to a typical patient panel. As a result, only half of the evidence based medical care is provided.”
- Bodenheimer, T.
“….it would take a primary care doctor 18 hours per day to provide all the recommended preventive and chronic care services to a typical patient panel. As a result, only half of the evidence based medical care is provided.”
- Bodenheimer, T.
New standardized work flow processes
New standardized work flow processes
Efficiency– LEAN principles
Create work flows as a team - and walk through them as if you were a patient
Utilization of resources Cross training and role definition Quality improvement model - using PDSA (plan,
do, study, act) to make process changes
Efficiency– LEAN principles
Create work flows as a team - and walk through them as if you were a patient
Utilization of resources Cross training and role definition Quality improvement model - using PDSA (plan,
do, study, act) to make process changes
Work flows/new processesWork flows/new processes
Flow through from patient’s perspective Identify each key touch point Who does what at each of those points
Scheduling, check in, pre-visit prep, visit, care management, check out, post-visit follow-up, billing, phone triage, etc.
Flow through from patient’s perspective Identify each key touch point Who does what at each of those points
Scheduling, check in, pre-visit prep, visit, care management, check out, post-visit follow-up, billing, phone triage, etc.
All of us are smarter than any one of us
All of us are smarter than any one of us
Challenges and approachesChallenges and approaches
Lack of buy-in– Identify and use your champions (early adopters)– Leave the laggards alone for now– Maintain the leadership commitment and involvement
Change fatigue– Take breaks– Frequent check-ins on how everyone is doing– Plan incentives and small goals that are easier to
achieve
Lack of buy-in– Identify and use your champions (early adopters)– Leave the laggards alone for now– Maintain the leadership commitment and involvement
Change fatigue– Take breaks– Frequent check-ins on how everyone is doing– Plan incentives and small goals that are easier to
achieve
Steps to do:Steps to do:
Get leadership committed and involved Identify your team and begin communication Create work flows as a team Define team roles specific to the work flow Create a specific communication plan (I.e., daily
team huddles at what time) Cross train and do PDSA quality training as
needed
Get leadership committed and involved Identify your team and begin communication Create work flows as a team Define team roles specific to the work flow Create a specific communication plan (I.e., daily
team huddles at what time) Cross train and do PDSA quality training as
needed
Questions?Questions?