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?