Communications critical to developing clinical teams

"Team" is the latest buzzword in redesigning medical practice to provide more effective and more satisfying care. But what is a team?

"When you say 'team,' people think of all sorts of different things," said Bertha Safford, MD, one of a five-physician family practice in northwestern Washington that developed a team approach several years ago. "They don't think about important issues like motivating the office staff and keeping buy-in once the novelty value of a team approach has worn off. That's part of what they don't teach in medical school."

Another item missing from the medical school curriculum: Why medical practices need a team approach.

"When the office functions as a proactive team, they motivate patients to become active and informed participants in their own care," she said at the American Academy of Family Physicians Scientific Assembly in Chicago on Wednesday. "We want to change the whole construct of care. The goal is that everybody works to the absolute limit of their license. A nurse rooming patients is certainly not working up to her or his license!"

What can teams do? Regulatory restrictions are the only limit, Dr Safford said. She has issued general orders that empower front office staff to make appointments for mammograms and other routine procedures under specific circumstances.

Other orders put medical assistants (MA) in charge of tracking and administering immunizations. MA's routinely perform diabetic foot exams and other standard procedures, freeing the physician to devote more time and attention to areas that actually require physician-level training and experience.

Dr Safford explained that empowering the staff to take more responsibility and to make more decisions that impact the patient not only gives physicians more time to spend with patients, it boosts overall staff performance. In her practice, staff turnover has decreased, staff is more engaged, office morale has improved, and office processes and procedures have been streamlined.

"If we upset the hierarchy of the practice and we empower the staff, them we allow them to work to their maximum," Dr Safford said. "The practical effect is that when your practice operates as a team, patient satisfaction is higher and clinical outcomes are better."

But creating a team practice is easier said than done.

"You need to co-create a vision of what team practice can be," explained Organizational Development Specialist Cynthia Manning, MA, ABS, who helped coach Dr Safford and her practice through the multi-year team redesign.

"It starts with names. If a staffer calls you 'Doctor' during meetings and in the office when patients aren't around, and you call her 'Missy," there may be a barrier to consider. Creating a clear vision of where you want the practice to go starts with communication."

Every successful team transformation starts with a sponsor, Manning said. The sponsor does not have to be a physician, but it must be someone with the ability and authority to evaluate and reallocate resources.

Each team transformation also needs a team leader, who is someone other than the sponsor, she added. Since one of the goals of team practice is to expand staff roles, it makes sense to bring a nonphysician into a role with significant authority.

"You need a high degree of trust among team members," she said. "One of the biggest barriers to working together is people being afraid to give constructive feedback to each other. You have to find ways to bring up those elephants in the room."

One such "elephant" in any practice is the role physicians play. It has to change dramatically if team practice is to work well.

"The typical office culture doesn't allow anyone to say much of anything to the physician. It can be easy to forget that many staffers don't have the experience or the cultural training to speak their mind. We need to take extra steps to make the staff feel comfortable talking together and get them all involved and committed to change."