Transcript Teaming Up with Patients, Families, and Community to Improve

Teaming Up with Patients,
Families, and Community to
Improve Health Care
Perry Dickinson, MD
Department of Family Medicine
University of Colorado Denver
Outline
• Transdisciplinary teamwork in the practice
– clinicians and staff members
• Patient- and family-centered care
• Community focus
• What do we know about teams?
Which Way Are We Headed?
Possibilities...
• The PCMH model, if fully realized, will
encourage and incent clinicians and practices
to team up with patients, families, and the
community to improve health
• Coordination of care, population management,
patient centered care all focus people in that
direction
• Dependent on payment, other structural
issues – but also very dependent on us
• Requires a cultural transformation
PCMH is a Team Sport
• No way for primary care clinicians to provide
everything their patients need by themselves
• Multiple levels of teamwork necessary:
– Clinicians and staff members
– Coordination with rest of health care system
– Patients – personalized care plans, selfmanagement, patient advisory groups
– Community partners
Teams in the Practice
• Multiple studies - using staff at higher level in
team approach increases patient, staff,
clinician satisfaction, quality and efficiency of
care
• Goal is everyone working at the top of their
license and skills
• Physicians are usually the biggest hurdle –
hesitant to delegate tasks
• Also cultural transformation for staff, patients
Working Together
Levels of Team Care
• Multidisciplinary – each discipline
independently contributes its expertise –
work in parallel
• Interdisciplinary – team members work
together closely, communicate frequently
to optimize care – each contributes skill
and expertise to support the team’ work
• Transdisciplinary – roles blur as functions
overlap, interchange
Who Is The Team?
• Within the practice – everyone – front office, MAs,
RNs, FNPs, PAs, physicians
• Sometimes within the practice (or at least wellcoordinated with the practice) – mental and
behavioral health, care managers, social
services, pharmacists, others….
• Patients and families are important team
members at all levels
• “Medical Neighborhood” – other professionals or
organizations that “share care” for your patients
• Community resources
Population Management
• Chronic Care Model and PCMH both
increase practice’s focus on populations of
patients instead of the individuals who
present for care
• Responsibility for health (and quality
indicators) of entire population of patients
signed up for care
• Increases awareness of importance of
community issues in determining health
Core Concepts of Patient- and
Family-Centered Care
• Respect and dignity – patient and family perspectives,
cultural norms, beliefs, and choices are listened to and
honored
• Information Sharing – receive timely, complete, and
accurate information
• Participation - in care and decision-making encouraged
and supported
• Collaboration - on a practice-wide basis in design of
delivery of care
• Feedback – from patients is regularly sought and
listened to
Patient Input
• Multiple ways to obtain patient input and
feedback for practice change and improvement
• Tremendous source of wisdom, ideas
• Patient and family advisors
– Advisory councils
– Involvement in practice improvement teams
• Takes time and patience (for both patients and
practice) to develop fully
• Patient experience survey as a quality measure
Self Management Support
• Providing patients with the information, tools,
and support they need to take care of health
problems in their daily lives
• Not patient education
• Personal health plans developed with patient
prioritization, goal setting, action plan,
monitoring
• Requires that we partner with the patient and
family in a different way
Community Engagement
• Many of the resources for selfmanagement support are in the
community
• Have to identify and partner with
community groups
• Should lead to assessment of strengths
and problems in the community
• Can lead to community-level advocacy
Teamwork Is Central to the
PCMH
• So what do we know about teamwork?
Crucial Elements of Teamwork
• Mutual respect and trust
• Willingness to abandon assumptions
• Understanding of the distinct roles of each
team member…
• But, a willingness to blur roles when
appropriate
• Flexibility
• Communication
• Relationships!
Effective Teams Need
•
•
•
•
•
•
•
Clear purpose - vision
Coordination, time to meet
Patience – it takes time to get there
Protocols and procedures
Conflict resolution skills (and willingness)
Active participation by everyone
Collective and individual accountability
Barriers to Teamwork
• Traditional hierarchical leadership
• Reluctance to question “the leader” or “the
expert”
• Cultural differences – “cognitive maps”
• Unwillingness to take on new roles
• Communication styles
• Lack of supportive organizational structure
• Exclusion of team members
Reality
Even if you are on the right track, you’ll get
run over if you just sit there
~ Will Rogers
Thank You!
• Contact Information:
– Perry Dickinson:
[email protected]