Teamwork Excellence: An International Perspective Len Fromer, M.D., FAAFP

Teamwork and Excellence The combined action of a group of people, especially when effective and efficient. The quality of being outstanding or extremely good.

Potential Benefits of a Patient-Centric, Team-Based Approach Improve Quality of Patient Care Reduce ER Visits Leverage Community Resources Improve Patient Engagement & Provider Care Coordination Reduce Unnecessary or Redundant Testing Potentially Lower Direct and Indirect Costs Reduce Unnecessary Referrals Improve Patient Experience Reduce Inappropriate Medications and Medication Errors Manage “Transitions” In Care Reduce Unnecessary and Lengthy Hospitalizations Read from slide. Data indicate the team-based model benefits the patient and the practice. 593506.01

Netherlands Socio-technical systems theory Group dynamics Self-managing teams Double loop learning feedback Bitter et al, Team Performance Management, Vol 19, no 5/6, 2013, pp.263-278

Sweden Structured patient sorting system Process improvement Empowerment of professionals Team development Contextualized framework to support multiple concomitant QI processes Maun et al, BMC Family Practice, 2014, vol 15:189, 1471-2296

Spain Cross disciplinary teams involving every employee on empowered and well trained teams Define clear roles Focus on patients Formulate shared objectives Facilitate internal communications Tanco et al, TQM Journal, Vol 23, no. 6, 2011, pp. 598-610

China Professional framework for healthcare provider teams Framework categories: clinical competence, communication, ethics, humanism, excellence, accountability, altruism, integrity Provider teams: teamwork, self-management, health promotion, economic considerations Different team member ranked the categories in different order of importance Pan et al, Medical Teacher, 2013, 35, e1531-e1536

India Achieving high quality and cost effective teams via training of primary care teams to deliver evidence based outpatient care Training of the primary care teams to be done by hospital clinicians Enable primary care clinics to become centers of excellence Rao and Mont, White Paper, BMJ Online 2012; 344:e3151

Brazil Reorient patient education practices Emphasize professionals’ skills and work goals Evaluate educational interventions for team members Team strategies for health promotion and prevention, and control of chronic conditions Torres et al, BMC Public Health 2010, 10:583

Australia Teamwork Code of Conduct Understand your role in the team Advocate for clear delineation of roles and responsibilities Recognize that there is a team leader Effective internal communication Inform patients about the roles of each team member Medical Board of Australia, Code of Conduct for Doctors, enacted 2009

Canada Culture, leadership, and EMR functionality are more important than organizational composition of teams Interpersonal aspects of team override organizational elements in determining best practices Leadership is the key Howard et al, Can Fam Physician, 2011; 57:e185-91

The Population Health Model Population Health Management is the best way to provide better care for a larger group but patient engagement is key to it’s success. The secret sauce is how to do both- how to effectively manage populations yet when you get down to the individual patient level, provide that type of personal preference that allows that patient’s health to move forward. Therefore, we need population management plus patient engagement. Our goal is that all patients “enjoy greener pastures but cow number one can eat alfalfa and cow number two can eat snicker-doodles”.- President and Medical Director, Sharp Reese-Stealy 593506.01

The Integrated Team Caregivers Patient Pharmacists Physicians Specialists Hospitalists Nurses Therapists Behavioral Health Patient Physicians Wellness or Health Coaches Lab and Radiology Professionals Rehab Skilled Case Managers 593506.01

Transition Connector Community Team Collaborative Team Patient PCP Specialist Skilled Nursing Facility LTC Services Pharmacy Community Clinic Home Care GCM/CM Rehabilitation Hospice Community Resources Health Plan Medical Home Collaborative Team Patient Physician Pharmacist Nurse Social Worker Case Manager Allied Health Respiratory Therapist Dietitian Physical Therapist Educator WHO IS THE CONNECTOR? 593506.01

Transitioning The Continuum of Care with Bi-Directional Communication Home Care PCP/Medical Home LTC Motivational Interventions Adherence Advocate Community Health Center Assessment & Support Non-Adherence Behavior Health Change Coordination & Care Plan Medication Reconciliation Assessment Facilitation Care Plan Hospital Patient TOC CM Motivational Advocacy Adherence Prescription Health Promotion Health Plan Assessment & Support Specialist Assessment & Care Plan Increase Productivity Hospice Pharmacy Employer 593506.01

The Population Health Model Population Health Management is the best way to provide better care for a larger group but patient engagement is key to it’s success. The secret sauce is how to do both- how to effectively manage populations yet when you get down to the individual patient level, provide that type of personal preference that allows that patient’s health to move forward. Therefore, we need population management plus patient engagement. Our goal is that all patients “enjoy greener pastures but cow number one can eat alfalfa and cow number two can eat snicker-doodles”.- President and Medical Director, Sharp Reese-Stealy 593506.01

Task Grid Exercise

Collaboration for Improved Asthma Care: Assigning Roles with a Task Grid 593506.01

Sharing Team Responsibilities for Asthma Visits Task Who’s Role is it Now?* Who Might be able to do it? Training or Templates Needed? Next Steps for Role Transition? Check Registry for Wellness & Imm’s Schedule Pt Visit Vital Signs Individual written asthma tx plan Trigger testing and avoidance Spirometry/Peak Flow History/Physical Exam Med Reconciliation * Clerk, MA, Care Coordinator, RN, or Doctor?

Follow Up Exercise Map-Out Existing Roles & Responsibilities Explore Shared Team Responsibilities Plan How to Address Any Identified Special Healthcare Needs Goal: to Increase % of asthma patients receiving guidelines recommended care leading to control

Team-Based Care: Every Member Plays a Part Shared Responsibilities to Reach A Common Goal* Develop asthma action plan with patient Taught patient to monitor for and avoid triggers Checked medication adherence Updated patient portal Distributed educational tools Lifestyle education (diet/exercise) Outreach to patient after appointment MD  date Asthma Educator/ Nurse Office Staff Pharmacy *Sample Task List Implement face-to-face communication, e-mails, phone calls, and patient portals to streamline, to educate, to succeed

Sharing Team Responsibilities for Asthma Task Who’s Role is it Now?* Who Might be able to do it? Training or Templates Needed? Next Steps for Role Transition? * Clerk, MA, Care Coordinator, RN, or Doctor?