by Dr. Suzanne Berman

Too Much to Do, Too Little Time: Is Team-Based Care the Answer?

As pediatricians, it seems like every day someone is asking us to take on additional work to transform our practices into  Patient Centered Medical Homes (PCMH), meet payer quality and cost metrics, screen for and address mental and behavioral health issues, review 13-page reports from emergency department visits – to name just a few. The fact is it’s impossible to do all of this work AND maintain the joy of caring for children, spend any reasonable amount of time with our family/friends, and take care of ourselves. In response, do we accept the status quo and find a way to leave clinical medicine or retire early? Personally, I think there is another solution: team-based care.

Thriving, innovative practices – where pediatricians and staff come to work energized – have found a way to implement team-based care in a way that empowers everyone and spreads meaningful (and seemingly meaningless) work around. To make this happen, pediatricians must shift their management style from controlling to overseeing, create and empower a great team, and keep the patient and family at the center of it all.

Giving Up Some Control

By nature many physicians are perfectionists and, as such, we believe we must do everything ourselves. This is completely possible if you are only seeing 10 patients per day. However, most of us can’t earn a living or meet our community’s needs at that volume. So, if we are going to be efficient and effective, we have to give up some control. That doesn’t mean abdicating all responsibility, as continued oversight is needed to ensure appropriate care. However, it does mean identifying the appropriate person or people in the practice who can take some of the work off of your plate. In instances where the work can be automated, an investment in technology may be warranted.

Ask yourself these questions: Is administering vaccines yourself the best use of your time or can you hire someone to do this so you can see two extra patients per day? Is it worthwhile answering all of your own portal messages or can nursing staff do that for you? Can you teach existing staff to be scribes or care coordinators or a combination of both? Should you create a smaller care team of one to two providers and a few clinical staff members to work together on a panel of patients? Are you the best person to painstakingly work with patients who struggle with chronic constipation/encopresis or do you have a really empathic team member who can do frequent check-ins with these families and adjust treatment plans according to your practice treatment algorithm (and get paid using chronic care management codes)?

Empowering the Team

Once you have assembled a great team, empower them to solve problems and serve the patients. If you keep the family as the focus and create a culture of meeting patients’ needs, team members are more likely to act on their own and feel good about what they have done. For example, suppose your care team is aware that a mother is undergoing chemotherapy and is at risk for infection. Since your team feels empowered to do what’s best for the family, they decide to schedule the child’s appointment 10 minutes before your office officially opens so that mom’s exposure to germs is lessened. While the family is there, a team member notices that none of the children in the family have had their flu vaccines, so they administer flu shots to the family. They also proactively identify and schedule all of the siblings’ well visits.

Expanding Clinical Staff’s Responsibilities

Today, we have more information on patients than we might have ever thought possible, enabling us to provide better care to our patients. This also means that you are likely having to sort through piles of information (e.g., printed charts from a new patient’s previous pediatrician that are 100+ pages long, faxes and written duplicate reports from urgent care facilities, emergency departments, and specialists). Train your clinical staff to do data entry and data reconciliation in the EHR, setting clear guidelines so they know what they can and can’t do within the system. In addition, ask them to follow-up with parents to make sure the family understood your instructions. By expanding the clinical staff’s responsibilities beyond simply taking temperatures and recording chief complaints, they become more important to the care of the patient and family. This is a win-win for everyone. The family feels cared for, the staff gets personal satisfaction from helping, and you have a few less items on your plate to worry about.

Embracing the Family and Others as Part of the Team

Keeping the family at the center of a care team also means realizing the family is part of the team. Use your patient portal to engage families in their child’s care. Encourage parents to regularly communicate with your clinical team via the portal for follow-up/outcome statuses, to ask questions, and to close any care gaps. Plus, have parents complete pre-visit surveys so they can identify the concerns they would like to address during the visit.

Forward-thinking practices also realize that there may be expertise missing from the current team. Would your patients benefit from a lactation consultant, an asthma educator, a dietician or a psychologist? Should you find a way to incorporate these individuals into your office team or can the patient’s care team extend to other community-based resources and your care coordinator facilitate the shared care?

Cheering on the Team

Take a purposeful look at your office team, and make a commitment to provide a Superbowl quality lineup for your patients. It’s important to remember that you are the team’s leader, but you don’t have to play every position or even play all four quarters. Sometimes supervising from the sidelines and cheering on the team members can be more effective and just as rewarding.