Having gotten all of the members of our team on board, how do we get them to actually get together?
We’ve all got busy days, all have lots of jobs to do, pulled in multiple different directions. The time needed to be thoughtful and really invest in the patient’s care is missing from our day. We need to make room for it, to get together, to really apply ourselves to the mission at hand — this incredible thing, this unique opportunity called today’s patient appointment?
But for any given patient, different members of the staff may have different goals in mind for the day, tasks that need to be accomplished for the patient. And the patients themselves have their own agenda that they are going to present to us. Wouldn’t it be nice if we could align some or all of these?
Enter pre-visit planning.
Planning ahead for each appointment before the patient walks in the door would allow us to get a handle on at least some of what the patient needs that day: missing healthcare maintenance, vaccinations, condition-specific testing. Information could be collected from the medical chart from prior visits, and data from specialists that the patient has seen in the interim could be gathered and reviewed as well.
Point-of-care testing could be pre-ordered, annual mammograms scheduled, expected blood tests set up in the lab, and other resources anticipated for the day such as nutrition visits, social worker appointments, care coordination, and patient education sessions could be penciled into the schedule, all in preparation for the patient’s arrival.
Getting all the members of the team together to focus on the patient, before they arrive, can also help us see the patients as real people, less like a body passing through the office, stopping at multiple stations along the way, working to get them out the door. The members of the team can share insights, bring things to each other’s attention that any one of us might have missed — the forest for the trees.
So how do we make this work? There have been multiple attempts to put huddles in place in practices, and we have all seen these come, linger, wither, and fail. Often the model focuses on work flow, inspirational messages from administration, and ongoing efforts to “stick to a script” so we can increase patient satisfaction scores.
I have no real interest in showing up at yet another meeting where we all say we should work together as a team to better care for our patients, as if remembering to always serve them with a smile will get us the highest scores on those after-visit surveys. We are not a fast-food restaurant, and just a smile will no longer cut it.
But I do believe we need to build a daily huddle that actually works to improve the care of our patients — one that focuses on efficiencies of scale, utilizing the data from our patient registries, information retrieval systems, and dashboards, and the dedicated work of the care coordinators and other members of the team doing preparatory work.
In this way, the time invested in the huddle will make the day work better, leaving more time for every member of the team to get done what really matters for the patients. Once again, practicing up to our licenses.
Think of it like this: at the beginning of a day — a practice session, if you will — everyone comes to the huddle. The front desk staff, registrars, medical assistants, nurse practitioners, residents, attendings, nurses, physician assistants, care coordinators, social workers: all the members of the team.
No one runs the huddle, and everyone runs the huddle. It is the place where we can go through the entire schedule of the day, talking about lessons learned from yesterday, and setting up for the day ahead. Information will be retrieved live from our patient registries for management of chronic disease conditions, healthcare maintenance, and acute-care protocols, based on patients’ known medical conditions and the reasons for their appointment that day.
Everyone gets to put their two cents in, filling in the gaps (we all know they are there) from each of our separate task lists, coming together to fill these holes, to provide a more cohesive and comprehensive healthcare visit, and hopefully to provide that quality of care we and our patients are looking for.
Isn’t this better than the system we have now, where all of us are always playing catch-up?
An effective and efficient huddle that gets something done has the potential to truly change the way we care for patients and can undoubtedly make the experience a better one for all involved.
And maybe it will even boost our patient satisfaction scores.
Fred N. Pelzman is associate professor of medicine, New York Presbyterian Hospital and associate director, Weill Cornell Internal Medicine Associates, New York City, NY. He blogs at Building the Patient-Centered Medical Home.
