How do we get the many disparate members of our healthcare team together to provide better care in a patient-centered medical home?
Doctors (attendings and residents), nurse practitioners, nurses, medical assistants, phlebotomists, registrars, medical secretaries, social workers, community care organizers, pharmacists … the list goes on and on.
As it is right now, everyone is so busy trying to do their own job, to keep up with all of their paperwork, to click all their administrative boxes, to keep their supervisors happy, to keep the patients happy, to keep our customer satisfaction scores up, that no one really has the time or the support to even figure out how to act like a team.
Sometimes what it feels like we need to do is stop, slow down, take a deep breath, and really look at what it is we’re trying to accomplish here. Is what we are doing really in the best interest of our patients?
As Dr. Paul Batalden (one of the leading thinkers in healthcare improvement) has said, every system is perfectly designed to achieve exactly the results it gets. Clearly, what we are getting is not what we want. So we’d better design a different system.
First, we need buy in. Getting all the members of the potential team together, all at the same table, all convinced of the need to make these changes in the systems we use to take care of patients.
Perhaps the registrars at the front desk are not used to thinking about themselves as a member of a team. They see themselves as arriving in the morning for a job, punching a time clock, sitting at their computer station, answering phones, checking patients in, processing referrals.
Rewriting their job descriptions, re-tasking them so they feel ownership of the patients and the practice (and are appreciated and compensated as such) will be some of the difficult but necessary steps to take.
But we need more than lip service, more than simple platitudes or niceties to convince them that really engaging in the process of care is important, that they are an important part of the healthcare team.
Yet we do a poor job of integrating them into that team. And sometimes we don’t recognize that they (and many others) can make the lives of our patients better.
Recently a nearly blind, mildly demented, non-English speaking patient of mine was mailed a referral instructing her to set up an appointment on her own for neurocognitive evaluation. That is the way referrals are processed here. But the patient could not see or read the information on the paper, and could not have fathomed what to do with that information if she had been able to.
One of the registrars noticed on her return visit that she had not made the appointment, and gently, almost lovingly, guided her through the process right there at her desk. Maybe not the most efficient way, maybe not the way the system was set up for referrals, but it got the job done. And everyone felt better.
That registrar was a member of the team.
We need to help all the members of the team see these patients as their responsibility, their mission, and that their day-to-day job involves more than just the busy work and the administrative work. That it involves the actual caring, the taking care of the patients, helping them to achieve better health.
We are going to be breaking apart the traditional mold, recreating the roles of all those involved, to build a better team.
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.
