Nudging Physicians Toward Team-Based Care

This article appears in the November 2011 issue of HealthLeaders magazine.

Preparing for a shortage of medical talent to treat the expected influx of patients in coming years is difficult work. It’s made even more difficult by the traditional doctor-first attitude that imbues the healthcare workflow. That often means the physician is the bottleneck—all treatment decisions need to filter through him or her. Many systems are trying a myriad of ways to take some of the workaday functions off the physician’s plate, with the difficult task of providing a method of physician oversight of such functions.

Those tackling this set of problems often find physicians are apprehensive about loss of autonomy, income, and career stability. Meanwhile, other members of the care team continue to feel marginalized, as ingrained attitudes about hierarchies are hard
to change.

But there are successes; they tend to come from institutions that are not afraid to try new ideas to take on the challenge of creating better patient access, tracking, and delivery of care.

Many of the changes necessary to prepare for a different future focus first on the changing medical staff model, and the responsibilities of everyone—not just the doctors—who are expected to deliver on the organization’s strategic direction.

Reframing the conversations

Thomas Noren, MD, led a 2009 medical staff reorganization at Marquette (MI) General Health System’s main component, 225-staffed-bed, Level II trauma center Marquette General Hospital. This initiative created 20 team-based groups that bring together medical staff members of similar experience and expertise so that issues, visions, and problems can be deliberated by colleagues who share common interests.

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