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Nudging Physicians Toward Team-Based Care

Philip Betbeze, for HealthLeaders Media, December 8, 2011

Noren, who serves as chief medical officer, says Marquette General’s traditional department structure—which consisted of medical, surgical, and others—needed to change.

“There was not much accomplished in those meetings in the past,” he says. “We concluded that had to do with the disparity of interests. The department of surgery has lots of different worlds, for example, so having a constructive conversation about looking at data and performance improvement had inherent limitations.”

 Marquette calls the medical staff evolution that ensued from this reengineering “service lines,” but the aim is far from maximizing the revenue potential surrounding profitable disease-based systems—the thought that is traditionally connoted by the term.

“I realize you’re usually talking about product lines when you mention service lines as a concept,” says Noren. “We thought service to the customer rang well so we stuck with it. But this is specifically a medical staff reorganization designed to foster hospital-physician alignment.”

Marquette General’s 21 different service lines convene meetings eight times a year, and traditional departments meet only quarterly. Service line meetings are led by elected medical staff leaders who, Noren says, possess the skills to generate enthusiasm for accomplishment. Each service line contains medical staff members, program directors, quality managers, the CMO, COO, and representatives from decision support, care management, nursing, and marketing. Additionally, ad hoc committees have people from all service lines working together on specific overlapping programs, such as the breast health committee, which includes cancer, pathology, imaging, and women’s health service line representatives.

The meetings have standing agendas, which include regular review of Press Ganey patient satisfaction scores, Premier Quality Advisor data, actions from the value analysis team, and suggestions for developing regional physician work team interactions. They follow “Rimmerman’s rules,” according to Noren, which means “everyone has an equal voice. The philosophy is all ideas are good until the best one arises.”

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1 comments on "Nudging Physicians Toward Team-Based Care"


Stefani D (12/8/2011 at 11:26 AM)
Atul Gwande wrote that physicians are trained to behave like cowboys - independent, autonomous, even arogant. But today, he goes on to say, we need pit crews. The image is relevant - unless there is consequence for behavior that is not in the patient's best interest, the transition to pit crews will be delayed.