ROUNDS Preview: Developing True Team Medicine

Without a team structure, there is no incentive or method to look for care gaps that could cause more complications or expense for the patient, says Benjamin K. Chu, MD, an internist and group president of Kaiser Permanente Southern California and Hawaii.

"It is so important to have a mirror held up to us that forces us to look at our system as a whole," Chu says. "If you just say, 'It's your responsibility to do this, Dr. Primary Care,' or 'It's your responsibility to take care of these things, Dr. Hospitalist,' it's just not going to happen. There's no way that individuals acting alone can close those gaps or solve those problems."

Along with accountability has to come tools so that all members of the team know what the patient needs—sometimes even before the patient does.

"If you call up our call center to make an appointment, the call center agent will actually have a list of the gaps in your care plan," Chu says. "So, for example, if you haven't had a cancer screening or a mammography, or if your blood pressure has been out of order, they'll actually try to arrange for follow-up for you on the phone."

Beyond tools and accountability is the culture of team medicine, one that many physicians whose medical education and training have been built around a physician-centric model can be slow to embrace. Jack Cochran, MD, a plastic and reconstructive surgeon and executive director of the Permanente Federation, says he often hears Kaiser Permanente has been able to make significant strides only because of its model.