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Hard-Nosed About Physician Teamwork

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   May 16, 2013

A Michigan healthcare system tells physicians: Be part of a multidisciplinary team or go away. Though many physicians are not collaborative by nature, a team-based approach is the only way to ensure success, says Spectrum Health.

For physicians at Spectrum Health System in Grand Rapids, MI, the multidisciplinary concept is taken seriously. The cardiology team is blunt when it evaluates doctors who are part of the group: you must be totally immersed in the team concept, or you will be asked to leave the group. Sorry.

Within Spectrum's cardiothoracic critical care unit at the Frederik Meijer Heart & Vascular Institute, for instance, the group has "tried to create an atmosphere that selfish behavior is not tolerated," says Michael Dickinson, MD, medical director of the heart failure and transplantation center for Spectrum Health. "We would say only certain physicians are allowed to be 'citizens' of the unit."

The multidisciplinary concept in healthcare is touted, encouraged, and practiced, to improve patient care in a coordinated approach. The Institute for Healthcare Improvement (IHI), for instance, encourages the multidisciplinary rounding concept, which it describes simply as "several key members of the team caring for patients to come together and offer expertise in patient care."

But as the IHI reported in 2011, "too frequently physicians alone prescribe care for patients" without the input of other providers such as nurses, pharmacists, respiratory therapists, nutritionists, physical therapists, occupational therapists, and social workers.

One incarnation of Spectrum Health's multidisciplinary teams is the cardiothoracic critical care unit. These patients have "persistent, disabling symptoms" and they "may keep coming in and out of the hospital," says Dickinson. The clinic provides a range of services including heart transplants, mechanical circulatory support, and an acute heart failure program. It also includes a multidisciplinary "shock team" to rapidly assess patient conditions.

The cardiac team is critical to Spectrum Health's success, and its multidisciplinary approach is essential to make the unit work, Dickinson says. (Cardiac care's significance and its role as a growing margin contributor is reflected in the March 2013 HealthLeaders Media Intelligence Report.)

To become a member of the Spectrum cardiothoracic team, physicians must "exhibit behaviors that show they can do multidisciplinary care," Dickinson says. The unit comprises eight physician members, nurses, social workers, and other staff. A quality common to each doctor within the unit is that they have a "healthy disrespect for themselves and realize they need all of us to get involved," Dickinson says. By "healthy disrespect," he means that these physicians express confidence in their individual abilities while acknowledging that each of their voices isn't the only one, and doesn't always have to be the loudest in the room. The team seeks uniformity of purpose. Some physicians "have come in and have left over the years, based on their personality and willingness to work," Dickinson says. (He would not reveal how many physicians have been asked to leave the unit.)

"We are captains of the ship, coordinating care with other specialties to make it work," Dickinson says.

The shock team employs an immediate, team-based response. "The focus is on patients not responding well to therapy, and these patients have a high risk for readmissions. It takes a multidisciplinary team to take care of these patients," Dickinson says. "In some ways, the system has not worked for them. These are complicated patients."

Running a smooth multidisciplinary team is no easy task. "It's really hard to do," Dickinson says of the team-based concept. "It's not something that comes naturally [for physicians]," he says. "Most physicians would migrate off and make decisions on their own. Most physicians develop passive-aggressive personalities, and are not good at being collaborative."

In some cases, it's clear that the physicians don't embrace the team concept and won't ever be a fit. Sometimes, however, there are doctors who just need some guidance to become part of a multidisciplinary group.

Dickinson describes a situation in which a physician leader worked with a specialist who "nobody liked" because that person did not adhere to the multidisciplinary style. The doctor in question "would implement plans and put in orders and go in the opposite direction of what we were doing," Dickinson says. It became clear that the other doctors did not want this physician rounding in the ICU.

The clinical team did not give up on the problematic team member. The physician leader approached the doctor and asked if they could round together for a week. The leader spent at least an hour each day with the physician. "They would walk side by side through the unit, seeing patients together," Dickinson recalls.

The physician eventually gained a stronger sense of what the multidisciplinary team was about. Once the concept clicked, he found the multidisciplinary team approach appealing. Now, the physician "looks at issues and comes up with lists, saying, 'Let's see what this patient needs. Let's talk through this.' And it has completely changed the way in which we think about this doc."

"This physician needed a model, a mentor who could help them see another approach. And the goal was achieved."

The extra effort of Dickinson's team paid off, demonstrating a high level of commitment to both the physician and the team itself, and improving patient care.


Joe Cantlupe is a senior editor with HealthLeaders Media Online.

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