For years, medical providers have claimed to work as a team. However, the reality was that the physician – particularly the primary care provider – typically managed most patient visits on his or her own. Everything from examinations to copious note-taking was on the one doctor’s shoulders.
St. Joseph Heritage Healthcare knew there had to be a better way, and it was our physicians who sought the change. Not only were doctors exhausted from examining patients and taking notes on each visit in 15-minute blocks of time, they were saddled with mountains of administrative duties after-hours. The joy of practicing medicine seemed fleeting and the feeling of isolation was apparent. Our doctors were together in a group practice, but essentially alone.
Team-based care has been a welcome solution and a natural extension of our focus on patient-centered care. In our new set-up, physicians, nurses, medical assistants and administrative team members share responsibilities for the patient visit and follow-up, as do social workers, care managers and pharmacists, when warranted. Typically these shared responsibilities include patient intake, patient history updates, and follow-up communication and planning with the patient. The result is often a more satisfying and comprehensive visit for both patient and doctor.
One physician described the change as returning to the true art of medicine. “We have the time to connect with patients, and that is what truly differentiates the best doctors,” he says. “We are rediscovering our passion for medicine and are reinvigorated by the work.”
While everyone on our team understood and appreciated this approach when first introduced, changes to everyone’s routines were required. Most of the changes focused on improving communication among the team of care professionals. For example, mornings now include team huddles in which the physicians, nurses, medical assistants and others meet to discuss the office’s schedule for the day and particular challenges. At some of our sites, these meetings involve social workers/care managers who get to know the patients on the daily schedule who will most likely need behavioral health or other services. Our team-based care approach also draws on the expertise of pharmacists, who assist providers with medication reconciliation and patient education.
When time permits, staff members and physicians often share stories of the past day’s successes to motivate the team to continue working to the best of their abilities. We have found that, for the most part, processes do improve when a team is involved. Because effective teamwork requires everyone to pitch in and work efficiently, the team is always seeking ways to improve upon their evidence-based protocols. It is typical for a team to review each portion of the patient encounter to ensure nothing slips through the cracks.
Patients, too, have noticed the difference. They appreciate the time spent with a physician who is focused on communicating with them rather than entering notes into the computer. Additionally, administrative processes have become more efficient and staff are more knowledgeable about each patient’s needs. Patient and family members have remarked that they notice they have an entire team behind them rather than one physician and a few hurried staff members.
With our new approach, we can also take time to educate patients on the tools they have for managing their care. These tools include on-line scheduling and checking test results via the patient portal. Telemedicine and e-visits also are available. These enhancements are not only more convenient for certain patients, they have opened up scheduling slots for others who want or need an office visit.
With office visits better managed and patient satisfaction on the rise, we are also better equipped to welcome larger patient volumes. Whereas physicians previously struggled with managing 1,500 patients, we now believe they these volumes can increase by at least 25 to 50 percent without compromising high levels of clinical practice and patient satisfaction.
Although this new team-based model is still relatively new for us, we are discovering additional benefits almost every day. Our patients are appreciative. Physicians and staff are finding greater satisfaction in their work. And everyone is more inclined to keep improving on a model that is already proving very successful.
Kevin Manemann is president and CEO of St. Joseph Heritage Healthcare. Part of St. Joseph Health, St. Joseph Heritage Healthcare (Heritage) was founded in 1994 and includes eight medical groups throughout California. In addition to its medical groups, Heritage supports six distinct affiliated physician networks throughout the state. Combined, they provide residents access to more than 2,000 providers in virtually every specialty. Heritage medical groups and affiliated physicians have received top honors from various organizations, including the Orange County Medical Association for Physicians of Excellence and the Integrated Healthcare Association with distinction in clinical quality.
Kevin Manemann, President & CEO