How to maximise the potential of a multidisciplinary team?
How to break down the silos? Service providers like physicians are very used to the traditional healthcare delivery model in which physician does everything and patients are also very used to see physicians for all kinds of issues/problems. How can we effectively right siting care and allow healthcare professionals to practice at the top of their license?
Participant comments on How to maximise the potential of a multidisciplinary team?
a triage model that starts at the moment when a patient makes the appointment. Even in my profession as a dermatologist, which is concidered as a small specialism quite a difference is subspecialties is present. Referrals are mostly digital and sometimes even accompanied by foto’s so a division can be made easily. The doctor with the right subspecialism is chosen by the planningoffice to have the first consultation. If a patient has a written referral from their GP and make an appointment by telephone they are asked to read out this letter. We saved a lot of time and money with this system. For example: surgical oriented dermatologist recieve patients of whom is suspected or known that a malignancy is the reason of their referral. OR-time is already reserved for taking out the tumor at this first consultation. This saves at least one consultation-slot and prevents patientfrustration being planned another day expecting to be treated instantly.
The customer has to see the benefit of seeing what they may consider to be a less important person. If the triage adds value to them (eg they have more time to tell their story, have their feelings acknowledged etc) there is a greater chance of them seeing value in the interaction
I recently went to a Team-Based Care conference in Green Bay by Bellin Health. They were having poor performance to population health metrics, physician burnout/turnover, decreased patient access and satisfaction. They purposefully developed an ambulatory team based care model. Their primary care team typically consisted of a physician, medical assistant and possibly advanced practice provider. Now they typically have 2 MAs per provider with teams including physicians, advanced practice providers, RNs, pharmacy, social work and behavioral health. They distribute pharmacy, social work and behavioral health across several clinics. MAs do a component of scribing and provider directed order entry. Providers are responsible to review and sign orders, meds, etc.
Since making this change they have seen improved performance to pop health metrics, improved provider and patient satisfaction and improved productivity. Provider turnover has reduced. They are now expanding to ambulatory specialty care.
It has taken a few years for them to do this.
I was impressed by the number of physicians from their system who were present and endorsed this method.
They have also addressed the regulatory issues associated with this.
We are in the process of developing this for our region.
I think one of the ways to do this is to bring the team together and clearly define everyone’s capabilities. Based on a skills assessment open discussions can be had regarding the roles and expectations of the different team members. In the process, I have found that we have often identified holes in the team where we had individuals performing below the lvel of their licensure because we did not have the adequate staff to perform a function. For example, as we looked at clinic workflow, we found that we had nurses in the EHR checking patients out and scheduling appointments as opposed to a scheduling clerk. This was creating a huge bottleneck in the clinic but after discussions, we decided to proceed with additional schedulers and enhancing their training as opposed to hiring additional/replacement nurses.
I think a good way might be using lean methodology to analyse clinical processes in multidiscplinary teams and to incorporate people with all different backgrounds in the analysis. Using the techniques of value stream mapping, can help you optimise the efforts of people with different backgrounds and make physicians perform at the top of their license.
Why would a physician wants to perform dull work unless he or she is payed very well for production rather than performing on the top of their skills. I like the idea of value stream mapping to make a change.
Clearly delineate responsibilities – reallocate and redistribute responsibilities based on it. If you have mid level providers (NP/PAs) – From a patient perspective, for new patient visits consider not designating them to NP/PA alone. For most follow-ups have physician give a couple of minutes summarizing the assessment and plan. Goes a long way in patient satisfaction.