University of Wisconsin–Madison Medical College of Wisconsin

Focus on Team-Based Care

Sarina Schrager, MD, MS, WMJ Interim Editor-in-Chief

WMJ. 2020;119(3): 149,148.

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“No one can whistle a symphony. It takes a whole orchestra to play it.” – H.E. Luccock

Team-based health care is defined as patient care provided by at least 2 different health care professionals. Gone are the days where the doctor or nurse works alone. It is now the norm for most health care teams to involve several members from a variety of disciplines. Nurses, case managers, physical or occupational therapists, clinical pharmacists, behavioral health clinicians, social workers, and others all work together to provide holistic, comprehensive care. Each member of the team has a unique contribution to the overall care plan. The physician may address medical issues, while the clinical pharmacist is attentive to medication interactions and the social worker focuses on social determinants of health, for example.

Research shows that when these team members work collaboratively to provide high quality, coordinated care, patient outcomes and satisfaction are improved. A 2017 study that looked at Press Ganey scores found that teamwork and communication between the clinical team correlated with improved patient satisfaction scores,1 and there is some preliminary evidence that team-based care may also improve clinician satisfaction and decrease burnout.2

The Institute of Medicine has described successful teams as having 5 characteristics—shared goals, clear roles, mutual trust, effective communication, and measurable processes and outcomes3—characteristics evident in 5 papers in this issues of WMJ that explore the influence and impact of non-physician health care providers. The papers are wide-ranging, and each addresses several of the principles of team-based care (see Box in full text pdf). For example, the paper by Bonnette, et al describes the development of a multidisciplinary leadership daily huddle (shared goals, trust, and communication).4 This daily meeting, which includes physician leaders, nurses, administrative staff, and members of different support staff serves as a means of communicating issues, checking in with each other, and planning for the future. The team found that having a structured, regular method of interaction enabled the organization to improve communication and develop a better sense of camaraderie.

Bryant et al describe an innovative program developed by the UW Center for Patient Partnerships called the Community Resource Navigator program, which uses undergraduate and law students to connect patients from underserved clinics with community resources.5 By addressing social determinants of health, the program expands access for patients to support services (shared goals, trust). The study looked at patients’ reactions to the use of the navigators and found that the program improved patients’ trust in the health care team and the clinic itself.

Genetic counselors provide direct patient care and help patients decide whether to get genetic tests, how to interpret results of genetic tests, and are able to tease out high-risk family medical history. Nationally, the number of trained genetic counselors who provide direct patient care has decreased. The study by Dawson et al in this issue confirms that there is also a shortage of genetic counselors providing direct patient care in Wisconsin (clear roles, communication).6 Most of the workforce is concentrated near Milwaukee or Madison, which puts many patients in rural Wisconsin without the services of genetic counselors.

Finally, two articles in this issue explore the impact of clinical pharmacists on the health care team. Pharmacists are no longer limited to dispensing medications. Many pharmacists administer vaccines, provide medication reviews, and manage both hypertension and diabetes based on protocols. Some clinical pharmacists also manage INRs.

The article by Hartkopf et al reports findings from a survey looking at satisfaction of health care teams with the work of the clinical pharmacist.7 The majority of clinicians were happy for the input of clinical pharmacists, especially when they were able to manage chronic diseases. MacKinnon et al looked at attitudes of pharmacists and other clinicians on administration of vaccines by pharmacists.8 Most participants saw this in a favorable light, but the ability of pharmacists to provide vaccines was often limited by insurance coverage (shared outcomes, communication, trust).

If we consider the orchestra metaphor, we can imagine each individual member of the care team—from the clinician to the nurse to the clinical pharmacist to the patient navigator—all working together to perform as a health care orchestra. Each orchestra member plays their own instrument, contributing to the overall arrangement of the piece. Similarly, each care team member works in harmony to comprise a healthy, team environment that will improve patient care.

References
  1. Smith CD, Balatbat C, Corbridge S, et al. Implementing optimal team-based care to reduce clinician burnout. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC; 2018. Accessed September 10, 2020. https://nam.edu/implementing-optimal-team-based-care-to-reduceclinician-burnout. doi.10.31478/201809c
  2. Heath S. Nurse communication teamwork to boost care experience scores. PatientEngagementHIT. July 25, 2017. Accessed August 29, 2020. https://patientengagementhit.com/news/nurse-communication-teamwork-to-boost-care-experience-scores
  3. Mitchell P, Wynia M, Golden R, et al. Core principles and values of effective team-based health care. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC; 2012. doi.10.31478/201210c
  4. Bonnette K, Smart J, Morrey M, et al. The development of a daily comprehensive and multidisciplinary healthcare leadership huddle. WMJ. 2020;119(3):205-210.
  5. Bryant A, Walsh-Felz A, Jacklitz J, Lindberg S. The impact of a community resource navigator program on patient trust. WMJ. 2020;119(3):190-193.
  6. Dawson C, Syverson E, Chelius T, et al. Does supply equal demand? The workforce of direct patient care genetic counselors in Wisconsin. WMJ. 2020;119(3):158-164.
  7. Hartkopf K, Norman J, Stiener S. Implementing clinical pharmacists in primary care: care team satisfaction results. WMJ. 2020;119(3):194-197.
  8. MacKinnon GE, Pabian I, MacKinnon K, et al. Comparison of Wisconsin health care providers’ and pharmacists’ attitudes towards vaccine administration and perceived barriers. WMJ. 2020;119(3):151-157.