Commentary

Team Care: Fact or Fiction?

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Randy Danielsen discusses the concept of team care and considers the realities of trying to share patient care effectively and efficiently.


 

I was pleased at this year’s AAPA conference to see my colleague Dwight Deter, PA-C, CDE, DFAAPA, and his supervising physician, Wilbur J. Strader, MD, receive the PAragon Award for Physician-PA Partnership. Their 35+ successful years of working together in the field of endocrinology is a testament to the concept of team-based health care.

Following that meeting, I paused to ponder the whole issue of team care. Today, medicine deals with a spectrum of physical, social, psychological, financial, and developmental issues in clinical practice. Is it realistic for the physician, or any single clinician for that matter, to be accountable for all patient care?

Many say interprofessional teams are the answer to providing comprehensive care. Is this true? No medical group would dare admit that they do not practice team medicine, at least in concept. But is it working? (I’m just asking!)

There has been a lot of talk about team care. Other than the general rhetoric that medical care is best provided by an interprofessional team, and that the patient and family should be the central focus of care, there appears to be little to guide us. Well, OK, there are now textbooks, Web sites, and seminars that focus on interprofessional collaboration, but they all seem to highlight the major barriers to making it happen. Some universities are well on their way to collaborative education, but the jury is still out as to how to make it work in practice.

Effective interprofessional teams will not occur automatically. There are a number of key elements that are necessary. Baggs and Schmitt1 defined team care as representatives of different health professions working together to improve their effectiveness. Individual disciplines bring particular knowledge and skills, which can then facilitate a more thorough intervention and improve quality of care.

As we look at the big picture of interprofessonal collaborative practice, many questions come to mind. Do we need to educate teams for the delivery of health care? Who should be educated to serve on these teams? How should we educate health professionals so they can work in teams? What are the obstacles to providing interprofessional education?

The last question seems to be the most ominous. Many barriers have already been identified, such as attitudes, values, compensation, and unfamiliarity with working in teams. The biggest barriers occur during the educational process. All too often, each discipline is educated individually (what I call silo education), with little opportunity for students to relate to their counterparts in other professions. How can we then expect them to work together in practice? There is no doubt that many of these barriers are brought on by lack of time, money, and locations or facilities big enough to manage this type of educational initiative.

Health care providers’ ability to work effectively together in a team approach to patient care has, of course, never been more important. Many believe that physician-PA or physician-NP partnership is a proven and invaluable part of our health care delivery system and that the development of more highly effective teams could be pivotal to its future success. But in today’s fast-paced environment, how do the most successful physician-PA/NP teams make their practice work?

A few years ago, in partnership with the AAPA, the NCCPA Foundation (now called the nccPA Health Foundation) produced “Shaping Great Physician-PA Teams,” a documentary that showed how five physician-PA teams work together. (The video is online at www.paexcellence .org/programs/programs_best_practices.html).

The teams embodied five key success factors:

1. Shared Priorities: The members of the most successful teams had similar practice priorities.

2. Frequent and Effective Communication: Members of the health care team communicated with each other regularly. In fact, many cited this as the single most important factor in their success.

3. Physician Accessibility and Approachability: The physician was accessible and approachable, so team members knew they could turn to him/her for assistance when needed.

4. Consistency in the Delivery of Patient Care: Patients received consistent care and messages when they saw each member of the health care team.

5. Mutual Trust and Respect: All members of the health care team regarded and treated each other with respect and trust.2

Now, not everything about team-based care is positive. Some have found that collaboration is more time-consuming than independent work. It takes time to initiate a working relationship, and the actual development takes even longer. Does the benefit of this process outweigh the disadvantages?

One of the criticisms brought against the idea of team care is that it can “dilute” ownership: If everyone has responsibility for the patient, no one has responsibility for the patient. So dare I even bring up this next topic? We have all heard that the physician is the “captain of the ship” or should be the “team leader,” yet every member of the team has separate obligations, or duties, toward the patient based on the provider’s profession, scope of practice, and individual skills. I am sure our physician colleagues will say they certainly have the most liability for patient care on the team. This brings me back to the five items mentioned above—perhaps that is where we should keep our focus.

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