Key tenets for team-based care
In referring specifically to the challenges of team-based care in teaching clinics, Dr. Kong highlighted several areas that thriving programs have worked to emphasis and improve.
Stable team structures. Residents who are assigned to working with the same medical assistant (MA) on a schedule that is on a set day of the week, not one that is formed based on the demands of the hospital. At Greater Lawrence Family Medicine Residency, a teaching health center in Massachusetts, residents work on the same team throughout their entire GME tenure. Nurse practitioners oversee mini-teams and the larger teams are guided by faculty members.
Co-location. Traditionally, MAs and residents are in separate rooms requiring people to go back and forth to have any communication. Dr. Kong cited a 2015 study indicating that “teams with dense daily face-to-face interactions among all team members are better positioned to deliver higher quality cardiovascular disease care at a lower cost.”
Dr. Kong highlighted the integrated work space at Central Washington Family Medicine in Yakima and how co-locaton put people who are working together most frequently near each other, which creates a more cohesive team environment.
Sharing the care. Shifting to a team-oriented care model allows all team members to contribute and take ownership of a patient’s health. At Erie Family Health Center in Pennsylvania, RNs who take on this enhanced role allows them to teach spirometry, and MAs can teach clinic flow. Non-physician staff members also participate in morbidity and mortality conferences.
Increasing staff. Having more MAs allows them to take on more responsibilities, such as taking histories and vital signs, conducting medication reconciliation and completing orders.
The MAs remain with the patient throughout their entire visit, functioning as in-room documentation support while the physician is with the patient and then walking the patient through an after-visit summary. When residents work within this model, the scope of the MA’s responsibilities differs based on where a resident is in their training.