How the Cleveland Clinic overcame barriers to team-based care

Sara Berg
Senior Staff Writer
AMA Wire
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If you have started implementing team-based care, you are seeing changes in your organization structure with new roles, titles and responsibilities. But with those changes, you might encounter some barriers to team-based care.

Since implementing team-based care in 2010, Cleveland Clinic has overcome barriers for continual improvement in patient care. As a multispecialty health system with about 4,000 providers in different specialties and about 50,000 caregivers on site on any given day, the Cleveland Clinic sees about a quarter of a million patients a year.

This team-based care model was piloted in primary care, but soon after implementation other specialties followed. While team-based care has not taken over the entire system, it continues to pop up in pockets of practices, specialties and locations. 

“I can’t imagine going back to what I was doing before. From day one, 10 years ago, I felt like a burden had been lifted off my shoulders,” said AMA member Kevin Hopkins, MD, during the Team-Based Care Training Camp, held by the AMA and Bellin Health in meeting spaces housed in Green Bay’s famed Lambeau Field.

Dr. Hopkins is a pioneer in advanced models of team-based care, a family physician, and medical director of the Cleveland Clinic Strongsville Family Health and Ambulatory Surgery Center, a multispecialty ambulatory location with about 150 providers in different specialties and about 400 caregivers on site on any given day.

“I became a much better doctor and took better care of my patients because a lot of that care was spread out among multiple caregivers instead of having it rest squarely on my shoulders,” Dr. Hopkins said.

Here is how the Cleveland Clinic overcame barriers to team-based care to achieve its aims of better patient care and improved satisfaction among physicians, health professionals and practice staff.

Barrier: patient reluctance

A new model of care can often come with patient concerns and conflicts, such as a reluctance to share personal information with an additional person in the room.

How it was overcome. After “flipping the switch” and seeing patients differently one day compared with the day prior, Dr. Hopkins and his colleagues found it was very well received and few patients questioned it.

“We introduced it in a way that made it feel like this additional person in the care room was there for my benefit and the benefit of the patient,” he said. “They were there to be an advocate for their care, and an extra set of eyes and ears to make sure that we provide the best care possible.”

If patients did object, Dr. Hopkins would say, “Anything that you want to talk about with me, you can talk about with these ladies in the room. They’re medical professionals. And not only that, they’re kind and compassionate human beings who are also here because they care about you and your health.”

“Over time we have built great acceptance,” he said. “I can’t remember the last time I asked one of my MAs to leave the room.”

Barrier: physician apprehension

Doctors clearly want help, but at the same time can be reluctant to undergo a big change to their practice style. Already struggling, and often burned out, a significant disruption may not be something they are enthused about.

How it was overcome. Ask primary care physicians what they enjoy most about their work. What is the most professionally and personally fulfilling? It won’t be clinician order entry, said Dr. Hopkins—it’s about relationships.  

“It is managing chronic diseases over time, and avoiding complications and bad outcomes,” he said. “It’s about treating acute illnesses and conditions and making people feel better.”

Physicians should focus on those aspects of patient care because it is what doctors are great at. That is what’s most vital to physician job satisfaction.

Barrier: financial concerns

When implementing team-based care, executive leadership is concerned about the cost of adding new positions within the practice.

How it was overcome. Dr. Hopkins and his colleagues demonstrated how team-based care improved the quality of practice while cutting the rate of physician burnout and turnover. Showing the numbers and specifics to executive leadership can be an eye-opener.

For example, in Dr. Hopkins’ practice, seeing one additional patient per half day session offset the cost of having an additional MA on his team.

“When you start to quantify it and the fact that it can cost anywhere from half a million to a million dollars to replace a physician who has left because of burnout, it starts to make a lot of sense to your finance people,” he said. “We start to ask the question of how can we afford not to do something like this?”

Search for a member of the executive leadership team who will be a willing partner and try a pilot for six months. Lay out how to define success and figure out what to do for a quick win. For Dr. Hopkins, as soon as small amounts of volume were added, finance and executive leadership saw the benefit.  

“They started to see the numbers and how this could mean a million dollars in revenue per provider,” he said. “If we start to spread and scale this, what a difference this makes to us as an organization.”

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