A greater number of technologies, increasingly burdensome regulations and a higher volume of patients have caused physicians to rethink the distribution of work in their practices to spend more time with their patients. Learn about what an expert calls the “hero model” and why the culture of medicine should shift toward physician-led team-based care.
“We need to move away from the hero model, where doctors do everything they can and then ask for help afterwards,” said Bruce Bagley, MD, senior advisor for professional satisfaction and practice sustainability at the AMA. “Team-based care is about rethinking how we get our work done and what parts need to be done by the physician versus what parts could be done by other members of the team.”
Changing the culture of medicine
Dr. Bagley, who previously served as president and CEO of TransferMED, a subsidiary of the American Academy of Family Physicians, is an expert in team-based care and travels the country helping practices implement this new model of care.
“The team-based idea is to redistribute the work strategically,” Dr. Bagley said. “Instead of sending all the work to the most highly trained person to distribute, real team-based care is to think about how the work can be distributed before it gets to the most highly trained person.”
Team-based care often is seen as a way for every team member to work at the top of their license or skill level. “I know that’s been a catch phrase, and to me that doesn’t say enough,” Dr. Bagley said. “We’re not talking about traditional roles. Physicians, nurses and pharmacists weren’t trained to use registries to manage chronic illness,” he said. “They weren’t trained in patient engagement, motivational interviewing, shared goal setting—this is all new material. The work is no longer defined by the plaques on the wall.”
How to get started in your practice
When approaching team-based care in your practice, Dr. Bagley said you have to “reorganize how you’re doing your work and acknowledge that to be successful you need to be more integrated. This is a team sport.”
Ask yourself these three questions:
- What can you change about yourself?
- What can you change about your work environment?
- What can you change about the system?
“I think there’s an awful lot of energy going into complaining about the system,” Dr. Bagley said, “when the best way to change that is to support your specialty chapter or the AMA—the people that can really make some systematic changes that you can’t quite do as an individual.”
“Take that energy and use it to change the things you have control over, like the workings of your local health system or your attitude toward your work,” he said.
“If I’m running a one or two doctor office,” Dr. Bagley said, “I’m going to take a loyal employee and send her out to a training session on how to use a registry or how to do motivational interviewing or other things.”
“There is no official list of team members that you need for team-based care,” he said. “The focus should be on the tasks that need to be done and how to distribute them among the players that you already have.”
Resources for practice improvement
The AMA’s STEPS Forward™ collection of practice improvement strategies can help your practice implement team-based care. The module details the individual elements of a team-based care model and shows you how to bring all of those elements together.
Dr. Bagley recently spoke to the Alaska Chapter of the American College of Physicians and the Alaska Osteopathic Medical Association at an event in Anchorage and also will be speaking in Washington, D.C., April 12. Visit the STEPS Forward live events page for more information on these and other scheduled events focusing on practice improvement strategies.
More than 25 modules are available in the AMA’s STEPS Forward collection, and several more will be added later this year, thanks to a grant from and collaboration with the Transforming Clinical Practices Initiative.
