Last week, Atul Gawande, MD, a surgeon and celebrated writer, published his latest piece. In "The Heroism of Incremental Care," Gawande writes that he once thought surgery was the way to save the most lives. Instead, he says, it's the slow, steady work of primary care doctors working in teams who improve health outcomes.
But how do you set up such a team? How do you avoid burning out the very providers whose care can make such a difference?
Kirsten Meisinger, MD, has traveled the world advising teams on how to implement patient-centered medical homes. She’s teaching in the upcoming IHI program, Advancing Team-Based Primary Care, from March 20–21 in San Francisco, California. IHI asked her how team-based care can improve outcomes for patients and joy in work for staff.
Do you think team-based care can help fight the epidemic of burnout in primary care?
Traditional health care delivery can be a bit lonely — moving from patient to patient, room to room, and holding it all in your head or typing into a computer. Team care forces us to share stories and lean on each other to give the best possible care to each and every patient. We challenge ourselves, and we have more ambitious goals than we used to because we work in teams. Our site has seen a steady increase in joy in work and decrease in burnout as we strengthen our teams — pretty good evidence that this new model of care is worth it!
Primary care doctor Asaf Bitton, MD, MPH, is featured in Atul Gawande's latest piece,
"The Heroism of Incremental Care."
How do you convince a team to try this, especially when the physician is reluctant to relinquish tasks to others?
There is always someone in each environment who is willing to try this, and that person serves as the ambassador to those who are more hesitant to change the way they have practiced in the past. These “pilot team” members lead the way in a non-threatening manner for the practice as a whole. They are invaluable to leadership.
How do you prevent reimbursement rules from causing you a financial hit when you implement this model?
Team-based care is possible in both fee-for-service and in value-based payments, and it looks pretty much the same in both situations, believe it or not. There is often so much inefficiency in how staff and providers are doing their work when they’re not in a team-based model that this often is the place to start. In fee-for-service arrangements, teams can gain financial value by increasing volume. In value-based payment arrangements, they can increase panel size. The best case scenario is to do both in both systems, which is a win-win.
How do you make sure these changes will stick?
Maintaining the change is probably the most common place for team-based care to fail. Everyone thinks that once a change is in place, things will stay that way. But we know that time and again the tendency of systems is to revert back to how things used to be. Having the discipline to make sure a change is securely in place takes daily leadership attention for six months, then weekly attention, and then spot checks forever after. That’s a lot of work! But there are tried and true techniques to maintain this culture change.
Joy in Work is a featured track at this year's IHI National Forum.
Read more in “Team-Based Care: Optimizing Primary Care for Patients and Providers”