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Tuesday, August 20, 2013

Real team building in health care

We talk much about teams in health care and when it comes to completing short term tasks, we have built teams which can meet those goals. Where we have fallen short is in the building of teams tasked with addressing longer term issues, such as might be required to accomplish true coordinated care. This has been brought to my attention recently simply because we have fielded calls from patients with a variety of problems outside of our sphere of expertise. We were tagged with addressing these problems because we had people answering the phone.

The flippant answer is "Call your primary care physician". They take care of everything. That is really not fair to them but they tend to be the default choice in the eternal game of "Medical It". But who should a patient contact with a problem?

In order to have team care, one must first define who is on the team. Ask a patient who is on their medical team and you are likely to get blank stares. Ask them who is in charge and the stare continues. How can we have team care when no one knows who is on the team? In the rare circumstances where I get a list of various physicians who are involved in the care of a given patient I have no idea of what individual roles are played by these docs. Ask the patient who they call for particular problems and the likely answer is they will call whomever tends to respond to their queries. Talk about letting no good deed go unpunished.

In other industries there is a drive to find unmet needs and create products or services to meet those needs. In medicine, this is avoided like the plague. Unmet needs are likely markers for non-reimbursed or poorly reimbursed services.

Team building will require we define who is actually on health care teams, define which roles are filled,  making sure patients know who to turn to for specific issues, and striving to identify roles and tasks which need to be filled. Perhaps the first step is to do nothing more than to ask patients who is on their health care team and try to anticipate their needs, making sure they understand when it is appropriate to come to your window for help and when it is not.

Over time, this issue is going to be solved by patients recognizing where no one is stepping up to fill voids. At this point in time the voids are unrecognizable since no one's role is really defined and the team members are not defined either. Until then,we will simply pretend that we operate as a team with no roster and no positions.

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