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The Team Dance

Working in the back of a clinic can often leave clinicians feeling like they have two left feet. The chaos of patients coming and going amidst lost charts, frozen computers, numerous voice mails, and a pile of referrals can be overwhelming. Team members are left to dodge around the obstacles in an awkward and inefficient dance as they struggle to accomplish every task. Yet with a bit of instruction, members of each Patient Care Team can hone their skills to improve their communication and efficiency; they can learn to move in sync.

The Team Dance streamlines and fine-tunes the way Patient Care Teams (or provider MA teamlets) work together. It’s a rewarding and efficient way to carry out the patient visit process in the back office. Just as there are specific steps, pauses, turns and twists to a well performed dance, there is a certain choreography necessary when Patient Care Teams are working together. These steps emphasize communication between staff and dedication to quality patient care.

The basic structure of the Team Dance consists of 10 steps:

danceChart Prep: The chart prep anticipates the needs of each patient by reviewing his or her chart. Completing the chart the day or two before is the best way to plan for health maintenance and ensure that the patient has received necessary lab work or diagnostic tests needed before the follow up visit takes place.

Robust Confirmation Calls: These confirmation calls not only help to reduce no shows, but they also help to further connect the patient to all the care team members (not just the provider). Additionally, if done after chart prep and financial review, the robust confirmation call not only verifies the reason for the visit and communicates key information, but it can also advise a patient of an outstanding balance due or ask a patient for more detailed information regarding financial plan eligibility.

Patient Care Team Huddles: The Huddle is the very basic starting point of communication for the clinic session. The Patient Care Team meets at the beginning of each shift to discuss the patients scheduled in that shift, the reasons for their visits, and what can be anticipated for them.

QuickStart: This approach is based on the principle that an appointment time is a promise made, and a promise made is a promise kept. The purpose of QuickStart is to ensure that the patient is in the room, with the provider, at the scheduled appointment time. There are many ways to achieve QuickStart, but they are all based on having a sense of urgency to do whatever it takes to begin seeing patients on time. Having an efficient huddle and deploying the entire team to get the first patient(s) is a key step for a successful QuickStart.

Jockey-ing the Schedule: This way of dynamically controlling the schedule causes you to be nimble, look ahead and constantly choose the right lane and the right timing for each appointment. Jockeying involves moving patients forward, backward or side to side on the schedule to accommodate them, reduce cycle times and enhance continuity. Jockey-ing can be done in the front or in the back, but it is a very effective tool to keep the patient care team on track and on schedule. It also empowers the team to make decisions about how to best accommodate their own patients whether they are scheduled, walk-in, or are running very early or late. Contact us for more information on our Jockey-ing the schedule and toolkits.

dance 2Robust Patient Intake/Vitaling: This approach to intake consists of a two-way conversation in which the MA/nurse applies critical thinking and logic to obtain as much information as possible for the provider. It is an intake that focuses on the patient’s specific needs for this visit. This information will allow the MA/nurse to fully support and expedite the patient’s visit.

The 30-Second Report: This is a brief but crucial verbal interaction between the MA/nurse and the provider that takes place right before the provider enters the exam room (often in the hallway outside the exam room door or some other private but close space). It’s the time to convey, in 30 seconds, a rich summary of what the MA/nurse discovered during the patient intake conversation. This communication supports the clinician by decreasing the amount of the time it takes to discern the patient’s needs and concerns. Deliberate communication adds to the discussion which began in the huddle and further prepares the provider for this patient’s visit.

The Midway Knock: This is where the Team Dance gains momentum. Halfway through the allotted visit time, the MA/nurse gives a mindful but quick knock on the exam room door to check in with the provider. The MA or nurse listens through the door for a conversation break, knocks, and asks, “Is there anything I can do for you?” This saves time, as the provider does not have to leave the room to track down the MA/nurse. It’s also an opportunity for the MA/nurse to receive direction immediately, which saves the patient time.

Charting in Real Time: Documenting medical care while it’s still fresh in the clinician’s mind, rather than documenting through recall at the end of a busy shift or day is part of good patient care. It is critical for timely billing as well. During the Team Dance, the provider finishes documentation at the end of every visit before moving on to the next patient.

Communicate, Communicate, Communicate: The rest of the Team Dance is about maintaining the rhythm of communication with the other members of the clinic. Communicating with the front desk, other teams, and other departments requires fluidity and skill. This is used to optimize the flow of the day. Communication is the intangible net that catches us when the expectations of the day fall short.

The Team Dance relies upon communication and relationships among the care teams to carry out the steps effectively. One ideal relationship has been coined the “sheep and shepherd relationship”. The sheep (the provider) is protected and guided by the shepherd (the MA or nurse). The shepherd is responsible for making sure that the sheep gets through the day safely and happily and the shepherd is the buffer. Often in successful teams, the sheep will entrust the schedule to the shepherd and the shepherd protects the sheep from interruptions and distractions and ensures that the sheep has time to finish charting and do all the necessary steps that are required. The sheep is in fact in a very empowered position when she or he no longer has to worry about the clerical and administrative pressures of the day and can focus on what they do well— seeing patients.

text box 2Most health care providers learn how to practice medicine from the perspective of assessing, treating, and evaluating the patient’s medical condition, yet they often find themselves distracted from patient care as they try to manage other team members and a patient schedule. It’s no wonder that the components of efficient work within a team is left to observation, experience, and frustrating trial and error. By practicing and eventually mastering the Team Dance, teams can learn to anticipate one another, just as dance partners anticipate each other’s moves in order to reach their ultimate goal—a flawless performance.

Patient Care Teams that adopt the Team Dance come to know what kind of support to expect from each other. Team members who work together every day to improve the flow of the office learn to anticipate each other’s next move. They build on a strong foundation to improve their communication, and their efforts have a positive impact on the quality of the healthcare delivered to each patient at every visit.

Written by Laura Spindola, RN, Coach

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