Building Effective Care Teams: A Provider’s Perspective
How much of a difference does a patient care team truly make in health care delivery? And, more practically, how do you build a great team so it’s not just an empty word, but rather a cohesive group that benefits patients?
We talked to Dr. Timothy Spurrell, Obstetrician/Gynecologist and Women’s Health Center Medical Director, about how he builds high-functioning patient care teams. Dr. Spurrell not only has a reputation for stellar customer service among his patients, but support staff also love working with him. According to Danna Freedman-Shara, the Center Manager:
“I have worked closely with Dr. Spurrell for almost five years. In that time, I have watched how his attitude and encouragement pushes clinical staff to become their highest selves. In particular, Dr. Spurrell reinforces the essential role of support staff in health center operations. He teaches them to be leaders, and as a result, they excel. Each medical assistant is charged with facilitating flow, upholding quality standards, providing exemplary customer service, and ensuring the provider is able to work to the top of their license.”
Coleman Associates has been training health centers to work in teams since 1993. Team-based healthcare has seen tremendous growth in recent years, in part stimulated by the Affordable Care Act and the need to accommodate many thousands of newly insured patients. Adding to the pressure to work in teams are such organizations as the National Committee for Quality Assurance (NCQA), which requires team-based care as part of the Patient Centered Medical Home accreditation. Many other organizations endorse patient-centered teams, such as The Joint Commission on Accreditation of Hospitals (JCAHO), the Institute of Medicine (IOM), the American Hospital Association (AHA), and The MacColl Institute for Healthcare Innovation.
We interviewed Dr. Spurrell about the process he undertakes when creating outstanding patient care teams, and he shared the following with us..
Q: Why do you think it’s important to have Patient Care Teams (PCTs)?
TS: “I don’t see patients alone anymore; it’s my team who sees patients. If it were just me alone doing everything by myself, I couldn’t do it. First, the team coordinates the patient’s care. My medical assistants get records from our patients’ previous visits, and they prep for the visit and tell me what the patient is due for or remind me what the patient said she wanted the last time I saw her.
Second, each team member picks up on cues to get patients what they need and want. Often my medical assistant will tell me something she learned from the patient’s intake that helps me get right to the point when I walk in the door. It could be something like, ‘she seemed nervous when going through her informed consent for the colposcopy’ or ‘she’s with her kiddo and he’s a little rambunctious so I can come in and hold him during the exam.’ My team helps me get the patient the exact care she needs while helping me deliver that care in a delicate and empathetic way. If I can think for a moment before I walk in the door about how to ease the patient’s fears about the colposcopy, it saves me time in the room so that I can focus on her.
And lastly, my team can add patients to the schedule because we work together and because the team runs my schedule. My medical assistant (MA) can determine where additional patients can fit in the schedule based on no-shows, cancellations, or our flow, and can then ensure that those additional visits go smoothly by prepping ahead of time. The reason I work in community health is to see the patients who really need to be seen. I couldn’t do that without a patient care team. The team helps me see more patients than if I were working alone. They QuickStart* visits with me (by being in the room with me and the patient at the same time) so that we can work concurrently to save time. Working linearly (for example, when the patient has to see the MA before I can go in the room) just takes more time, period. QuickStart benefits my patients. If I didn’t have a team, patients would have to wait longer to see me—longer in the waiting room and longer to get an appointment.”
“My team helps me see patients by:
- Coordinating the patient’s care and prepping for visits ahead of time.
- QuickStarting* some patient visits so we can work synchronously instead of linearly to save time.
- Assessing patients fully in the intake** and then giving me a heads up before I go into the room.
- Working additional patients into the schedule and making key flow decisions.”
*QuickStarting is a Coleman Associates term for the provider and MA starting the first visit of the session together. Beginning the first visit together ensures that the patient is being seen by his or her provider at the scheduled appointment time.
**The Robust Intake and 30-Second Report that Dr. Spurrell refers to are Coleman Associates terms. The Robust Intake refers to the MA getting the most information possible at the time of his or her intake. The 30-Second Report is a quick download of the Robust Intake information to the provider before the provider goes into the exam room. More information can be found about these and other Team Dance steps on our website.
Q: What does a Patient Care Team (PCT) need to function well?
TS: “For me, the biggest thing a PCT should have is trust. It’s important to establish trust among the team. Team members may have trouble believing that I, as a doctor, expect them to have a prominent role in delivering care. Once they understand that I really do count on them, that they really are an important part of the patient’s visit and that their work plays a vital role in the patient’s life, we develop trust and a mutual dependence on one another to deliver the best quality visit.”
Q: Conversely, what do you notice when the team isn’t functioning well?
TS: “Well, dysfunctional teams defer to me for every decision. They don’t challenge my decisions; they don’t challenge one another. Dysfunctional teams don’t trust one another or even trust me. They don’t admit when they are unsure or don’t know how to do something. They lose focus on outcomes and just go through the motions, checking boxes to complete their part of the job. They follow the templates and don’t use their judgment. The team becomes complacent.
When all team members play their roles well, we get more information than when I just talk to patients myself. A well-functioning team will talk to patients and get a lot of great information and that allows me to simply continue that conversation. A non-functioning team just gets the basic information that’s on the template. That makes me miss opportunities because of things patients may not say to me. They may have been more likely to be candid with another member of the team.”
Q: How do you help build the team around you to be as highly functioning as you describe above?
TS: “As ‘The Doctor,’ when I walk in the clinic door, I already command a lot of attention. I don’t need to do anything special to make that happen. What I do need is to have partners in the clinic. I encourage the team by giving the staff permission to be extensions of me throughout the clinic. Patients sense this and it gives them the feeling of being cared for by many versus cared for by one.”
Q: Can you share some language or tips you use to help empower your team?
TS: “I tell my assistants that they’re running me. I literally say, ‘I don’t know where to go next. You’re the boss. You run the show.’ I say things like that because I want them to have control over the flow. I praise and thank them for getting information from patients that helps me make a diagnosis or prescribe a treatment plan. I constantly reinforce the decisions that they are making. And that builds them up to do the hard part, frankly. I get to come in at the end of the visit and be the ‘closer.’ I tell them, ‘I just do the medicine stuff.’ I tell them that they do everything else, which is the hard part.”
Q: What does your team do for you when you see patients?
TS: “My team, whether it’s my medical assistant or nurse, make me smarter and they make me look better! It’s common sense that when more eyes are looking at a chart or more people are talking to a patient and taking direct responsibility for a patient, then the outcomes improve. There have been so many times when the MA or nurse on our team has told me, ‘don’t forget to ask her about (you name it)’ on my way into a room when already I had forgotten! The patient feels I know her and even goes online to review me as thoughtful and caring, but in fact I have been prepped and coached by my team to excel.”
Q: What advice do you have for providers who are new to working in a team?
TS: “Let go of managing the schedule! Hand over flow decisions to the MA and focus on the patient and your documentation. I don’t even look at my schedule. I, of course, look at the chart, but I rely on my MA to tell me who’s next, which medical record to open in EHR and avoid even the temptation to make scheduling decisions.
Because I am the medical director, support staff often defer to me. So I flip it to change the culture. I defer to them! I ask questions about flow (‘Where do you want me?’), I ask for advice on how to approach a patient (‘She seems upset but not when you were with her. How did you do that?’), and I apologize for not being polite (‘Please and thank you for everything!’). I also set expectations. No longer do I run late, the team runs late. Each person has a function, a responsibility, and the expectation to execute and perform. “
Q: What advice do you have for MAs who are on a patient care team?
TS: “I think being surrounded by people with advanced degrees and titles, it must be difficult to understand how to fit in. My medical training was limited to what happens within the exam room. I wasn’t trained to manage flow, coordinate care, or optimize the patient’s experience within a health center. I’d encourage MAs to understand that their role is vital and vast within a health center, and their impact on patients’ lives matters. It’s those patient interactions with the MAs that contribute so much to a patient’s opinion regarding her care, and the likelihood he or she will return again. My advice is to understand your role and maximize it.”
Q: Do you have advice for administrators on how to build great patient care teams?
TS: “Well, patient care teams aren’t merely an option … or just a good idea, they are essential for quality health care. Health care teams improve access and drive patient experience. So one bit of advice is to clearly communicate to staff that the bad old days of ‘the doctor is running late’ be replaced by team successes and failures, rather than individually derived. Role definition, role expectation, and role respect are all central to establishing and maintaining a highly functioning patient care team that starts and finishes on time and doesn’t make patients wait, but, most importantly, delivers high quality care to their patients.
In addition, there is not a team in the world that doesn’t need coaching from time to time, and the same is true for health care teams. I’ve seen some high functioning teams start to slip and need redirection. Watch the data and pay attention to trends and intervene to fix problems.
Lastly, attrition is common to every workplace but can change team dynamics. Ideally, members of the team should interview any new team member to ensure a good fit. Training should focus on team needs. Teams need to understand that roles mature and strengthen over time, and during transition times, responsibilities will shift to accommodate new team members.”
Here’s an easy checklist you can use to follow Dr. Spurrell’s advice at your health center:
- Providers, let go! If you’re a new or seasoned provider, hand patient flow control over to your support team so they can manage you and all the logistics of patient flow.
- Providers and managers, empower your support team! Use language like, ‘you tell me where to go next’ or ‘you’re in charge’ to give your MAs the mandate to manage your time and to show them that you want to be led!
- If you’re an MA, step into your role! Communicate well with your patients and the provider on your team. Gather information and relay it. Tell your provider where to go next and what to do.Let your provider make the medical decisions, not the flow decisions!
- Patient Care Teams, erase “Doctor or Provider” from your vocabulary and replace it with “team!” The team runs late, not the doctor. The team sees patients, not just the provider. Make each a day about the team’s victory or failures, not just the provider’s.
- Administrators & PCTs, listen to what patients say about their visits. You’ll know teams are having a big impact by watching what patients say and write about their clinic experiences. If they rave about the level of care they received from their team—not just the provider—then you’ll know it’s a high functioning team!
- Lastly, Administrators, bring in the Patient Care Team members to interview a potential new member of the team (provider or MA). The team should be part of major hiring decisions to ensure a good fit and to encourage buy-in.
Working together on a team—a tightly-knit group of people that works together consistently, day after day—can change not only how you work but also how you feel about the work you are doing.
When each team member contributes meaningfully to the care of each patient, quality goes up, job satisfaction goes up, and patients are thrilled by the care they receive.
Teamwork is really the only way to go!
Co-Authored by Amanda Laramie, Timothy Spurrell and Pamela Weisse