Overview of Coleman’s Learning Collaborative in Supporting: Team-Based Care in Primary Care Settings
Team-based care is a critical contributor to improved health outcomes, higher patient satisfaction, improved patient access, and decreased provider burnout (1, 2, 3). Team-based care involves clarifying and redesigning clinical roles to improve communication, reduce redundancy, and improve efficiency. As provider burnout rates increase, patient satisfaction decreases, and healthcare costs soar (3, 8), the need for structured learning collaboratives designed to help care teams improve patient-centered care practices over time becomes increasingly evident.
Alongside engaged leadership and patient-team partnership, team-based care is one of the 10 building blocks of primary care (2, 3, 14). A “necessity for the survival of adult primary care” (2), high-performing care practices view team-based care as critical. In fact, a provider that does not utilize a clinical care team for 2,500 patients would spend 17.4 hours daily on providing appropriate and recommended care to their patients (2). Additionally, operational challenges, bureaucratic issues, and an increasingly disjointed and retrofitted care approach contributes not only to increasing provider burnout, but also to increasing burden of cost on the healthcare industry (6). In 2019, the estimate of attributable cost of physician burnout in the United States was (conservatively) approximately “$4.6 billion in costs related to physician turnover and reduced clinical hours” attributable to physician burnout (6, 11).
Team-based care works to optimize primary care for both patients and providers, resulting in improved safety, quality, and reliability of care; increased patient satisfaction; reduced waste (especially time); and improved outcomes (7).
Team-based care supports healthcare professionals and patients alike as the healthcare industry focuses increasingly on embracing value-based care (10). Care practices who are struggling with patient satisfaction, reduced efficiency, low productivity, and high rates of missed opportunities can benefit from training programs that provide a foundation for teams to redesign their approach to care. Missed opportunities are any opportunity in the care team’s schedule that went unused for any reason, such as no-show appointments, unscheduled appointments, scheduling errors, inability to absorb a walk-in or unplanned need, or other clinic-based overlooked opportunities (3, 10).
Team-based care “clarifies roles and responsibilities of clinicians and staff, reduces duplication of tasks and poor communication, and standardizes day-to-day processes” (14). As patients in primary care settings become sicker, with multiple chronic diagnoses, “Care teams provide patients with greater continuity of care and management of chronic conditions.” (14).
Training programs for team-based care are learning collaboratives that provide structure, support, and momentum to make changes happen in a shorter timeframe. The Dramatic Performance Improvement™ (DPI™) program offered through Coleman Associates works alongside care teams to “find new ways of working that improve productivity, increase patient access, reduce patient waiting time, develop teamwork, improve staff satisfaction, fortify patient-centered medical homes, improve patient experience, optimize the use of technology” (4).
The intent of the DPI™ program offered through Coleman Associates is to utilize evidence-based practices to support the systematic shifts required to change a practice over time. The DPI™ program supports a top-down, bottom-up approach to transforming care teams by providing the knowledge, skills, and support needed to implement a team-based approach within a medical practice. Approaching team-based care using this structured learning collaborative has resulted in reduced no show rates, reduction in missed opportunities, increased productivity, improved patient access (improved third next available appointment times), and improved quality of patient outcomes (4, 9).
Decreased provider burnout is a positive side effect of these approaches, as increasing productivity and improvement in the systems that tend to burn out providers are also the systems that decrease the ability to see patients to begin with. Other systems that prevent or delay providers from seeing patients include poor time management, high rate of missed opportunities, redundancy in care, silos in departments, poor communication, lack of clarity in care roles, and poor patient satisfaction; these areas can also see improvement with team-based care approaches (2, 3, 14, 15).
DESCRIPTION & OUTCOME OF PROGRAM
The DPI™ program is a 10-month commitment to improve operational metrics. Over the course of 10 months, the Coleman Associates team works closely with leadership and clinicians within a practice to implement true change in a step-by-step process. Working with 45 teams over the last two years, Coleman Associates has noted sustained changes and improvements in missed opportunities, decreased cycle times, improved patient outcomes, and decreased no-show appointments, improved 3rd next available appointment times (a data point that more sensitively reflects true appointment availability compared to next appointment time per the Institute for Healthcare Improvement); increased productivity; and decreased provider burnout (9).
The results of the DPI™ program suggest that team-based care in a primary care setting that is committed to redesigning their approach to patient care, are gaining knowledge and skills through the learning collaborative that is advancing patient care. These initial results are consistent with other studies that have been conducted (5, 10, 14, 12, 15). Furthermore, Coleman Associates is finding that provider burnout is being reduced as productivity increases. While this has not been a focus of their trainings, it has been noted as a positive byproduct, as most systems that contribute to provider burnout are the same systems that are inhibiting seeing patients, including missed opportunities, poor communication, redundancy in care tasks, silos in patient care, etc. (3, 15).
As noted in other collaborative learning approaches (14, 15), care teams require the organizational and leadership support to engage in activities – both in training and in practice—and to implement newfound knowledge and skills. Teams that do not have leadership support have been shown to struggle with implementing the team-based approach to care (14).
The unintended consequences of provider-centered care (as opposed to team-based and patient-centered care) are burnout, lower productivity, high turnover of staff, inconsistent quality measures, decreased patient satisfaction, and decreased patient access to care (see figure 2; 14). For the top third of Coleman’s DPI™ learning collaborative teams, there has been a sustained decrease in cycle time (43% for the top third of DPI™️ teams); a 83% decrease in missed opportunities (any appointment slot that goes unused for any reason); and a 84% increase in productivity. Overall, teams transformed organizations over the 10-month learning collaborative, with a 25% decrease in cycle time, 31% increase in productivity, and 14% decrease in missed opportunities. (See figure 1)
Team-based care approaches have been shown to support improved patient outcomes, reduced healthcare costs, higher patient satisfaction, and reduced provider burnout (2, 3, 14). Utilizing a learning collaborative such as Coleman Associates’ DPI™️ training program can provide a foundation and direction to a care team as they attempt to change their care practices over time. To ensure team capabilities and capacity remain successful and sustainable, it is imperative that leadership is supportive of both training, change, and sustained focus on shifting culture within the care team or practice. Workplace cultural and large-scale operational changes can take time, consistency, support, and the recognition that continuing education and practice will be necessary (14). Once the team-based approaches are implemented, however, care teams have seen many positive outcomes, including increased productivity, improved patient outcomes, improved communication, improved teamwork, higher patient satisfaction, and fewer missed opportunities.