TEAMWORK in PCMH: How Well Are Health Systems Developing This Competency?
The Patient-Centered Medical Home (PCMH) is an idea whose time has come—although it’s not a new concept. Internal Medicine, Family Physicians and Pediatricians all claim to have proposed this idea 20+ years ago. In fact, for those of us who were practicing 20 years ago PCMH sounds like the way we practiced all the time (admittedly without the population management).
What has held back the full scale implementation of PCMH all these years, however, are TWO important prerequisites: Affordable, usable Information Technology and a new model of Teamwork:
1) Information Technology support from an EMR, asynchronous secure patient messaging and business intelligence (disease registries, clinical decision support)
2) A new Team System within the clinic that expands the roles of every member of the team and links each person’s contribution to patient experience and outcomes; physician becomes physician-leader, nurse becomes nurse-educator, medical assistant becomes patient-advocate etc.
The good news is the information technology tools have matured and become more affordable to a point we can confidently say “we’re ready for PCMH. However, team work and change management, uh…. not as far along.
Recently I heard a presentation by a PCMH physician leader and trailblazer and was struck by his honesty as he described the “back-sliding” of their “team” three months after roll-out of their PCMH initiative. After initial success with the PCMH, the staff fell back into their old roles of minimum communication and little coordination–more self-preservation than patient-centered. Their group discovered there’s a lot more to “team development” than just the PCMH “huddle.”
PCMH resources abound, including many on the AAFP site. One excellent AAFP tool is a handy “PCMH Checklist” that clinic leaders can use as a guide. It is a clear outline of requirements in multiple areas (Technology being just one, Team Development being another) in order to succeed with PCMH. Here is one section from the PCMH Checklist:
Does your practice offer individuals and teams opportunities for development through:
- Ongoing education
- Leadership training
- Team meetings
- Roles and responsibilities that are stimulating and rewarding
- Shared vision and responsibility for quality of care
- Value for the contributions of all individuals
As one goes down the list, it’s not a surprise that a clinic might gloss over these requirements, or defer them to a “next phase” after the EMR implementation. However group practices and health systems that are serious about implementing PCMH need to make as much of an investment in educating and training the physician leaders and the staff as they do in the EMR.
PCMH is one of the reasons the Physician Coaching Institute was inspired to develop a series of programs and training workshops aimed at developing the “front line” teamwork. A team is more than a collection of individuals working hard in the role—we know they all do. A PCMH team is a group of well-trained professionals who share the groups values and commitment, and who understand how their work impacts and improves on the team’s results– a team system.