‘Teamwork Works’: Lessons Learned From the Front Line of Team-Based Care

This blog post first appeared on the Robert Wood Johnson Foundation Human Capital Blog.

As the patient-centered medical home (PCMH) has emerged as a model for providing effective team-based care that can help offset the impending primary care provider shortage, so, too, is there a growing need for educational strategies that promote interprofessional collaboration. A short report published online by the Journal of Interprofessional Care describes the strategies in place at the VA Connecticut Healthcare System Center of Excellence in Primary Care Education (CoEPCE) and indicates promising results in just one year: doubled productivity in patient care delivered by faculty providers, and a marked increase in same-day clinic access for patients receiving care from an interprofessional team.

The Connecticut CoEPCE, like four other program sites funded through the U.S. Department of Veterans Affairs Office of Academic Affiliations, builds on the VA’s system-wide PCMH model, known as Patient Aligned Care Teams (PACT). It seeks to develop exportable models of interprofessional education and patient care, according to the report, “Moving From Silos to Teamwork: Integration of Interprofessional Trainees Into a Medical Home Model.” The CoEPCE sites share four core curricular domains—shared decision-making, sustained relationships, interprofessional collaboration, and performance improvement—and the Connecticut center groups together physician, nurse practitioner (NP), pharmacy, and health psychology trainees.

The trainees divide their time evenly between interactive educational sessions and caring for patients, guided by faculty who provide supervision, mentorship, and collaborative shared care. Additionally, the Connecticut center incorporates a one-year post-master’s adult NP interprofessional clinical fellowship, to further enhance clinical proficiency and teamwork experience for NPs.

“The data behind teamwork are very powerful,” said the report’s lead author, Theodore Long, MD, an Robert Wood Johnson Foundation Clinical Scholar and one of the first physician residents at the CoEPCE in Connecticut, “but having strong data doesn’t necessarily mean that teamwork is universally appreciated. There can be uncertainty about the meaning and purpose of teamwork. Seeing it in action has made a big impression on me, and on other trainees, giving us all a personal understanding of what teamwork is about and why it’s crucial to promote it on a wide scale in health care.”

In addition to increases in productivity and clinic access, the report describes clinical innovations developed by trainees, including a tool for communicating about patients as trainees change rotations, and a tool focused on safe transitions of care for high-risk patients.

Long pointed out that the PCMH in the CoEPCE setting is geared toward specific needs of veterans, of course, and “there are different challenges in different populations.” There are also “financial challenges to implementing patient-centered medical homes in general,” he said. “In the VA environment, we were fortunate to have a strong degree of buy-in from leadership up front”—something the report emphasizes as important to the success of PCMHs.

“Our experience lends support to expansion of the PCMH model across care environments,” Long added. “Teamwork works, and let’s focus on that.”

Read the report “Moving From Silos to Teamwork.”

“Outside the Box” Programs Can Benefit Patients

A recent HealthLeaders Media article profiles the Centering Healthcare Institute’s CEO and President Sharon Schindler Rising and her "outside the box" approach to healthcare. Rising developed the Centering model of group healthcare and piloted the first CenteringPregnancy model in 1993 as a nurse midwife.

In Rising’s model, eight to twelve pregnant women with similar gestational ages meet 10 times in a group, receiving the same information and exams they would get in traditional prenatal care, but in a community setting. The program was popular with patients and providers, Rising told HealthLeaders. The Centering model has since received national recognition in research studies and CMS grants to create sites across the country.

Providing prenatal care in groups completely "disrupts" the normal model of healthcare delivery and Rising told HealthLeaders that many health systems are not ready for that kind of change. She is working not only to promote Centering, but also to change health systems and believes the time is right for “disruption” to the system, particularly with the relatively new emphasis placed on patient satisfaction and engagement, and patient-centered medical homes.

Funding Opportunity on Patient-Centered Outcomes Research

The Agency for Healthcare Research and Quality (AHRQ) is seeking applications for the new Patient-Centered Outcomes Research (PCOR) Pathway to Independence Award program. The primary purpose of this program is to increase and maintain a strong cohort of new and talented AHRQ-supported independent investigators trained in comparative effectiveness methods to conduct patient care outcomes research. The program is designed to facilitate a timely transition from a junior non-tenure track faculty or a postdoctoral research position (or their equivalents) to a stable independent research career. It targets investigators early in their careers to support their development in new sophisticated methodological comparative effectiveness research skills, interdisciplinary perspectives, and capabilities in PCOR.

The deadline to submit an application is December 17.

Click here for more information.

A Quick Round Up of Nurses Responses to The Supreme Court's Ruling on Health Care Reform

With the Supreme Court ruling to uphold the entire Patient Protection & Affordable Care Act (ACA), we thought it would be fitting to share with you some responses by nursing organizations across the country in response to this landmark ruling.

Ohio Nurses Association Questions Impact of Issue 3 with the Supreme Court's Decision to Uphold Health Care Reform

Last November, the citizens of Ohio voted in support of legislation (Issue 3) that said no law can force someone to have insurance, thus negating the individual mandate included in the ACA. The Ohio Nurses Association is now left wondering how will Ohio implement the provisions in the ACA and what effect will this have on the nursing workforce?

Nurse leaders happy with ruling on ACA

The ANA has touted the law’s potential to increase the profile of RNs in the healthcare system through new models such as accountable care organizations and medical homes. These models would rely on RNs’ expertise in care coordination, the ANA has said.

ANA Lauds Supreme Court Decision Upholding Health Care Reform Law

The American Nurses Association (ANA) lauds the U.S. Supreme Court's decision today to uphold the Affordable Care Act (ACA), including the "minimum coverage provision," hailing it as a victory for all patients and their families.

Nurses: 'Court Ruling Does Not End Healthcare Crisis Or the Need to Continue the Campaign for Reform'

The Supreme Court decision should not be seen as the end of the efforts by health care activists for a permanent fix of our broken healthcare system, said National Nurses United. The union pledged to step up a campaign for a reform that is not based on extending the grip of a failed private insurance system, but "on a universal program based on patient need, not on profits or ability to pay.

Nurses, Care Coordinators Are Gaining Importance in ACOs

Earlier this morning, Jennifer Lubell, of AISHealth.com, detailed the growing importance of nurses in the ACO model of care. These "embedded nurses", or care coordinators, have been found to be an essential part of the ACO framework as they improve patient outcomes by providing a significant communication link between the patient and physician. Insurance companies, including Cigna and Aetna, have touted the care coordinator role as a key contributor to improved patient outcomes.

Click here to read the full article.

New Jersey Nurses Train to Coordinate Their Patients' Care

Last week, Beth Fitzgerald, reporting for NJ Spotlight, discussed how new nurses are learning a variety of skills to act as population care coordinators. The program, which is a collaborative effort between Horizon Healthcare Innovations (HHI), Duke University School of Nursing and Rutgers University College of Nursing, emphasizes the importance of new nurses taking on the roles of coach and health advocate in order to improve coordinated follow-up and preventive and wellness care. The program is also based off of the patient-centered medical home model of care and focuses on patient engagement to improve the overall quality of care.

Click here to read more about the new initiative.

New Nursing Program Promises to Advance Patient Care Quality and Safety

Yesterday, the Johns Hopkins University School of Nursing announced the acceptance of a new grant, funded by The Helene Fuld Health Trust of New York, that will prepare 200 new clinical nurses over the next five years in quality improvement and patient safety that is firmly grounded in leadership development. This initiative will specifically focus on the vulnerable elderly population, who are the responsibile for a high percentage of redadmissions in hospitals nationwide. This education intiative aligns with recommendations to bolster the nursing workforce made in IOM's Future of Nursing: Leading Change, Advancing Health report.

Click here to read the news article.

Click here to read other blogposts related to the IOM's report.

Nurse Midwives Empower Patients With Delivery Options

Yesterday, Linda Friedel, reporting for Kansas City Community News, detailed the strong bonds nurse midwives foster with patients. The article, which included personal reflections of different certified nurse midwives experiences, discussed the varying roles midwives play throughout their patients' pregnancy and how this role contributes to patient empowerment and autonomy.

Click here to read the full article.

New RWJF Video Highlights Health Providers Working in Teams To Provide High-Quality Patient Care

Earlier this month, the Robert Wood Johnson Foundation's Human Capital Portfolio released a video highlighting the positive impact multidisciplinary collaboration can have on patients' lives. This video features Children's Medical Services in Southeast Florida, where interprofessional collaboration has been highly effective in treating medically fragile children.



Click here to read more about this video and other similar projects being funded by RWJF's Human Capital Portfolio.

Georgia Perimeter College' Nursing Capstone Project Addresses Patient Diversity

With patient-centered care being a topic of interest in health care as of late, Georgia Perimeter College's School of Nursing has embraced this concept, and integrated patient-centered care into its curriculum. Yesterday, Laura Raines, of the Atlanta Journal-Constitution, detailed the implementation of a senior capstone project to make nursing students more culturally aware of the multicultural population nurses work with on a daily basis.

Click here to read the full article.

Click here to read other blogposts with news stories from the AJC (they cover nursing issues on a consistent basis and are regularly featured on our blog).