Teamwork--It's the People

“Curmudge, you promised to resume our discussion of the medical home. We spent most of October and November of 2009 on this topic, but it came to an abrupt halt when everyone in the clinics became involved with treating folks with H1N1 flu. Most of what we wrote came from the literature, but we couldn’t complete our study by describing how it was working out at Affinity.”

“That’s it, Jaded Julie. Now the team members at our pilot site at Koeller Street have time to talk with me, so we’ll pick up the medical home story where we left off.”

“You’re assuming our readers remember what they read seven months ago? If they can do that, they’ve got better memories than you have.”

“Doesn’t everyone? Well if they need a one-stop refresher, they can go back to our posting of November 19, 2009.”

“So compared with what we read in late November, how is the medical home team at Koeller Street doing?”

“Stated most simply, Julie, ‘they’re doing it.’ That’s the story, and it’s time for my morning nap. So if you’ll excuse me…”

“Wait, Curmudge! You can’t just drift off without telling me how they are doing whatever they are doing. You once told me about how you became a teamwork zealot many years ago when you worked in industry. The teamwork exhibited at Koeller Street must have delighted you. What have they done to make that happen?”

“It’s the people, Jaded Julie. They have the right people. There are lots of books written about teamwork; but if you don’t have the right people on the team, applying the principles in the books will be an uphill struggle.”

“Okay, amateur psychologist, after just a one-hour meeting, how did you conclude that these were the right people?”

“After over 40 years attending meetings like ours—on both sides of the table—it was evident to me that the team got along well together and that they seemed to accept my presence. I didn’t see any eye-rolling (what’s this nut-cake doing here?) or squinting (when will he leave?). The team had been assembled from within and outside of Affinity. In addition to their professional qualifications, team members were ‘hand-selected’ who were congenial, communicative, and interested in cross-training. One member indicated that her position with the team was ‘the best job she has had in 14 years.’ On an earlier occasion another team member stated, ‘I have come from many a broken home (presumably an inefficient conventional medical office)—I now could never settle for anything less than a medical home.’”

“Those certainly are impressive testimonials. So what did the group do to make their team a medical home? ‘You can’t tell the players without a scorecard,’ so perhaps you can start by telling me the number of people at each position.”

“The team is what one would expect in a medical home: one physician, two nurse practitioners, one RN specialist, four health care associates (five people with two sharing a position), four patient service representatives, and one social worker who serves as a behavioral health provider and case coordinator. The makeup and functions of medical home teams might be different at other sites depending on the patient panel size and demographics. Duties of these people are generally as described in our posting back on November 12, 2009.”

“There are no surprises there. So, Curmudge, where does the teamwork come in?”

“The physician and nurse practitioners work collaboratively; this keeps any one of them from being overloaded and provides more prompt personalized care for the patients. In Lean we call this load leveling. The nurses (health care associates) work as a team, with no nurse assigned exclusively to a provider. In addition, on a daily rotating basis, one nurse sits with the patient service reps to handle calls from patients who need to speak with a nurse. She is called the ‘nurse of the day’ (NOD), and she provides patients a single, familiar voice on the phone for calls and call-backs during the day.”

“I know, Curmudge, that cross-training is one of your hot-button topics. The team does that in a big way.”

“They certainly do, Julie. The patient service reps learn from the health care associates so that they can room patients and take vitals in addition to scheduling and record-keeping. When people are interested in career development, this is a way for them to ‘be all they can be.’ In health care language, this is called ‘encouraging people to work up to the full scope of their licensure and potential.’”

“So what is today’s bottom line, Curmudge?”

“The medical home concept is a model for primary patient care; it is not a template supplying every detail. The team members at Koeller Street are working together to develop the detailed workflows that work best for their team. Continuous improvement—the heart of Lean—is the heart of their medical home.”

Affinity’s Kaizen Curmudgeon