Patients Charting the Course Citizen Engagement and the Learning Health System: Workshop Summary (2011) / Chapter Skim
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8 Team-Based Care and the Learning Culture
8 Team-Based Care and the Learning Culture
Pages 187-212
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From page 187... ...
Team-based care has yet to proliferate widely, yet numerous excellent team-based programs around the United States demonstrate their added value in generating superb patient-centered health outcomes and science-driven care. The papers in this chapter delve into three aspects of team-based care as they apply to a learning health system: general concepts in team-based care; strategies for using teams to promote clinical excellence, continuous improvement, and real-time feedback; and the added value and efficiency that team care brings to streamline care transitions.
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From page 188... ...
Lammert offers several recommendations for accelerating teambased care and driving centers of excellence, including a shift in medical schools' teaching strategies to more of an interactive, team-based model; rapid process improvement workshops; and incorporation of routine learning collaboration in real practice settings. Alice Bonner, formerly of the Massachusetts Department of Health (now Centers for Medicare & Medicaid Services)
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From page 189... ...
This description of a continuous learning environment might best be viewed as conceptually simple but difficult to accomplish. The difficulty exists because stellar continuous learning environments rely on outstanding leadership, teamwork, and improvement.
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From page 190... ...
and others sought to understand the relationship between teamwork and error and to develop a training program to address the issues involved. The end result was a program entitled Cockpit Resource Management, so named because the goal was to have groups work effectively with the members of the team and whatever was available in the physical environment.
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From page 191... ...
Aviation incorporated CRM concepts as a central component of its core strategy, while for the most part, health care continues to view patient-centered care and evidence-based medicine as the two mainstays for achieving excellence. Teamwork is perceived as necessary but also soft and fuzzy, peripheral to the real work at hand and assignable to the simulation center and patient safety office.
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From page 192... ...
Model for Improvement are focused primarily on using statistics to manage variation in stable industrial processes, and derive from the teachings of skilled statisticians and managers such as Shewhart, Juran, and Deming (Juran, 1995)
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From page 193... ...
In health care, Deming's work is the underpinning for IHI's Model for Improvement. Shewhart and Deming's improvement science looks at stable industrial processes, evaluates the variation in output of the end product, and applies improvement techniques when appropriate to minimize unnecessary variation.
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From page 194... ...
This is an important insight for newly appointed department chairs, division chiefs, and healthcare managers and directors, yet few healthcare leaders assume these positions knowing how to do this work. Effective managers establish a learning-to-action cycle that gathers information from across their span of authority and then shapes improvement activities.
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From page 195... ...
For that matter, debriefing can help improve the briefing process, ensuring that team members function more effectively when formulating the next game plan. Conclusion Health care has a long way to go from its current state to one comprising continuous learning environments.
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From page 196... ...
MEASURES AND STRATEGIES FOR CLINICAL EXCELLENCE AND CONTINUOUS IMPROVEMENT Joyce Lammert, M.D., Ph.D. Virginia Mason Medical Center In 2001, the Institute of Medicine (IOM)
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From page 197... ...
. Team learning for medical students has until now been TABLE 8-2 Changing Provider Culture in Health Care 20th Century 21st Century Taking care of the sick Promoting health and well-being Physician-centered Patient-centered Gestalt Evidence-based See one, do one, teach one Simulation, simulator Know it all Know what to ask and how to find the answer Autonomy Collaborative/team The health of my patient The health of a population of patients My fault Faulty systems Total patient care commitment, 24/7 Work hour restrictions, physician wellness Learning: batched, episodic Learning: continuous, embedded TABLE 8-3 Changing Culture: Medical School 20th Century 21st Century Unidirectional learning Interactive, team learning Knowing everything Knowing essentials, asking questions, finding answers Individual accountability Team accountability Departments Service line training Role models: lengthy resumés and Role model: "quality provider" grants Passing boards Competency- and milestone-based training and certification
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From page 198... ...
The formation of cardiovascular, neuroscience, and cancer institutes represents a move toward more collaborative care models. Ideally, medical student training would include training in working in interdisciplinary teams that cross service lines.
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From page 199... ...
Training in the internal medicine residents' continuity clinic is another example of the power of the LEAN management system. Several years of process improvement work have centered on improving the primary care experience for patients, providers, and staff.
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From page 200... ...
They reinforce the importance of continuous improvement and learning among the entire healthcare team. ACGME also recommended outcome-based assessment of residents during their training.
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From page 201... ...
Learning organizations also need to find ways to engage physicians in guideline development, patient safety initiatives, and leadership/team training. Physicians are data driven, and providing accurate data on clinical outcomes and patient satisfaction can lead to organizational and individual improvement.
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From page 202... ...
, Massachusetts Health Data Consortium, and Harvard Medical School The Massachusetts Strategic Plan for Care Transitions: A Model for a Learning Health System The healthcare system in the United States demonstrates significant patient safety and quality deficiencies (Snow et al., 2009) and therefore fails to provide value for those who use and pay for it.
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From page 203... ...
Given the range of healthcare settings and the number of providers involved in treating patients, it is not surprising that communication problems and other errors in treatment persist as patients move across the continuum of care (see Box 8-1)
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This vision calls for care that is organized around regions and communities; that is delivered by integrated systems coordinated across settings; and in which the flow of patient information is seamless and secure among all of a patient's providers, insurers, and patients themselves. To accomplish this transformational change, the Massachusetts healthcare community will require collaboration and effective partnerships focused on the creation of a patient-centered care model delivered within learning healthcare systems and encompassing the entire continuum of care.
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recognition of red flags. The model was tested on 750 patients aged 65 and older at the University of Colorado Health Sciences Center, randomized at the time of hospitalization to receive either the coaching intervention or usual care.
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From page 206... ...
About 3 years ago, a small group of clinicians, healthcare administrators, and government agency staff, coordinated by the Massachusetts Health Data Consortium and Massachusetts Senior Care Foundation, came together to discuss gaps in such efforts and how to disseminate individual work more broadly. That group grew to more than 100 stakeholders and is now known as the Care Transitions Forum, representing a community of interest that meets quarterly to share best practices and provide mentorship to institutions and organizations across the state.
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We believe Massachusetts can be a model healthcare learning state and can lead the nation in improving care transitions and reducing avoidable hospitalizations. Objectives We had a number of objectives in writing the strategic plan.
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From page 208... ...
The Massachusetts strategic plan for care transitions outlines a strategy for tracking progress and measuring successes and challenges. Performance measurement is essential if the best practices and lessons learned from state demonstrations and national research and care models are to be implemented effectively on a statewide basis.
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The most prominent of these was the Health Care Quality and Cost Council, which had been established under Massachusetts' landmark healthcare reform law in 2006. With the Kingdon policy hurdles passed, Massachusetts has now moved into the implementation phase, with workgroups already engaged in the refinement and deployment of a statewide interfacility transfer form and process, as well as state surveyor education around effective care transitions.
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2007. The learning healthcare system: Workshop summary.
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2010. Team training of medical students in the 21st century: Would Flexner approve?
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From page 212... ...
2000. The role of patient care teams in chronic disease management.
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