There Is No “I” in Teamwork in the Patient-Centered Medical Home

Abstract

Evidence suggests that teamwork is essential for safe, reliable practice. Creating health care teams able to function effectively in patient-centered medical homes (PCMHs), practices that organize care around the patient and demonstrate achievement of defined quality care standards, remains challenging. Preparing trainees for practice in interprofessional teams is particularly challenging in academic health centers where health professions curricula are largely siloed. Here, the authors review a well-delineated set of teamwork competencies that are important for high-functioning teams and suggest how these competencies might be useful for interprofessional team training and achievement of PCMH standards. The five competencies are (1) team leadership, the ability to coordinate team members' activities, ensure appropriate task distribution, evaluate effectiveness, and inspire high-level performance, (2) mutual performance monitoring, the ability to develop a shared understanding among team members regarding intentions, roles, and responsibilities so as to accurately monitor one another's performance for collective success, (3) backup behavior, the ability to anticipate the needs of other team members and shift responsibilities during times of variable workload, (4) adaptability, the capability of team members to adjust their strategy for completing tasks on the basis of feedback from the work environment, and (5) team orientation, the tendency to prioritize team goals over individual goals, encourage alternative perspectives, and show respect and regard for each team member. Relating each competency to a vignette from an academic primary care clinic, the authors describe potential strategies for improving teamwork learning and applying the teamwork competences to academic PCMH practices.

Who is responsible for what tasks within primary care: Perceived task allocation among primary care providers and interdisciplinary team members

“…27,28 Multiple team members indicating responsibility for a task could reflect team flexibility, where all members are willing to perform a given task if needed; however, the perception among PCPs that they are solely responsible for most tasks suggests that a better understanding of the proportions of time team members spend on different types of tasks is needed. Some tasks, such as lifestyle counseling, or patient education, are complex and time intensive; these tasks might optimally require sharing among multiple team members such that PCPs, RNs, and LPNs each devoted an equal percent of time in this area.…”

Interprofessional Education for Whom? — Challenges and Lessons Learned from Its Implementation in Developed Countries and Their Application to Developing Countries: A Systematic Review

“…It may simplify task shifting when health professionals acquire the necessary competencies [20]. When medical doctors and nurses are trained together, they can acquire some of the skills of the other.…”

Do medical residents perform patient-centered medical home tasks? A mixed-methods study

“…Lack of communication within the multidisciplinary team was cited as a barrier to patient-centered care by both residents and faculty/staff in the focus groups. Expanding access to these professionals for residents and creating workflows that facilitate communication may promote collaboration and team functioning [25]. In both 4 + 1 and traditional scheduling models, consideration must be paid to ensuring effective communication and teamwork given residents spend only 10–20% of their time in the ambulatory clinic.…”