Learn how a family medicine clinic is using team-based care to see more patients, achieve higher quality scores, and get back 8-10 hours of personal free time.
Michael Werner, MD, and his practice had been following a traditional care model for 7 years. One day, he read a letter written by his 7-year-old daughter and was saddened to find that she wondered why he wasn't home very much. In speaking with his group, he discovered that other physicians and their families were experiencing the same frustration, and they were interested in pursuing a team care approach to improve workflow efficiency and work-life balance.
Developing the Intervention
The practice began the team-based care approach by assigning 3 team care assistants (TCAs) to support each physician: 2 registered nurses (RNs) and 1 certified medical assistant (MA). Initially the practice tried to implement the model with only 2 RNs per physician, but they found that it was difficult to keep up with the workload. Therefore, each of the 3 physicians in the practice who use the team-based care model hired an additional team member to form their TCA team.
The TCAs are now an integral part of the practice and provide continuity for patients during their visits. During rooming, the TCA collects patient information. When the physician enters the exam room, the TCA synthesizes this information to present the most pertinent details. The TCA then stays in the room to act as a scribe. When the physician portion of the visit is complete, the TCA assists in the discharge process and makes sure that the patient understands the doctor's recommendations.
“At first the TCAs were nervous about using question sets and then reporting data to me in front of patients. They were also worried about documenting the visit. It didn't take long for them to see the positive impact it was having both on my side and on the patient's side. They are now much more comfortable with the process and their role in patient care. They are an integral part of the patient's experience with our practice.”—Michael T. Werner, MD
The main challenge encountered during implementation was documenting visits in real time in the electronic health record system (EHR). To address the EHR challenges, the practice created modifications in the form of “dot phrases” or “smartphrases” that were shorthand for commonly used documentation. Once these were implemented, the process became more fluid and efficient because the TCAs were able to work more quickly and consistently in the EHR.
The team care model took approximately 2 months to get off the ground. Once it was established, patient visits became more efficient and documentation in the EHR became less of a distraction during patient interactions. Physicians now spend less time searching for old notes or records because the TCA has already pulled up relevant files for them. In addition, the team-based care approach alleviates pressure on physicians to take notes during the visit or dictate at the end of the workday or afterhours.
Between-visit care has also improved. With the expanded team, patient calls are returned promptly and between-visit concerns are addressed in a timelier fashion. Fewer questions require the physician's direct input because their TCAs are trained to answer most patient inquiries.
As their comfort with the new team-based process has grown, the TCAs have started taking an increasingly proactive role in the practice. For example, they now review charts the day before visits to prepare for each patient's arrival. During the pre-clinic huddle each day, they give a report on why a patient is coming in, what health maintenance needs should be brought up during the visit, and whether any labs, immunizations, or additional screening is anticipated. This preparedness has greatly improved the office's efficiency and saved physicians time previously spent on documentation.
“I have seen 235 more patients in the first 6 months since implementation. For me, this is equivalent to approximately 4 additional weeks of patient care. I have done more, billed more, dictated less, and have more face time with my patients. And, my family gets to see me!”—Michael T. Werner, MD
Dr Werner and his team are constantly refining their team-based care model. They continue to see improvements in the clinic's bottom line while improving quality of care with more appropriate use of team members in a team care environment.
Kaukauna Clinic is an independent multi-physician family practice group providing care to residents of the Fox Valley and surrounding areas in Wisconsin. Board certified family physicians and nurse practitioners provide compassionate, high quality care to patients of all ages.