Health Team Models

There are many ways to develop health-oriented teams. The approach will depend on the needs of patients, the availability of team members, the size of the clinic, strategic planning, and the support of administration and clinic staff. Teams can be initiated in all sizes of clinics, from large, complex institutions to small, rural settings, and may take many forms. For example, a team may include only the family physician and two health coaches or medical assistants. This "teamlet" model extends the office visit to include communication before the visit, after the visit, and between visits (Bodenheimer and Laing, 2007). The teamlet uses these opportunities to address patient needs and develops appropriate strategies. The health team's common mission is working toward the greatest improvement in the patient's quality of life. If the group agrees to work toward uncovering root causes of symptoms, this common goal will progress to disease resolution.

The team does not need to share the same space as long as they maintain communication and build intermember relationships. This will help clinicians learn of each other's interests and talents in relation to common goals, fostering mutual understanding, trust, and respect. Without the team concept, there will simply be separate therapies and professionals working in isolation, causing fragmentation of care.

Table 2-3 Defining Disciplinary Teams

Term

Definition

Multidisciplinar^ team

Additive. "Comprised of more than two professionals from different health care disciplines who work with the same patient, set of patients, or clinical condition, but provide care independently of each other' (Interdisciplinary Team Building). For example, a patient may have visits with both a primary care practitioner (PCP) and physical therapist (PT). Although the PCP may view clinical notes or a report from the PT, the two disciplines usually do not interact.

Interdisciplinary team

Interactive. An ongoing and integrated care team of one patient, set of patients, or clinical condition. Team members develop collegial relationships with shared goals and joint decision making. They interact, supporting as well as questioning each other's opinions, and negotiate to develop health strategies based on the needs of the individual.

Transdisciplinary team

Holistic. Professionals learn from each other and in the process transcend traditional disciplinary boundaries, which may result in new knowledge. Often, the greater the difference between professions (epistemologic distance; e.g., engineering and humanities), the more likely insight will develop toward the creation of a new way to solve a problem.

Data from Choi BC, Pak AW. Multidisciplinarity, interdisciplinarity and transdiscipli-narity in health research, services, education and policy. 1. Definitions, objectives, and evidence of effectiveness. 3. Discipline, inter-discipline distance, and selection of discipline. Clin Invest Med 2006;29:351-64; 2008;31:E41-E48.

Data from Choi BC, Pak AW. Multidisciplinarity, interdisciplinarity and transdiscipli-narity in health research, services, education and policy. 1. Definitions, objectives, and evidence of effectiveness. 3. Discipline, inter-discipline distance, and selection of discipline. Clin Invest Med 2006;29:351-64; 2008;31:E41-E48.

Table 2-4 Health-Oriented Team Creation Worksheet (Example: Achieving Optimal Back Health)

Task

Action

Health need of my community

Achieving optimal back health

Identify professionals to address health need.

1. Manual practitioner

2. Physical therapist

3. Psychologist/"mindfulness" instructor

4. Health coach

Delineate the team-focused goal/mission.

To empower patients to learn how to achieve their ideal back function and health.

Name the health-oriented program.

"Back to Health" program

Create relationships between team members.

Team members to meet initially to develop program goal/mission and methods of interacting. Periodic meetings as needed for team building and interactions around patient issues.

Agree on team communication method.

Fax or e-mail will be sent to the team for referrals, findings, and discussion.

Follow up and promote sustainability.

Patient will meet periodically with health coach/nurse at the medical home to sustain lifestyle behaviors.

The most important ingredient in effective teams is trust— trust that each team member will play his or her particular part in care delivery and process improvement (Sargeant et al., 2008). Changing to an effective team approach takes humility and time and requires constant fine-tuning and quality improvement. However, the physician can begin in any domain that fits the readiness of the practice (see Table 2-4), and the effects will often spread to other domains. The following checklist provides some places to start in a practice assessment format.

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