Toolkit for Implementing the Chronic Care Model in an Academic Environment
The Oregon Health & Science University found several factors assisted them in their successful team-building endeavors, including holding meetings and sharing responsibility for tasks.
Three Team-Building Factors
Three factors defined the team-building aspect of the Oregon Health & Science University project:
Holding regular patient-care team meetings in the practice where team members work. To help build team identity and enhance communication, members of the support staff have offices in the same area where the planned visits are conducted. The team's social worker, lead nurse, and lead medical assistant for the project join the team in the shared workspace during planned visits, while residents share a common workspace in the same area as well.
By sharing the same work area, members of the practice team were able to deliver individualized care for each patient through a fluid communication structure at the point of care.
Empowering team with shared responsibility. In addition to training the team in the Chronic Care Model and the aim of the Academic Chronic Care Collaborative project, the team held weekly meetings to identify improvement opportunities using a plan-do-study-act (PDSA) approach.
Having the team take responsibility for targeting areas for improvement was important to Oregon Health & Science University's success in the collaborative because team members were more inclined to embrace changes generated from within its own PDSA cycles than those mandated from outside the group.
During several months of discussion and planning, team members shifted from a doctor-centered, hierarchical model of care to a highly functional improvement team where everyone's ideas are valued and "failed" cycles are seen as some of the most important learning opportunities.
Similarly, the new team-based approach expanded roles to share responsibility of care:
- Medical assistants were trained to perform both brief and monofilament foot examinations, record findings on an electronic image, and make decisions about the appropriate exam for each patient based on guidelines.
- Medical assistants were also trained to expedite immunization compliance by assessing each patient's immunization history, entering orders for appropriate immunizations, and obtaining consent and administering the influenza and pneumococcal immunizations based on protocol. Physicians received reminders to co-sign these orders and phone-call documentation.
- The team registered nurse was empowered to follow up by telephone with patients between visits based on guidelines and protocols. In particular, patients who set new self-management action plans all received follow up from the nurse or a medical assistant to whom the task was delegated.
- Building trust. Redefining team roles to share responsibility also required that physicians learn to trust support staff and staff learn to trust that physicians would validate their decisions and actions.