High quality high performing practices do not happen by accident. Bodenheimer & colleagues in The 10 Building Blocks of High-Performing Primary Care (Ann Fam Med 2014;166-171. doi: 10.1370/afm.1616.) have looked at what seems to be the important building blocks and linked the blocks with Starfield's 4 pillars of primary care.
1. Engaged leadership - fully engaged un the process of change
2. Data driven Improvement - monitoring the progress towards objectives
3. Empanelment - linking each patient with a care team and named GP
4. Team Based care - A good team means one GP can do more
5. Patient-Team partnership - includes addressing what matters to the patient and shared decision making
6. Population Management - having teams to match the needs of different patient groups
7. Continuity of Care - 1 of Starfield 4 Pillars of Primary Care
8. Prompt access to care - 1 of Starfield 4 Pillars of Primary Care
9.Comprehensiveness and Coordination -2 of 4 Starfield Pillars of Primary Care
10. Template for the future - Offer patients choices for what they need with a team that can share the care
GPFUQ #214 How do you build a health care team with good structure (anatomy or hardware) and good culture (physiology or software)?
In the Anatomy and Physiology of Primary Care Teams (JAMA Internal Medicine January 2019 Volume 179, Number 1 p 61-2) Bodenheimer reviews how primary care flourish by creating teams that share the care, with well-trained and empowered team members taking on functions that do not require a medical degree. Evidence is accumulating that primary care teams can improve care, reduce health care costs, and make inroads in the problem of clinician burnout. But not any team will do. To be effective, teams must be stable, build a positive team culture, and share the care.
Team structure has 2 facets: (1) who is on the team and (2) how stable is the team. Team culture also has 2 components: (1) how team members work together and (2) how teams share the care.
Teambuilding has 3 phases: planning, adoption, and routinized phases of team building. Routinized practices have at least 6 years of team-based care with standardized workflows.
For clinicians, the emotional exhaustion component of burnout was high when team culture was low. When team culture was high, emotional exhaustion was significantly lower for clinicians working with the same medical assistant compared with clinicians
without a stable team.
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