With healthcare complexity increasing daily, traditional models of delivering care fail to offer a viable framework capable of delivering high quality care at a reasonable cost. The rapid and ever-changing medical knowledge makes It impossible for any healthcare professional to assimilate and retain the up-to-date information necessary to properly treat patients. Although healthcare information technology offers a tool to assist in managing this information, placing the patient in the center of the care delivery team allows for the construction of healthcare information technology workflows that best leverage the skills of each care giver and the capabilities of information technology tools.
The evolution of physicians from barber-surgeons to doctors created a healthcare practice where society expected physicians to possess a comprehensive satchel of knowledge and skills that superseded those of a nurse, pharmacist, therapist, and other clinical professionals. Considering physicians went through the most rigorous selection process and training when compared to these peers, a hierarchy built upon physician leadership of patient care seemed practical. As medical knowledge expanded beyond the human capability to assimilate it, this model no longer provides an effective approach to caring for patients.
Understand Skills and Knowledge
A 21st century approach to care delivery requires an understanding of the skills and knowledge of each care team provider, and development of a patient-centered care model built upon the team approach to a clinical problem rather than a top-down methodology driven solely by the physician.
Each current care team member offers a unique perspective to a patient’s clinical problems. This viewpoint grows from that professional’s training and clinical experiences. In addition, each care giver spends varying amounts of time with a patient. This allows some clinicians to collect data points on patients that might not be readily available to others whose patient interaction time is limited.
For example, among all clinicians, nurses spend the most amount of time with both the patient and family members. The information available to be collected by nurses exceeds all similar information available to the other clinicians. Although utilizing this information to formulate and deliver a care plan makes rational sense, structural workflow issues often prevent that information from being used effectively by the other care team clinicians.
Obstacle to Sharing Information
In addition, the workflow dictated by existing electronic medical record and other healthcare information technology systems often forms an obstacle to effective patient information sharing. The focus on clinical documentation to satisfy the needs of the electronic record decreases time for effective communication with peers that allows robust collaboration on patient care. Relying on the expansive electronic record to facilitate communication and collaboration fails to recognize the “needle in the haystack” problem presented by unfocused clinical documentation segmented into reporting silos by clinical discipline and responsibility.
Effective structure of a clinical team coupled with intelligent and efficient healthcare information technology driven workflows offer a meaningful way to deliver high quality knowledge driven care delivered by the appropriately skilled clinicians in tune with the approach and activities of all the other members of the care team.
Rather than a top-down approach to care team management, care teams should reflect the structure of an orchestra. Although a conductor directs each of the musicians, each player offers input to the conductor and brings nuance to the playing of the music. The sheet music provides each player with a common plan to deliver a symphony to the audience. Although the conductor has ultimate control over the orchestra, each musician reading from the same score delivers an individual performance that collectively generates the applause when the music stops.
If we think about care delivery similarly, we can construct a care delivery model that better utilizes the skills of each clinician while directing all of them to follow the same approach to bringing a patient to a healthy state.
First, a care delivery team must truly be a team where each member receives equal respect for their skills and knowledge. Although the physician may know more about medicine overall, each care team member will know more about how to assess or deliver some aspect of the patient’s care. Failure to leverage each team member similarly leads to missed clues about the patient’s condition, ignoring of alternative methods of treatment, and errors in judgement derived from decision making lacking all the available pertinent facts.
Healthcare information technology retains the ability to construct the “sheet music” for patient care, so that all team members work synergistically and collaboratively towards improving a patient’s condition. Effective clinical decision support software offers a method to provide disease and patient specific medical knowledge to every member of the care team. By synchronizing this medical knowledge among clinicians, the activities and interventions delivered by the care team maintain a higher probability of effectiveness.
In addition to medical knowledge synchronicity, the information must fall within an effective and clinician friendly workflow to increase the likelihood the information will be used by the care giver at the point of care. Making the delivery of the knowledge a regular, expected, and accepted piece of the workflow for care delivery allows the flexibility to change that medical knowledge as needed while not decreasing the probability that it will be synthesized.
Changed Yet Unchanged
For the care giver, the changed knowledge is perceived as unchanged as it fits the pattern of information delivery expected in the unchanged workflow. Such an approach could allow the rapid deployment of new medical information in patient care without the need for extensive and often ineffective medical education on the discovery of a new piece of relevant medical knowledge. The education, training and deployment all become bonded together in the workflow of every team member.
Although our informaticists continue to research the best ways to deploy healthcare information technology, focus on a highly collaborative care team formed from multiple disciplines must be their target group. In addition, attention should be paid to the role of clinical decision support in the development of clinical workflows targeted at entire care teams rather than its individual members.
Excerpts from “Build a Care Team” published in Patient Safety and Quality Healthcare