Teams in Primary Care

Last week, the FIDO project team had a conversation with Dr Tom Bodenheimer, UCSF faculty member and founding director of UCSF’s Center for Excellence in Primary Care.   Tom has worked diligently to understand health care in the United States.  For many years he has studied ways to organize primary care to provide better care for patients and more joy in work for the people providing the care, for example his 2013 article in the Annals of Family Medicine, “In search of joy in practice: a report of 23 high-functioning primary care practices.” (Ann Fam Med. 2013 May-Jun;11(3):272-8. doi: 10.1370/afm.1531.)

FIDO (“Facilities with Innovative Designs in Organizations”) seeks to document and demonstrate effective design ideas for primary care facilities.   We were eager to hear Tom talk about how care teams should work and the physical and information environment that can help those teams provide great care, reliably.

Tom describes a teamlet as the core unit of team-based care. A teamlet consists of a clinician (MD, nurse practitioner or physician’s assistant) with an assistant or two.   In Lean terms, a teamlet is a cell in the primary care value stream.   Tom also describes a support group that can support three teamlets; a typical support group includes a pharmacist, a nurse, a social worker, behavioral health specialist, and a care manager.  The support group and the three teamlets constitute an entire care team.   Tom introduces team-based care in this presentation at Intermountain Health (accessed 20 July 2017).

Of course, not all primary care practices will be limited to three providers.

Just as Project FIDO has focused on modular physical design, a primary care practice can be built from a number of entire care teams.

One more team member?

The best primary care practices rigorously study and use data on groups of patients as well as data on individual patients.  Relevant patient and panel data, easy to see and updated daily and weekly, appear to be critical to great team performance.   

Tom raised the idea of adding one more member to the extended care team:  a data person to midwife daily and weekly data gathering and display in the workplace.  A dedicated data person for the extended team increases the odds that data tasks will get done; on the other hand, such a role can send a message that other team members don’t need to pay attention to data quality and interpretation.

Regardless of who on the team gathers and displays relevant data to monitor and improve care, it’s clear that design of a high performing primary care clinic must accommodate using and viewing such data.   Whether or not we need a desk and chair for a dedicated data person, our primary care designs need to include space to welcome and nurture a data presence.