Team-based care has been linked to better access, higher patient satisfaction, and improved chronic care management. But it also opens the door to turf wars and friction — particularly among physicians and advanced practitioners who work together in the exam room. To keep care teams on task and preempt potential conflict, effective leadership is a must.
"The administrator is truly the kingpin of the practice," says Katrina Slavey, network executive for The Halley Consulting Group, a practice management consulting firm in Westerville, Ohio. "It's their job to create partnerships, not only between the physicians and providers, but with the entire staff. Synergy allows the practice to deliver the best possible care."
As practices transition to team-based delivery models, she says, either as a Patient-Centered Medical Home or Accountable Care Organization, the administrator, more than ever, must cultivate a collaborative culture, hold providers accountable, and communicate effectively with the staff.
The probability that providers will overstep their bounds, or under deliver, is drastically higher when roles are undefined. Such missteps fuel resentment and lower productivity. As such, every member of the care team must be crystal clear on what their job responsibilities entail. "It's amazing to see how many advanced providers, when put on a care team, aren't really sure what their roles are," says Elizabeth Woodcock, a practice management consultant with Atlanta-based Woodcock & Associates.
Job descriptions, she said, should include a detailed description of scope of service, some of which will depend on state guidelines. Physician assistants (PAs), for example, must practice medicine under the direct supervision of a physician, while nurse practitioners (NPs) may practice independently in 21 states, plus the District of Columbia. The remaining states restrict NP autonomy in some capacity.
That said, every care team is different. Some physicians want their advanced practitioners to copy them on every email to patients. Others want PAs to inform them of referrals for emergent patients only, or review their NP's responses when a patient calls in with a clinical query. Physicians and administrators should work together to clarify expectations, says Woodcock.
Likewise, office managers and administrators must hold every team member accountable for meeting quality and safety goals, including clinicians, and redirect those who perform tasks outside their defined job responsibilities, says Woodcock. Such dialogue should be viewed as a learning opportunity, not a slap on the wrist. By explaining how each role contributes to the mission of better care, that employee (or physician) gains a better understanding of where they fit on the care-team continuum and the value of their expertise.