New Review Shows Team-Based Care May Reduce Physician Burnout

Megan Brooks

September 17, 2018

Team-based healthcare improves patient outcomes, efficiency of care, and satisfaction and well-being of physicians, which may help reduce physician burnout, say the authors of a review and discussion paper published online September 17 by the National Academy of Medicine.

"Team-based care is becoming increasingly important as the healthcare delivery system moves from fee-for-service payments to value-based payment models and care itself becomes more complex," first author Cynthia Smith, MD, vice president of clinical programs for the American College of Physicians, said in a news release. "Studies that include a variety of clinical team types show an association with improved patient outcomes and clinician well-being."

"The evidence is clear that healthcare organizations that don't invest in training and sustaining their clinical teams will be at a significant financial disadvantage in the long term. High-functioning teams have tremendous potential to promote clinician well-being, which is foundational to effective and efficient healthcare," write the authors made up of representatives of the American Medical Association, UnitedHealth Group, American Society of Health-System Pharmacists, American Society of Anesthesiologists, and American College of Surgeons.

They define team-based care as the promotion of health services to individuals, families, and/or their communities by at least two health professionals working collaboratively with patients and their caregivers to accomplish shared goals within and across settings to achieve coordinated, high-quality care.

There is strong evidence in the literature to support team-based care in various settings, including ambulatory, emergency department, nursing home, and hospital-based care (intensive care units, wards, and operating rooms). For example:

  • A 2015 review of 52 studies of team-based care for hypertension found that teams achieved controlled blood pressure in 12% more patients than routine care.

  • A 2017 study found that a novel team-based standardized workflow model (e.g., proactive patient outreach, pre-visit schedule grooming, depression screening, care planning, and health coaching) improved patients' self-management of hypertension and diabetes. Over the first 6 months, patients experienced a decline in diastolic blood pressure and improved glycemic control.

  • A 2017 study showed improved survival outcomes in high-risk neuroblastoma patients with a multidisciplinary team-based care approach.

  • A 2008 study of a clinical pharmacy program involving development of professional relationships, nurse education on medication issues, and individualized medication reviews led to a reduction in drug use among nursing home residents with no change in illness or survival, and saved money.

There is also evidence that multidisciplinary team-based care leads to better performance on traditional measures of healthcare quality, such as use of the emergency department and hospital readmissions. And research has shown that optimizing team-based care is cost-effective, the authors point out.

Evidence in the literature also suggests an association between team-based care and physician well-being, the authors note. They point to one "methodologically sound" study demonstrating synergies between teamwork, clinician well-being and patient safety. The authors of this study concluded that addressing clinician emotional exhaustion is an important prerequisite for effective team-based care and patient safety.

Another study found that team culture is more predictive of clinician emotional exhaustion than team structure, while a separate study found that perceptions of better team culture, alone and in combination with tight team structure, were associated with lower clinician exhaustion.

A separate study found that higher work demands or the other physical, psychological, social, or organizational factors that require prolonged physical and/or psychological efforts from workers predicted higher burnout levels. However, teamwork was related to lower levels of burnout.

"These studies indicate that optimizing team-based care is one potential lever to help solve the complex problem of decreased clinician well-being," write Smith and colleagues.

Roadblocks and Solutions

The authors also address barriers to team-based care in the healthcare system as well as possible solutions. One key barrier is the electronic health record (EHR). 

EHRs improve continuous access to legible clinical information, but are not optimally designed to support clinical care, they point out. Current EHR platforms focus more on a single contributor to the notes than on multiple contributors, and they don't easily allow exchange of data about a patient among clinicians in different health systems. "Regulatory changes are needed to leverage the full potential of digital health information," the authors write.

In addition to digital health barriers, workforce barriers to team-based care also exist. They range from the training and mind-set of healthcare team members to team organization and leadership. They also include larger contextual issues related to resources and staffing patterns. The authors say process improvement methods, such as Lean Six Sigma and others, are helpful to analyze the current state of operations and identify waste. "In every system, there are such opportunities to identify and redeploy resources to promote team-based care," they write.

Payment barriers also exist to team-based care and are starting to be addressed, with a shift toward value-based care. "Notably, the passage of the Medicare Access and CHIP Reauthorization Act of 2015 created the Quality Payment Program, which shifts Medicare payment toward rewarding value over volume. As a result, accountable care organizations and other alternative payment models will likely become prevalent modes of care delivery. In light of these trends, it is in the interest of healthcare systems to embrace the shift to value now and not wait until it is the predominant mode of reimbursement," Smith and colleagues write.

Summing up, they say high-functioning care teams have a clear benefit for patients and "tremendous potential" to promote clinician well-being. Additional research is needed to help healthcare organizations routinely measure teamwork using reliable and valid instruments.

"There is also a need for longitudinal studies that better elucidate the relationship between high-functioning teams and clinician well-being, so healthcare organizations and practices have a clear roadmap for evidence-based implementation of team-based care," they conclude.

This work had no specific funding. Smith has reported receiving grants from the Center for Medicare and Medicaid Innovation and that she is employed by the American College of Physicians. A complete list of author disclosures is available with the original article.

NAM Perspectives. Published online September 17, 2018. Full text

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