Assignment Task:
A Well-Functioning Primary Care Team in a Small Private Office
Charles Burger is a private practitioner in Bangor, Maine. From a distance, this remarkable primary care practice resembles thousands of physician offices throughout the country. Upon entering the office door, it is clear that-within a traditional practice setting-Dr. Burger has created a smoothly functioning primary care team. The entire office functions as one team-two physicians and two nurse practitioners are the clinicians, complemented by medical assistants, greeters, receptionists, and schedulers. The practice is financially stable and is busy, with each clinician seeing 23 to 30 patients per day. The following case typifies how the team model works.
Ms. P called Dr. Burger's office complaining of recurrent abdominal discomfort after eating. The receptionist consulted her computerized triage protocol and provided Ms. P with a same-day appointment. When she arrived, the greeter, already aware of the patient's problem, gave her a medical history questionnaire specifically related to abdominal pain, which Ms. P filled out in the waiting room. Ms. P met with the medical assistant who checked her vital signs and quickly entered her questionnaire responses into the computer. Ms. P then saw the physician, who reviewed the history, performed a relevant physical examination, and consulted a diagnostic software program. Discussing the options with Ms. P, the physician and patient decided on a diagnostic and treatment plan. Ms. P then met with the scheduler, who arranged laboratory and ultrasound studies.
Dr. Burger's staff members were all trained at a 15-week course in quality management at a nearby college. Greeters, receptionists, and schedulers (who are cross-trained) also received six weeks of in-office training.
All clinical processes in Dr. Burger's office are guided by a system. The practice has adopted advanced-access scheduling, offering patients same-day appointments. For years, the office has tracked demand and can predict how each day will unfold. On Mondays, heavy with telephone calls, more staff act as receptionists and few scheduled appointments are made.
Whereas in most offices, receptionists are not trained to properly triage patients into emergency, urgent, and routine categories, Dr. Burger designed a triage system that receptionists consult on every telephone call. When Ms. P called with abdominal complaints, the receptionist pulled up the gastrointestinal screen on the triage protocol, which prompted a series of questions including pain severity and presence of vomiting, diarrhea, black and/or bloody stools, or fever. In the case of positive answers, the protocol tells the receptionist to send Ms. P to the emergency department. For milder symptoms, an appointment is made, perhaps with previsit laboratory studies. The interaction is routed to Ms. P's medical record and a clinician's e-mail in-box.
Most communication is routinized by the office's clinical systems. Team members do not attend endless meetings. Incoming calls are routed to the e-mail inbox of the appropriate team member. Urgent messages are delivered in person. Diagnostic studies go to the appropriate e-mail inbox and the medical record. The well-trained medical assistants order clinical preventive studies on the basis of the patient's age and sex. Clinic goals and performance measures are communicated to all staff by posters prominently displayed in the office.
After reading the article, analyze the case. Most importantly you should point out how the case exemplifies the strengths and/or weaknesses of team performance using Types Of Teams, Barriers To Effective Teamwork, Common Characteristics Of Successful Teams, Informal Or Formal Group Structure, And Cohesiveness