By Dan Paloski, Communications Specialist, AHA’s Physician Leadership Forum
In 2011, the American Hospital Association (AHA) and a roundtable of clinical and health system experts crafted a model for a redesigned primary care system, one that encompasses the birth to end-of-life continuum and defines primary care workforce roles. Two years later, the AHA convened another roundtable, this time to discuss reconfiguring the bedside care team in order to meet the demands of health care reform. Below are some key findings from the reports.
In “Workforce Roles in a Redesigned Primary Care Model,” the roundtable’s most important recommendation was the creation of a hub-and-spoke model where patients, their families and the healthy community are at the center of everything. Radiating out are the different health care professionals, charged with delivering care in a team-based setting and to the full scope of their practice. Communication is essential for this model to work, not only among those charged with providing care to the patient, but also with patients and families. Clinicians need to engage patients actively in discussions and decisions regarding their own care and develop strategies to help them effectively manage that care.
One of the greatest challenges highlighted by the roundtable was re-educating the workforce to work in a team-based model of care. In order for teams to function at their highest ability, a fundamental shift in how people are trained needs to take place. Medical schools, colleges, and centers of professional education need to redesign curricula to meet today’s current clinical needs. At the time of the report, roundtable members were concerned with the slow progress on the part of schools and universities in preparing their students for team-based care. In the three years since, some progress has been made. For example, two schools, Brown University and the University of Michigan, have incorporated inter-professional education into their curricula. Both universities are piloting workshops and programs that bring together students from different clinical disciplines and have them work together to solve different issues.
The report also emphasizes the need for a stronger partnership between the community and hospitals. Essentially, hospitals need to evolve into “health systems,” with hospitals as the drivers of community-based population health management. This issue is particularly important for rural areas where primary care access can be limited. Innovative ways to deliver care, including utilizing information technology, telehealth, after-hours access, and non-traditional settings will be vital. The focus should be on wellness that spans the full continuum, and not just on treating illnesses and chronic conditions. In a recent article for USA Today, Rich Umbdenstock, president and CEO of the American Hospital Association, said, “Hospitals are undergoing a major shift, building collaborative teams that are improving the coordination of health care. They’re partnering with other health care providers and experimenting with new ways to provide care where people live and work — not just at the local hospital.” Ultimately, this evolution of hospitals into “health systems” will not be successful without the establishment of a true and balanced partnership with the community.
In “Reconfiguring the Bedside Care Team of the Future,” the authors call for a paradigm shift in how the traditional bedside care team is defined. The report touches on a few of the same themes as the “Workforce Roles” report, namely making sure patients and their families are seen as essential members of the care team, as well as the use of information technology in facilitating and complementing the clinical judgment of the care team. The report identifies four other principles to guide this change in the bedside care team. First, bedside care team members must be fully engaged, working at the full scope of their practice. Second, the care team should be localized to a unit and should be limited to only those patients/families located within that unit. Team members must also be vigilant in coordinating communication with the patient/family. Third, the team should be balanced in regard to meeting patient needs. Evidence-based guidelines that improve care should be developed and followed by all team members. Fourth, no matter where they are in the continuum of care, patients needing acute care should be able to safely move through it.
In response to the shifting and evolving health care system, new models of care are needed, specifically concerning primary care and the bedside care team. With more patients coming into the system and a projected clinical workforce shortage, a team-based care approach with clinicians working to the full scope of their practice is critical. Care must revolve around the patient and family and must be available at any access point along the continuum. In 2015, the AHA Workforce Center plans on developing additional resources to assist hospitals with redesigning and reconfiguring their workforce to meet new care model demands. Copies of both white papers discussed above, along with other workforce resources, can be found at the AHA Workforce Center website, www.aha.org/workforce.