Engaging the Entire Team: More Energizing Than Your Morning Coffee

Improving quality metrics has been a focus for departments and services across Johns Hopkins Community Physicians (JHCP), and in fiscal year 2020, leaders in adult primary care made progress with one method in particular: engagement of the entire care team.

According to JHCP’s chief of internal medicine and primary care clinical innovation, Michael Albert, and chief of family medicine, Steven Blash, there are many benefits with a team-based approach to quality improvement. A major benefit is psychological: Teamwork makes big asks more manageable — it takes the onus off of one person, and distributes the workload. “Engaging everyone and working collaboratively is energizing,” Albert notes. “Knowing that I have a team that is also invested in quality improvement scores is motivating and gives us the best chance of success.” The more touchpoints with the patient, the more likely we are to capture quality outcomes, like hypertension and diabetes control, annual well visits and colorectal cancer screenings. The team-based approach can also ensure that every member of the care team is working at the top of their license.

One of the easiest and most effective ways to engage the whole team is through daily huddles. Blash says he and a member of his medical assistant (MA) team have a five-minute huddle every morning before patient care begins. They use the time to review the day’s appointments and who may be a candidate for a mammography, or who might need an A1C test for diabetes control. He says the meetings require a bit of preparation time, but that they are more than worth it, likening them to morning cups of coffee. “They are a centering experience for the day,” he says, “a time to re-focus and make a game plan.” He notes that his MAs often initiate the huddles, keeping him on track. Albert and Blash have noticed providers holding more morning huddles with their teams during the past year — a testament to their effectiveness.

A new method, similar to having the morning meetings, that emerged during fiscal year 2020 is holding a Secure Chat — a secure instant messaging function built into JHCP’s EMR, Epic. Before Secure Chat, teams could use the messaging capability in their in basket, but those messages would easily get buried among others. This new function increases real-time communication, and makes messages easy to find. Albert explains that Secure Chat has created another avenue for care teams to connect and collaborate — this is especially impactful during the COVID-19 pandemic, since physical distancing is required in practices. Other developments in team-based care in JHCP, like nonprescriber initiated patient orders (NIPOs), have also supported team involvement in recent years. For requests that do not require medical decision making (for example, when a patient requests a mammogram), staff can generate the referral without waiting for a provider’s signature.

These systematic approaches to team-based care are important, but each practice is different. Often, the most impactful workflow and protocol changes are unique to certain sites. For example, JHCP’s Canton Crossing location achieved high quality metrics in colorectal cancer screening with a Cologuard workflow — staff members are empowered to find eligible patients and enter orders for co-signature. Another example comes from Greater Dundalk, where leaders, staff members and providers have collectively agreed on standards for hypertension control. If a patient has elevated blood pressure, staff members can schedule an appointment on an agreed-upon interval to have the patient return for a blood pressure follow-up. Says Greater Dundalk practice administrator Nicole Oliver, “It would never be possible for our site to improve the care we provide our patients and in turn see positive movement in our quality metrics without the engagement of the entire team. Everyone plays a crucial role and must be engaged in helping take the best care of our patients.”

When staff members, in addition to providers, emphasize the importance of screenings and tests in an organized way, they not only boost quality metrics but also “send a powerful message of trust and confidence” to patients, notes Blash. “Our patients know that the entire team cares about bettering their health — it enhances connectiveness and a sense of community.”

The future of primary care will inevitably bring a shift of focus from volume to value — from how many patients we see to how well we take care of them. Albert and Blash say that is a reason to embrace the team-based care approach. Success is not easily produced in a silo — together, our teams improve quality of care for our patients.