team of health professionals

Modern healthcare is a team sport. Emerging approaches to diagnosisand a contemporary ‘patient-centred', biopsychosocial approach to medicine2 make it increasingly difficult, if not impossible, for a sole practitioner to provide optimal care3.

Team-based primary healthcare provides benefits over traditional sole-provider approaches4, with better quality care, lower use of health services and lower cost for team-based care compared to traditional practice management5. Many elements of team-based care are even associated with “joy in practice” for healthcare providers6.

There’s a wealth of evidence-based practical information about how to build and operate a high-functioning multidisciplinary healthcare team7,8 but there is little focus on patients’ roles in team-based care9, despite the need for inclusion of patients being identified almost two decades ago10.

These established characteristics of high-performing primary healthcare teams11 include:

  • Stable team structure
  • Colocation of team members
  • A cultural shift to sharing tasks and responsibilities
  • Defined roles, with training and feedback
  • Use of standing orders or treatment algorithms
  • Defined workflows
  • Appropriate staffing ratios
  • Ground rules
  • Effective communication

While they might be valuable to health practitioners, they don’t relate to patients’ roles at all.

The observation that Australian patients may not have a full understanding of team-based care and how it may benefit them9 suggests their roles are being overlooked in practice, as they seem to be in much of the research. Perhaps this is the legacy of the biomedical model of disease, which overlooks patient experience, as pointed out by George Engle when he proposed the biopsychosocial medical model12.

The small amount of research about patients’ roles in team-based healthcare demonstrates that patients want to be more involved. For example, a small Dutch study showed that patients who have experience of team-based care want to be active members of their own healthcare teams13. These informed patients want to attend team meetings, they place importance on team composition, meeting structure, and respectful communication, and they want to be able to understand discussions during their team meetings and the decisions that are reached13.

In Australia, where team-based healthcare is more common for patients with chronic disease, people with asthma are more likely to turn to family members, friends, or other laypeople for care rather than some of the health professionals in their multidisciplinary healthcare team14. This behaviour demonstrates patients’ value of the people they know and trust, who help them to look after themselves.

Burgeoning wellness and self-care markets demonstrate people’s desire to form relationships with others who help them look after themselves. Many patients already have a team of people who help them stay healthy and feeling well, which might include personal trainers, masseurs, yoga teachers, sports coaches, and all types of allied health professionals. These people would likely embrace the opportunity to integrate their self-care better with their primary healthcare if the opportunity arose15.

This year, Men’s Health Week focuses on what it means for men to have a team to support their physical, mental and social health. Depending on what is happening in men’s lives, the team might change, but the most invested team member never changes.

Engaging patients as active members of healthcare teams might not be easy but the benefits are likely worth it. There are solutions for overcoming many of the barriers (from the perspectives of practices11,14 and patients14) to the provision of high-quality team-based care. One place to start would be a conversation between patients and their GPs to work out each other’s understanding and expectations of the people on their teams, and where health professionals can help fill the gaps.

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[1] Price et al., 2017. A wellness study of 108 individuals using personal, dense, dynamic data clouds. Nature Biotechnology

[2] Mead & Bower, 2000. Patient-centredness: a conceptual framework and review of the empirical literature. Social Science & Medicine

[3] Fiscella & Epstein, 2008. So Much to Do, So Little Time. Archives of Internal Medicine

[4] Saint-Pierreet al., 2018. Multidisciplinary collaboration in primary care: a systematic review. Family Practice

[5] Reiss-Brennan et al., 2016. Association of Integrated Team-Based Care With Health Care Quality, Utilization, and Cost. JAMA

[6] Sinsky et al., 2013. In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices. The Annals of Family Medicine

[7] Ghorob & Bodenheimer, 2012. Share the Care: Building Teams in Primary Care Practices. The Journal of the American Board of Family Medicine

[8] Fiscella et al., 2017. Improving Care Teams' Functioning: Recommendations from Team Science. The Joint Commission Journal on Quality and Patient Safety

[9] Cheong et al., 2013. Multidisciplinary collaboration in primary care: through the eyes of patients. Australian Journal of Primary Health

[10] Kodner & Spreeuwenberg, 2002. Integrated care: meaning, logic, applications, and implications – a discussion paper. International Journal of Integrated Care

[11] Ghorob & Bodenheimer, 2015. Building teams in primary care: A practical guide. Families, Systems & Health

[12] Engel, 1977. The Need for a New Medical Model: A Challenge for Biomedicine. Science

[13] Van Dongen et al., 2017. “They Are Talking About Me, but Not with Me”: A Focus Group Study to Explore the Patient Perspective on Interprofessional Team Meetings in Primary Care. The Patient - Patient-Centered Outcomes Research

[14] Cheong et al., 2013. Primary health care teams and the patient perspective: A social network analysis. Research in Social and Administrative Pharmacy

[15] Samueli Foundation, 2019. Healthcare and Self-care.

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