Medical Associates Clinic and Health Plans, Dubuque, Iowa 52001, USA.
Ann Fam Med. 2013 May-Jun;11(3):272-8. doi: 10.1370/afm.1531.
We highlight primary care innovations gathered from high-functioning primary care practices, innovations we believe can facilitate joy in practice and mitigate physician burnout. To do so, we made site visits to 23 high-performing primary care practices and focused on how these practices distribute functions among the team, use technology to their advantage, improve outcomes with data, and make the job of primary care feasible and enjoyable as a life's vocation. Innovations identified include (1) proactive planned care, with previsit planning and previsit laboratory tests; (2) sharing clinical care among a team, with expanded rooming protocols, standing orders, and panel management; (3) sharing clerical tasks with collaborative documentation (scribing), nonphysician order entry, and streamlined prescription management; (4) improving communication by verbal messaging and in-box management; and (5) improving team functioning through co-location, team meetings, and work flow mapping. Our observations suggest that a shift from a physician-centric model of work distribution and responsibility to a shared-care model, with a higher level of clinical support staff per physician and frequent forums for communication, can result in high-functioning teams, improved professional satisfaction, and greater joy in practice.
我们强调了从高绩效初级保健实践中收集到的初级保健创新，我们相信这些创新可以促进实践中的快乐并减轻医生倦怠。为此，我们对 23 家高绩效初级保健实践进行了实地考察，并重点关注这些实践如何在团队中分配职能，利用技术发挥优势，利用数据改善结果，并使初级保健作为一种职业成为可行和令人愉快的工作。确定的创新包括：（1）主动计划护理，包括预访计划和预访实验室测试；（2）在团队中共享临床护理，扩大分诊协议、常规医嘱和面板管理；（3）通过协作文档（抄写）、非医师医嘱录入和简化处方管理共享文书工作；（4）通过口头信息和收件箱管理改善沟通；（5）通过共同办公、团队会议和工作流程映射改善团队运作。我们的观察表明，从以医生为中心的工作分配和责任模式向共享护理模式转变，每医生配备更多的临床支持人员，并经常进行沟通论坛，可以实现高绩效团队、提高专业满意度和更大的实践快乐。
