Ghorob Amireh, Bodenheimer Thomas
Center for Excellence in Primary Care, Department of Family and Community Medicine.
Fam Syst Health. 2015 Sep;33(3):182-92. doi: 10.1037/fsh0000120.
Primary care is changing to a team-based model. A number of high-performing primary-care practices in the United States have succeeded in making the transition to team-based care.
Site visits were conducted to 29 high-performing primary-care practices. Observations made in these practices were summarized for common elements exhibited by care teams. A limited literature search was done to review corroborating evidence.
Teams observed in the 29 practices were found to exhibit 9 elements: a stable team structure, colocation, a culture shift in progress from physician-driven to team-based care, defined roles with training and skill checks to reinforce those roles, standing orders and protocols, defined workflows and workflow mapping, staffing ratios adequate to facilitate new roles, ground rules, and modes of communication, including team meetings, huddles, and minute-to-minute interaction.
These 9 elements may be helpful to practices making the transition to team-based care.
初级保健正在转变为基于团队的模式。美国一些高效的初级保健机构已成功过渡到基于团队的护理模式。
对29个高效的初级保健机构进行了实地考察。总结了在这些机构中观察到的护理团队所展现的共同要素。进行了有限的文献检索以审查确证证据。
在这29个机构中观察到的团队展现出9个要素：稳定的团队结构、同地办公、正在从医生主导的护理向基于团队的护理进行文化转变、通过培训和技能检查来强化角色的明确角色、常备医嘱和诊疗规范、明确的工作流程及工作流程映射、足以促进新角色的人员配备比例、基本规则以及沟通模式，包括团队会议、碰头会和即时互动。
这9个要素可能有助于向基于团队的护理模式转变的机构。
