Harrod Molly, Weston Lauren E, Robinson Claire, Tremblay Adam, Greenstone Clinton L, Forman Jane
a VA Ann Arbor Healthcare System , Ann Arbor , Michigan , USA.
b Department of Internal Medicine , University of Michigan , Ann Arbor , Michigan , USA.
J Interprof Care. 2016 May;30(3):295-300. doi: 10.3109/13561820.2015.1130028. Epub 2016 Mar 30.
Within the US, the patient-centred medical home has become a predominant model in the delivery of primary care. This model requires a shift from the physician-centric model to an interprofessional team-based approach. Thus, healthcare staff are being reorganized into teams, resulting in having to work and relate to one another in new ways. In 2010, the Veterans Health Administration implemented the patient aligned care team (PACT) model, its version of the patient-centred medical home. The transition to the PACT model involved restructuring primary care staff into "teamlets", consisting of a registered nurse, licensed practical nurse, and administrative clerk for each full-time-equivalent primary care provider. This qualitative study used observation and semi-structured interviews to understand the factors that affect teamlet functioning as they implement this new model of care and how teams are interacting to address those factors. Findings suggest that role understanding includes understanding how each teamlet member's tasks are performed in the daily operations of the clinic. In addition, willingness to perform tasks that benefit the teamlet and acceptance of delegation from all teamlet members were found to be important for teamlet functioning and cohesion. In order for healthcare teams to provide patient-centred care, it is important to provide guidance and support about what these new relationships and roles will entail. The building of team relationships is not a static process; ways of working together build over time and, therefore, should be seen as a continuous cycle of quality improvement.
在美国，以患者为中心的医疗之家已成为初级医疗服务提供的主要模式。这种模式需要从以医生为中心的模式转变为以跨专业团队为基础的方法。因此，医护人员正在被重新组建为团队，这就导致他们必须以新的方式相互协作和相处。2010年，退伍军人健康管理局实施了患者对齐护理团队（PACT）模式，即其版本的以患者为中心的医疗之家。向PACT模式的转变涉及将初级护理人员重组为“小团队”，每个全职等效的初级护理提供者配备一名注册护士、一名执业护士和一名行政职员。这项定性研究采用观察和半结构化访谈的方法，以了解在实施这种新的护理模式时影响小团队运作的因素，以及团队如何相互作用来应对这些因素。研究结果表明，角色理解包括了解每个小团队成员的任务在诊所日常运作中是如何执行的。此外，发现愿意执行对小团队有益的任务以及接受所有小团队成员的任务委托对小团队的运作和凝聚力很重要。为了使医疗团队能够提供以患者为中心的护理，重要的是要就这些新的关系和角色所涉及的内容提供指导和支持。团队关系的建立不是一个静态的过程；合作方式会随着时间的推移而发展，因此，应该被视为一个持续的质量改进循环。
