Howard Jenna, Miller William L, Willard-Grace Rachel, Burger Elizabeth Stewart, Kelleher Kelly J, Nutting Paul A, Hahn Karissa A, Crabtree Benjamin F
Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey (Drs Howard and Crabtree); Lehigh Valley Health Network, One City Center, Allentown, Pennsylvania (Dr Miller); Department of Family Community Medicine, University of California San Francisco (Ms Willard-Grace); Sunflower Foundation: Health Care for Kansans, Topeka (Dr Stewart Burger); The Research Institute at Nationwide Children's Hospital, Columbus, Ohio (Dr Kelleher); and Department of Family Medicine, University of Colorado Health Sciences Center, Aurora (Dr Nutting).
Qual Manag Health Care. 2018 Jul/Sep;27(3):123-129. doi: 10.1097/QMH.0000000000000176.
To learn from the experiences of innovative primary care practices that have successfully developed care teams.
A 2½-day working conference was convened with representatives from 10 innovative primary care practices, content experts, and researchers to discuss experiences of developing care teams. Qualitative data included observation notes, transcripts of conference sessions and interviews, and narrative summaries of innovations. Case summaries of practices and an analysis matrix were created to identify common themes.
Ten practices known nationally for innovations in team-based care participated in the conference represented by 1 to 2 practice members.
Two domains emerged related to creating effective teams and funding them. Participants emphasized the importance of making practice values explicit and involving everyone in the change process, standardizing routine processes, and mitigating resistance. They also highlighted that team-based care adds comprehensiveness, not necessarily productivity. They, thus, highlighted the need for a long-term financial vision, including resourcefulness and alternate funding.
Team-based care is possible and valuable in primary care. It is difficult to develop and sustain, however, and requires dedicated time and resources. The challenges these highly motivated practices described raise the question of feasibility for more average practices in the current funding environment.
借鉴成功组建护理团队的创新型初级保健实践经验。
召开了一次为期两天半的工作会议，与会代表来自10个创新型初级保健实践机构、内容专家和研究人员，以讨论组建护理团队的经验。定性数据包括观察记录、会议和访谈记录以及创新的叙述性总结。创建了实践案例总结和分析矩阵以识别共同主题。
10个在基于团队的护理创新方面全国闻名的实践机构参与了会议，每个机构有1至2名实践成员代表。
出现了与创建有效团队及其资金支持相关的两个领域。参与者强调明确实践价值观以及让每个人都参与变革过程、使常规流程标准化和减轻阻力的重要性。他们还强调基于团队的护理增加了全面性，但不一定提高了生产力。因此，他们强调需要有长期的财务愿景，包括足智多谋和寻找替代资金。
基于团队的护理在初级保健中是可行且有价值的。然而，其发展和维持具有难度，需要投入专门的时间和资源。这些积极性很高的实践机构所描述的挑战引发了一个问题，即在当前的资金环境下，对于更多普通实践机构而言是否可行。
