A new recipe for teamwork in primary care

Jordi Varela
Editor

 

Primary care teams in Spain are under pressure from the schedules of daily visits, which sends multidisciplinary teamwork to the background. To understand each other, the sessions are held whenever possible and the level of attendance and participation is often irregular, given that nothing encourages them. The core aspect of a primary care centre today is that each doctor and each nurse is assigned a contingent of citizens -presumed to be patients-, who, when requested, must be attended to as soon as possible.

Despite this stubborn reality, we now see that all primary care reforms, here and abroad, are aimed at fostering multidisciplinary teamwork, an issue that is creating tension within health centres, as that both managers and professionals do not know how to turn the individualistic model around. Inertia is thus playing a trick on us. For this reason, it is appreciated that King's Fund gave us a short recipe book to help primary care teams take a leap, which at this point seems to be costing too much and, for this reason, I have prepared a summary:

1. The three fundamentals of teamwork: a) each team must develop and share objectives that can be assumed by all (a DPO from above is not worth it); b) the roles and responsibilities of each of its members must be well established, but the team must be dynamic enough to revisit them whenever necessary; c) a climate of trust must be created, sufficient to be able to speak openly about everything and, therefore, we must find a type of periodic meeting that is as efficient as possible.

2. What professionals should multidisciplinary teams incorporate? For recruitment, you have to think of two concentric circles, in the first, there will be the basic clinical nucleus: doctors and nurses, and the professionals who should support them: clinical assistants, administrative, auxiliary care technicians, social workers, pharmacists, case managers and community health experts. In a second circle, there would be a group of professionals destined to expand primary care services: physiotherapists, psychologists, occupational therapists, dental hygienists, dentists, nutritionists, podiatrists, etc.

"Closing the gap, key areas for action on the health and care workforce", a document signed by The Health Foundation, King's Fund and Nuffield Trust, which was already mentioned in this blog by Cristina Adroher ("Who does what, we redefine the roles of healthcare professionals"), envisions the future of primary care in professional networks with a higher resolution capacity than the currently.

3. How can teams be organized? According to the King's Fund experts, there is no magic formula for what a primary care team should look like, but there are three aspects that should be taken into account: a) the idea that the team must be stronger than the individual action; b) the size of the teams should be manageable; c) gaps or duplications should be adjusted on the fly, balancing real needs with the interests of each of the professionals.

4. How can effective communication be achieved? An investigation carried out in Google concluded that the key to the success of efficient teams is psychological safety. Everything indicates that professionals want work environments in which they are not afraid to propose things or even to make mistakes in their proposals. Those responsible for the teams must therefore be very attentive to maintaining a level of quality internal communication, paying attention to the identification and resolution of problems.

5. Is it necessary to redesign the physical space? Primary care teams must consider the spaces in their centres, as most of them were designed when the priority was determined by waiting rooms and doctor's offices. Now it is necessary to develop functional plans that include the new priorities of multidisciplinary teamwork, telework and telemedicine; and no one is aware that waiting rooms can become spaces where new functionalities could gain ground (don't miss the post: "Can you imagine external consultations without waiting rooms?").

6. How should management autonomy be exercised? A new, more deregulated model requires more freedom of movement for professionals in an environment of greater trust, in which accountability takes the lead. In this sense, the authors of King's Fund call for new, more efficient mechanisms for evaluating professionals and more training strategies linked to the gaps and needs detected in multidisciplinary teams.

7. How to network with other teams? Fortunately, services other than the basic core of primary health care are deployed in the territory, such as, for example, social services, municipal services, mental health services, sexual and reproductive health services, care for addicted people, etc. The point is that you have to know how to weave a network through cooperation in projects and you have to learn from each other in the different ways of understanding problem-solving.

8. How to involve patients? The authors of the formulary propose to involve patients in internal decisions that may end up affecting services. They especially cite the difficulties observed in the current individualistic model to respond to the longitudinality in the doctor-patient relationship and how the different members of the team can generate the knowledge and trust necessary to provide a continuous service over time. It is at this point that, they say, it is convenient that patients are willing to collaborate.

The organizational model around the agendas of family doctors is stuck and shows signs of difficulties in maintaining longitudinality in health care, which is why it is necessary to leap multidisciplinary teamwork, the only way to ensuring continuity and expanding services, which is why I think the King's Fund recipe can be helpful in our country.