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Nursing Assignment

Healthcare Team Members Importance and their Roles

Healthcare Team Members Importance and their Roles -Members of a Healthcare Team in nursing foundation Importance of Nurses in the Healthcare Team

Healthcare is a complex and challenging field that requires a multidisciplinary approach to ensure optimal patient outcomes. The healthcare team plays a crucial role in providing patient-centered care, and effective communication and collaboration among team members are key components of success. In this article, we will explore the concept of a healthcare team, the importance of collaboration and communication, the different types of healthcare teams, and strategies for promoting effective teamwork.

Table of Contents

Definition of Health Care Team

A healthcare team is a group of healthcare professionals from different specialties who work together to provide patient-centered care. The team may include doctors, nurses, pharmacists , physical therapists, occupational therapists, social workers, and other healthcare professionals who work together to provide comprehensive care to patients.

Members of a Healthcare Team

When it comes to receiving quality healthcare, patients rely on a team of professionals to provide them with the necessary care and attention they need. The members of a healthcare team work together to provide the best possible care to patients, and each member plays a critical role in ensuring that patients receive the care they need. we will explore the different members of a healthcare team and their roles in patient care.

1. Physicians

Physicians are often the first point of contact for patients when they seek medical care. They are responsible for diagnosing and treating illnesses and injuries, prescribing medication, and ordering tests and other diagnostic procedures. They work with other members of the healthcare team to develop treatment plans and provide ongoing care to patients.

Nurses are an essential part of the healthcare team, providing patients with care and attention throughout their stay in the hospital. They work with physicians to administer medication, monitor patients’ vital signs, and provide emotional support to patients and their families.

3. Pharmacists

Pharmacists are responsible for dispensing medications and ensuring that patients receive the correct medications and dosages. They work closely with physicians and nurses to provide medication therapy management and ensure that patients understand how to take their medications correctly.

4. Physical Therapists

Physical therapists are responsible for helping patients regain their strength and mobility after an illness or injury. They work with patients to develop personalized treatment plans to help them achieve their goals and regain their independence.

5. Occupational Therapists

Occupational therapists help patients regain their ability to perform daily tasks, such as bathing, dressing, and cooking. They work with patients to develop personalized treatment plans to help them regain their independence and improve their quality of life.

6. Speech Therapists

Speech therapists work with patients who have difficulty speaking or swallowing due to an injury or illness. They help patients regain their ability to speak and swallow by developing personalized treatment plans.

7. Medical Social Workers

Medical social workers provide patients and their families with emotional support and assistance with navigating the healthcare system. They work with patients to identify their needs and connect them with community resources and services.

8. Dietitians

Dietitians play a critical role in patient care by developing personalized nutrition plans for patients. They work with patients to ensure that they receive the right nutrition to support their recovery and overall health.

9. Respiratory Therapists

Respiratory therapists are responsible for helping patients with breathing difficulties due to an illness or injury. They work with patients to develop personalized treatment plans to improve their breathing and overall health.

10. Diagnostic Professionals

Diagnostic professionals include radiologists, sonographers, and laboratory technicians. They are responsible for performing diagnostic tests and providing accurate results to physicians to aid in diagnosis and treatment plans.

11. Administrative Professionals

Administrative professionals include medical billers, coders, and receptionists. They play an important role in ensuring that the healthcare facility runs smoothly and that patients receive the best care possible.

The Importance of Nurses in Healthcare Team

The healthcare system is complex and requires a team of professionals to work together to ensure that patients receive the care they need. Each healthcare team member brings a unique set of skills and knowledge to the table, and when they work together, they can provide patients with the best possible care.

Providing Compassionate and Evidence-Based Care

Nurses are responsible for providing compassionate care to patients, which is an essential component of healing. They must be able to communicate effectively with patients and their families, listen to their concerns, and provide emotional support. Additionally, nurses must use evidence-based practice to provide the best possible care to their patients. This involves staying up-to-date on the latest research and using it to inform their clinical practice.

Managing Complex Medical Situations

Nurses are often the first healthcare professionals to assess patients and develop care plans. They are responsible for monitoring vital signs, administering medications, and managing complex medical situations. This includes recognizing and responding to changes in a patient’s condition and intervening as needed to prevent further deterioration.

Collaborating with Other Healthcare Professionals

Nurses work closely with other healthcare professionals, including doctors, pharmacists, and therapists, to provide comprehensive care to patients. They are responsible for communicating patient information, providing updates on treatment plans, and ensuring that all members of the healthcare team are working together effectively.

Collaboration and communication among healthcare team members are essential to providing high-quality patient care. Healthcare organizations must invest in strategies to promote effective teamwork, such as fostering a culture of collaboration and communication, utilizing technology to facilitate communication and collaboration, and providing ongoing education and training on effective teamwork. By working together, healthcare teams can improve patient outcomes, enhance patient safety, and reduce healthcare costs.

What is a healthcare team?

A healthcare team is a group of healthcare professionals from different specialties who work together to provide patient-centered care.

What are the benefits of effective collaboration and communication in healthcare teams?

Effective collaboration and communication can improve patient outcomes, enhance patient safety, and reduce healthcare costs.

What are some strategies for promoting effective teamwork in healthcare?

Strategies for promoting effective teamwork include fostering a culture of collaboration and communication, encouraging open communication among team members, utilizing technology to facilitate communication and collaboration, establishing clear roles and responsibilities for each team member, providing ongoing education and training on effective teamwork, and addressing conflicts in a timely and constructive manner.

What is the role of technology in facilitating communication and collaboration among healthcare team members?

Technology can play a significant role in facilitating communication and collaboration among healthcare team members. Tools such as electronic health records, telemedicine, and mobile apps can enhance communication and collaboration, improve access to patient information, and streamline workflows.

How can conflicts be addressed within a healthcare team?

Conflicts within a healthcare team can be addressed by promoting open communication, active listening, and mutual respect. Healthcare organizations can establish conflict resolution policies and provide training on techniques to help team members effectively address and resolve conflicts.

Why is teamwork important in healthcare?

Teamwork is essential in healthcare because it allows for better coordination and communication among healthcare professionals, which leads to better patient outcomes. By working together, healthcare professionals can provide patients with more personalized and efficient care.

How do healthcare teams collaborate?

Healthcare teams collaborate by sharing information, communicating effectively, and working together to develop treatment plans that meet the needs of the patient. They may use technology, such as electronic health records, to share patient information and collaborate more efficiently.

Can patients choose their healthcare team?

Patients may have some input in choosing their healthcare team, but ultimately, the team is determined by the healthcare facility and the patient’s specific needs. Patients can, however, request to work with certain healthcare professionals if they have a preference.

What is the role of a patient in a healthcare team?

The patient plays a critical role in the healthcare team by actively participating in their own care and communicating their needs and concerns to the healthcare professionals. By working together, patients and healthcare professionals can develop treatment plans that are tailored to the patient’s specific needs and preferences.

Please note that this article is for informational purposes only and should not substitute professional medical advice.

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Core Principles & Values of Effective Team-Based Health Care

This paper is the product of individuals who worked to identify basic principles and expectations for the coordinated contributions of various participants in the care process. It is intended to provide common reference points to guide coordinated collaboration among health professionals, patients, and families—ultimately helping to accelerate interprofessional team-based care. The authors are participants drawn from the Best Practices Innovation Collaborative of the Institute of Medicine (IOM) Roundtable on Value & Science-Driven Health Care. The Collaborative is inclusive—without walls—and its participants are drawn from professional organizations representing clinicians on the front lines of health care delivery; members of government agencies that are either actively involved in patient care or with programs and policies centrally concerned with the identification and application of best clinical services; and others involved in the evolution of the health care workforce and the health professions.

Teams in health care take many forms, for example, there are disaster response teams; teams that perform emergency operations; hospital teams caring for acutely ill patients; teams that care for people at home; office-based care teams; geographically disparate teams that care for ambulatory patients; teams limited to one clinician and patient; and teams that include the patient and loved ones, as well as a number of supporting health professionals. Teams in health care can therefore be large or small, centralized or dispersed, virtual or face-to-face—while their tasks can be focused and brief or broad and lengthy. This extreme heterogeneity in tasks, patient types, and settings is a challenge to defining optimal team-based health care, including specific guidance on the best structure and functions for teams. Still, regardless of their specific tasks, patients, and settings, effective teams throughout health care are guided by basic principles that can be measured, compared, learned, and replicated. This paper identifies and describes a set of core principles, the purpose of which is to help enable health professionals, researchers, policy makers, administrators, and patients to achieve appropriate, high-value team-based health care.

The Evolution of Teams in Health Care

Health care has not always been recognized as a team sport, as we have recently come to think of it. In the “good old days,” people were cared for by one all-knowing doctor who lived in the community, visited the home, and was available to attend to needs at any time of day or night. If nursing care was needed, it was often provided by family members, or in the case of a family of means, by a private-duty nurse who “lived in.” Although this conveyed elements of teamwork, health care has changed enormously since then and the pace has quickened even more dramatically in the past 20 years. The rapidity of change will continue to accelerate as both clinicians and patients integrate new technologies into their management of wellness, illness, and complicated aging. The clinician operating in isolation is now seen as undesirable in health care—a lone ranger, a cowboy, an individual who works long and hard to provide the care needed, but whose dependence on solitary resources and perspective may put the patient at risk. [1,2]

A driving force behind health care practitioners’ transition from being soloists to members of an orchestra is the complexity of modern health care, which is evolving at a breakneck pace. The U.S. National Guideline Clearinghouse now lists over 2,700 clinical practice guidelines, and, each year, the results of more than 25,000 new clinical trials are published. [3] No single person can absorb and use all this information. In order to benefit from the detailed information and specific knowledge needed for his or her health care, the typical Medicare beneficiary visits two primary care clinicians and five specialists per year, as well as providers of diagnostic, pharmacy, and other services. [4] This figure is several times larger for people with multiple chronic conditions. [5] The implication of these dynamics is enormous. By one estimate, primary care physicians caring for Medicare patients are linked in the care of their patients to, on average, 229 other physicians yearly, [6] to say nothing of the vital relationships between physicians, nurses, physician assistants, advanced practice nurses, pharmacists, social workers, dieticians, technicians, administrators, and many more members of the team. With the geometric rise in complexity in health care, which shows no signs of reversal, the number of connections among health care providers and patients will likely continue to increase and become more complicated. Data already suggest that referrals from primary care providers to specialists rose dramatically from 1999 to 2009. [7]

Given this complexity of information and interpersonal connections, it is not only difficult for one clinician to provide care in isolation but also potentially harmful. As multiple clinicians provide care to the same patient or family, clinicians become a team—a group working with at least one common aim: the best possible care—whether or not they acknowledge this fact. Each clinician relies upon information and action from other members of the team. Yet, without explicit acknowledgment and purposeful cultivation of the team, systematic inefficiencies and errors cannot be addressed and prevented. Now, more than ever, there is an obligation to strive for perfection in the science and practice of interprofessional team-based health care.

Urgent Need for High-Functioning Teams

The incorporation of multiple perspectives in health care offers the benefit of diverse knowledge and experience; however, in practice, shared responsibility without high-quality teamwork can be fraught with peril. For example, “handoffs,” in which one clinician gives over to another the primary responsibility for care of a hospitalized patient, are associated with both avoidable adverse events and “near misses,” due in part to inadequacy of communication among clinicians. [8,9,10,11,12] In addition to the immediate risks for patients, lack of purposeful team care can also lead to unnecessary waste and cost. [13] Given the frequently uncoordinated state of care by groups of people who have not developed team skills, it is not surprising that some clinicians report that team care can be cumbersome and may increase medical errors. [14] By acknowledging the aspects of collaboration inherent in health care and striving to improve systems and skills, identification of best practices in interdisciplinary team-based care holds the potential to address some of these dangers, and might help to control costs. [15,16] Identifying best practices through rigorous study and comparison remains a challenge, and data on optimal processes for team-based care are elusive at least partly due to lack of agreement about the core elements of team-based care. Once the underlying principles are defined, researchers will be able to more easily compare team-based care models, payers will be able to identify and promote effective practices, and the essential elements for promoting and spreading team-based care will be evident.

The State of Play

The high-performing team is now widely recognized as an essential tool for constructing a more patient-centered, coordinated, and effective health care delivery system. As a result, a number of models have been developed and implemented to coordinate the activities of health care providers. Building on foundations established by earlier reports from the IOM [17] and the Pew Health Professions Commission, [18] team-based care has gained additional momentum in recent years in the form of legislative support through the Patient Protection and Affordable Care Act of 2010 and the emergence of substantial interprofessional policy and practice development organizations, such as the Patient-Centered Primary Care Collaborative and the Interprofessional Education Collaborative (IPEC).

In addition to national initiatives, there are many deeply considered, well-executed initiatives in team-based care in pockets across the United States. High-functioning teams have been formed in a variety of practice environments, including both primary and acute care settings. [1,19,20,21,22,23,24] Teams have also been formed to serve specific patients or patient populations, for example, chronic care teams, hospital rapid response teams, and hospice teams. [25,26,27]

Analyses of the quality and cost of team-based care do not yet provide a comprehensive, incontrovertible picture of success. Still, two reviews indicate that team-based care can result in improvements in both health care quality and health outcomes, and one review indicates that costs may be better controlled, particularly in transitional care models. [16,28] Research on team-based care has been hindered by lack of common definitions. While common elements, success factors, and outcome measures are beginning to be described in a variety of team-based care scenarios, a widely-accepted framework does not yet exist to understand, compare, teach, and implement team-based care across settings and disciplines.

Fundamental to the success of any model for team-based care is the skill and reliability with which team members work together. Team function has been described in one conceptualization as a spectrum running from parallel practice, in which clinicians mostly work separately, to integrative care, in which the interdisciplinary team approach is pervasive and nonhierarchical and utilizes consensus building, with many variations along the way. [29] It is likely that the appropriate team structure varies by situation, as determined by the needs of the patient, the availability of staff and other resources, and more. A unifying set of principles must not only acknowledge this variation but embrace as formative the underlying situation-defined needs and capacities.

Despite the pervasiveness of people working together in health care, the explicit uptake of interprofessional team-based care has been limited. At the most basic level, establishing and maintaining high-functioning teams takes work. In economic terms, if the transaction costs of team functioning outweigh the benefit to team members, there is little incentive to embark on the journey toward formal team-based care. [30 Some of the specific costs that may be restraining forces include lack of experience and expertise, cultural silos, deficient infrastructure, and inadequate or absent reimbursement. [31] These barriers were outlined in a 2011 conference convened by the Health Resources and Services Administration, the Josiah Macy Jr. Foundation, the Robert Wood Johnson Foundation, and the ABIM Foundation in collaboration with IPEC. The publication of the proceedings, Team-Based Competencies: Building a Shared Foundation for Education and Clinical Practice, identified key barriers to change, including the absence of role models and reimbursement, resistance to change, and logistical barriers.

Despite these barriers, teams are built and maintained. Researchers have identified facilitators of team-based care, or factors that constitute and promote good teams and teamwork. For instance, Grumbach and Bodenheimer found that key facilitators include having measurable outcomes, clinical and administrative systems, division of labor, training of all team members, effective communication, and leadership. [1,30] IPEC has focused on effective interprofessional work and has defined four domains of core competencies: values/ethics, roles/responsibilities, communication, and teamwork/team-based care. [32]

Our aim is to build from this prior work to identify a set of core principles underlying team-based care across settings, as well as the essential values that are common to the members of high-functioning teams throughout health care. By doing so, we hope to help reduce barriers to team-based care, while supporting the facilitators of effective teamwork in health care.

The authors are individuals knowledgeable about team-based care who participated in an interprofessional work group that was drawn from the IOM’s Best Practices Innovation Collaborative. To achieve the goal of identifying basic principles and values for interprofessional team-based care, we first synthesized the factors previously identified in various health care contexts, then took these distilled principles to the field to understand how well they represent team-based care in action. We held monthly conference calls between October 2011 and June 2012 with frequent e-mail collaboration in the intervals. We then reviewed the health professions’ and “gray” literature and discussed common elements. Using this information, we drafted a definition of team-based care and a sample set of principles and values critical to team-based care. To test the applicability and validity of the principles and values, and to understand their on-the-ground actualization, we performed “reality check” interviews with members of team-based health care practices. Teams with various compositions, practice settings, and patient profiles were identified around the country through the literature review and the input of experts. A draft of the team-based care definition, principles, and values was sent to teams in advance of a telephone interview. We then interviewed members of the teams by telephone during January 2012 using a semi-structured approach. Based upon the results of the interviews, we refined the team-based care principles and values, identified key themes, and added illustrative examples.

A Proposed Definition of Team-Based Health Care

To inform a proposed definition of team-based care, we reviewed the literature and reflected on the definitions and factors identified in prior work. Elements found across the definitions we reviewed include the patient and family as team members, more than one clinician, mutual identification of the preferred goal, close coordination across settings, and clear communication and feedback channels. Ultimately, we chose to adapt the definition developed through a detailed literature review and consensus process by Naylor and colleagues. [28] Although this definition was developed for use in the context of primary care for chronically ill adults, its core elements were easily adapted to apply to the work of teams across settings:

Team-based health care is the provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient—to accomplish shared goals within and across settings to achieve coordinated, high-quality care. [28]

In the process of considering and refining the principles of team-based care, we noted that while teams are groups, they are also made up of individuals. In addition to particular behaviors that facilitate the function of the team, we heard from the teams we interviewed that certain personal values are necessary for individuals to function well within the team. This harmonizes with the core competency domain of “values/ethics” put forward in IPEC’s Team-Based Competencies.

The following are five personal values that characterize the most effective members of high-functioning teams in health care.

Honesty: Team members put a high value on effective communication within the team, including transparency about aims, decisions, uncertainty, and mistakes. Honesty is critical to continued improvement and for maintaining the mutual trust necessary for a high-functioning team.
Discipline: Team members carry out their roles and responsibilities with discipline, even when it seems inconvenient. At the same time, team members are disciplined in seeking out and sharing new information to improve individual and team functioning, even when doing so may be uncomfortable. Such discipline allows teams to develop and stick to their standards and protocols even as they seek ways to improve.
Creativity: Team members are excited by the possibility of tackling new or emerging problems creatively. They see even errors and unanticipated bad outcomes as potential opportunities to learn and improve.
Humility: Team members recognize differences in training but do not believe that one type of training or perspective is uniformly superior to the training of others. They also recognize that they are human and will make mistakes. Hence, a key value of working in a team is that fellow team members can rely on each other to help recognize and avert failures, regardless of where they are in the hierarchy. In this regard, as Atul Gawande has said, effective teamwork is a practical response to the recognition that each of us is imperfect and “no matter who you are, how experienced or smart, you will fail.” [2]
Curiosity: Team members are dedicated to reflecting upon the lessons learned in the course of their daily activities and using those insights for continuous improvement of their own work and the functioning of the team.

Principles of Team-Based Care

Each health care team is unique—it has its own purpose, size, setting, set of core members, and methods of communication. Despite these differences, we sought to identify core principles that embody “teamness.” After reviewing the literature and published accounts of team processes and design, five principles emerged: shared goals, clear roles, mutual trust, effective communication, and measurable processes and outcomes. These principles are not intended to be considered in isolation—they are interwoven, and each is dependent on the others. Eleven teams across the nation considered the principles, verified and clarified the meaning of each, and described how each comes into play in their own team environments. Descriptions of the teams are listed throughout. The following section describes each of the principles in detail, provides examples from the teams we interviewed, and considers organizational factors to support development of teams that cultivate these five principles, as well as the values that support high-quality team-based health care. Arguably, the most important organizational factor supporting team-based health care is institutional leadership that fully and unequivocally embraces and supports these principles in word and action. [33]

Shared Goals

The team—including the patient and, where appropriate, family members or other support persons—works to establish shared goals that reflect patient and family priorities, and that can be clearly articulated, understood, and supported by all team members.

The foundation of successful and effective team-based health care is the entire team’s active adoption of a clearly articulated set of shared goals for both the patient’s care and the team’s work in providing that care. Although obvious to some extent, the explicit development and articulation of a set of shared goals, with the active involvement of the patient, other caregivers, and family members, does not happen easily or by chance. We found that teams shared several strategies and practices with regard to establishing shared roles.

First, the patient, caregivers within the family, and the family itself must be viewed and respected as integral members of the team. High-functioning teams in health care strive to organize their mission, goals, and performance seamlessly around the needs and perspective of patients and families. This element is central to the most forward-thinking team-based care and represents a central tenet of a social compact between health care professionals and society. [34] As an example, this commitment to patient involvement in the team is central to team training within the Department of Veterans Affairs (VA) patient-aligned care team, which emphasizes that without the veteran (the patient), the team has no mission or goal. Team members are taught to think of things from the veteran’s point of view and align the team’s concerns and actions with those of the veteran. This “patient-centered” attitude is embedded in many of the teams interviewed, including the University of Pennsylvania Transitional Care Model, in which team members acknowledge explicitly that the patient and family are the ones who truly “own” the plan of care. (As described by Berwick (2009), patient-centeredness reflects an “experience (to the extent the informed, individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters—without exception—related to one’s person, circumstances, and relationships in health care.”)

Second, as part of integrating the patient into the team, high-functioning teams fully and actively embrace a shared commitment to the patient’s key role in goal setting. Many teams interviewed used their first meetings with the patient and family, or an initial “intake” interview, to begin the process of developing shared goals. The patient and family meeting is the tool employed by team members at Hospice of the Bluegrass, for example, to help team members develop a shared understanding of the full extent of the patient and family’s needs, which are then translated into stated goals of care. To engage in a full discussion, they noted, it is especially important for the team to be clear with the patient and family about all the types of needs the team is prepared to fulfill. Patients and families may not expect the full extent of services available. When such a comprehensive approach to patient needs is taken, though, patients and families are grateful to know that the team will collaborate with them to meet their needs to the extent possible.

Third, teams regularly evaluate their progress toward the shared goals and work together with patient and family members to refine and move toward achievement of these goals. At Cincinnati Children’s Hospital, this monitoring and updating takes place daily during patient- and family-centered rounds. Core elements of daily rounds include reviewing together the events of the past 24 hours, creating a daily assessment and plan of care, and reviewing and updating criteria for and progress toward hospital discharge. This process ensures that the team both reaffirms with regularity the applicability of the shared goals and offers an opportunity for clarification of intent and prevention of misunderstandings.

Organizational factors that enable development of shared goals include

Providing time, space, and support for meaningful, comprehensive information exchange between and among team members, particularly when a new team forms—for example, when a new patient/family begins to work with the team.
Facilitating establishment and maintenance of a written plan of care that is accessible and updatable by all team members.
Supporting teams’ capacity to monitor progress toward shared goals for the patient/family and the team.

The perspectives and experiences shared in the interviews strongly support the foundational nature of shared goals within the larger framework of team-based care principles. To achieve shared goals that are meaningful and robust, the patient and family must be integrally involved as members of the team in developing, refining, and updating the goals. While shared goals are the roadmap guiding the work of the team, the development and execution of these goals is dependent upon the other principles that follow. Clear roles, mutual trust, and effective communication among team members are essential for work to be done and goals to be met. Measurable processes and outcomes determine the level of success, help to refine goals over time, and guide improvement.

Clear Roles

There are clear expectations for each team member’s functions, responsibilities, and accountabilities, which optimize the team’s efficiency and often make it possible for the team to take advantage of division of labor, thereby accomplishing more than the sum of its parts.

Members of health care teams often come from different backgrounds, with specific knowledge, skills and behaviors established by standards of practice within their respective disciplines. Additionally, the team and its members may be influenced by traditional, cultural, and organizational norms present in health care environments. For these reasons it is essential that team members develop a deep understanding of and respect for how discipline-specific roles and responsibilities can be maximized to support achievement of the team’s shared goals. Attaining this level of understanding and respect depends upon successful cultivation of the personal values necessary for participating in team-based care, noted above. Training and working in interdisciplinary settings where these values are foundational also allows the team to safely challenge the boundaries of traditional roles and responsibilities to meet the needs of the patient.

Integrating patients and families fully into the team represents a particular challenge that requires careful planning. Patients and families are unique members of the team in several ways. First, patients and families often do not have formal training in health care. Although different health professionals may, at times, speak “different languages,” if patients and families are to be full members of the team, they must understand their fellow team members. Second, a number of different patients and families typically come in and out of the team many times per day. This requires continual adaptation by other team members who must “shift gears” as they form and reform teams on a regular basis. Finally, just as clinicians must adapt to the various patients they encounter, so, too, must patients learn the rules and customs of each new health care team with which they interact. Processes that introduce—and reintroduce—the patient and family to the roles, expectations, and rules of the team are critical if they are to participate as full members of the team.

Managing a team is challenging and becomes especially so as the membership increases and includes some or all of the following disciplines: licensed physical and mental health professionals (e.g., nurses, physicians, nurse practitioners, physician assistants, social workers, psychologists, pharmacists, physical, occupational and speech therapists, and dieticians); personal care providers (e.g., certified nurse aides and home health aides); community providers (e.g., spiritual care, community-based support, and social media); and the patient, family, and others close to the patient. In addition, it is possible to have teams integrated into larger teams. An example of this is the medication management team at Park Nicollet, which collaborates with and is a part of the Health Care Home team. To establish clear roles that support “teamness,” the teams we interviewed engage a number of strategies and practices.

First, team members determine the roles and responsibilities expected of them based on the shared goals and needs of the patient and family. At Hospice of the Bluegrass, team members anticipate a broad spectrum of patient and family needs that may, to some extent, alter the way in which they perform their professional duties. Following the patient and family meeting, in which the team identifies needs and goals that range from treating pain to addressing food insecurity to engaging spiritual services, the team members then lay out how they will intervene to maximize resources. This maximization may include adding responsibilities to particular team members’ work. For example, if the services of a chaplain are primarily required, he or she may also take on the responsibility of bringing supplies to the home, or asking about the level of pain. Inherent in these shared responsibilities is the identification of needs that require the knowledge and skills of other team members.

Second, team members must engage in honest, ongoing discussions about the level of preparation and capacities of individual members to allow the team to maximize their potential for best utilization of skills, interests, and resources. This frankness allows the team to inventory the discipline-specific assets of team members and ensure that they are creatively aligned with the team’s shared goals. Once they have engaged in the process of matching patient goals to needed roles and planning for the best utilization of team resources, team members must have the autonomy to implement these plans. For example, at El Rio Community Health Center, the clinical pharmacist serves as the primary care provider for patients with diabetes and comorbid conditions, such as hypertension and hyperlipidemia, requiring complex medication management. This occurs through a medical staff–approved collaborative practice agreement in which the pharmacist provides appropriate diagnostic, educational, and therapeutic management services, including prescribing medication and ordering laboratory tests, based on national standards of care for diabetes. [35] The arrangement is sharply focused on the needs of the patient while maximizing the expertise of health professionals in the clinic.

Third, while roles and responsibilities must be clearly defined and explicitly assigned, team members must anticipate and embrace flexibility as needed. For example, a challenge faced by patient-aligned care teams in the VA is the absence of personnel. If no replacement exists for an absent team member, then the team can become dysfunctional. Thus, while clear roles must exist to enable accountability and creativity, effective communication and flexibility must be built into the fabric of the team to ensure that seamless coverage is available. Building in flexibility requires that team members understand to the greatest extent possible the background, skillsets, and responsibilities of their teammates.

Fourth, team members must seek the appropriate balance between roles and responsibilities that fall to individual team members and those that are better accomplished collaboratively. Given the high transaction costs of using a team, clear roles help facilitate decisions about the appropriate engagement of multiple team members in particular scenarios. For example, the BRIGHTEN (Bridging Resources of an Interdisciplinary Geriatric Health Team via Electronic Networking) program at Rush University in Chicago finds that occasionally issues arise at team meetings that do not concern all team members or that are best handled by one or two team members alone. To flag these items and facilitate the work that requires full team engagement, the team has a standing rule that issues involving one or two team members will be handled outside of team meetings.

Finally, all teams have certain roles and responsibilities that are routinely indicated to support the team’s functioning. These roles include team leadership, record keeping, and meeting facilitation, as well as other administrative tasks. Carrying out routine tasks requires the team to utilize their resources creatively while avoiding pretense and superiority in the process. Routine tasks should be assigned in a manner similar to patient care tasks—balancing patient need, team goals, and local resources. Teams should determine which member is most appropriate for the role, recognizing that some roles may be best rotated across the team.

The issue of team leadership has sometimes been contentious, especially when approached in the political or legal arenas, where questions about team leadership often become entangled in professional “scope of practice” issues. In particular, arguments have arisen around “independent practice” versus team-based care and, where care is team-based, whether all team functions must be “physician-led,” and what this would imply for other health professionals with regard to care management decision making. These debates are taking place in many states, with a number of potential solutions taking shape, and this paper does not aim to resolve them. However, our interviews produced two potentially helpful observations. First, these questions seem much less problematic in the field than they are in the political arena. Among the teams we interviewed, notions of “independent practice” were not relevant because no one member of the team was seen as practicing alone, and leadership questions were not sources of conflict; rather, when leadership issues were raised they were portrayed as matters for open discussion that led to mutually agreeable solutions. Second, this relative lack of conflict might be because these teams use the term “leadership” in a nuanced way.

There is widespread agreement that effective teams require a clear leader, and these teams recognize that leadership of a team in any particular task should be determined by the needs of the team and not by traditional hierarchy. For example, the Mount Sinai palliative care team identified the need to improve a weekly clinical care meeting. They identified the main goal for the meeting: addressing complex patient issues in a context that ensured that each team member had an equal voice. The team assessed the training and skillsets of all team members, and, based upon the goal, determined—somewhat surprisingly, yet successfully—that the chaplain was the best person to run the clinical care meeting. This example nicely illustrates that being an effective team leader for a particular task (like running a team meeting) can require a set of skills that are distinct from those required for making clinical decisions.

While the teams we interviewed acknowledged that physicians are clinically and often legally accountable for many team actions, the physicians on the teams we interviewed were not micromanagers; instead, they were collaborators who did not seek or exercise authority to override decisions best made by other team members with particular expertise, whether in social work, chaplaincy, or care coordination, etc.

Since roles on the team vary by both professional capability as well as function, patients and their caregivers must be fully informed about these roles. Each team member should communicate his or her role clearly and solicit input from others, especially the patient and family, so that all responsibilities are clearly defined and understood. For example, at Park Nicollet, clinical pharmacists and pharmacy residents are placed directly next to other care providers to answer any questions that arise in the course of clinical care, as well as to make it apparent that all care providers work together. Likewise, during rounds at Cincinnati Children’s Hospital, all members of the team introduce themselves to each patient and family by name and then describe how they contribute to the team in clear language. Roles and responsibilities are discussed verbally and written into the care plan. The team explicitly solicits all opinions, including those of the patient and family.

While team members’ expertise and skills should be tailored to the needs of the patient, it is also important to recognize when unintended or unforeseen consequences may occur. The experience and skills of team members are likely to overlap, with the potential for confusion or frustration about roles and responsibilities, possibly leading to misunderstandings and disruption in care to the patient. For example, within the Park Nicollet medication management group, multiple team members are skilled and experienced in aspects of diabetes care and management. Team members work together to identify clearly the roles and responsibilities for which they are best suited, ensuring that roles are discrete and that the experience is harmonized for patients. After roles and responsibilities are clarified, team members may, at times, find themselves in situations for which they feel ill-prepared or are not comfortable. To ensure that team members are empowered to seek support at any time, the team must foster an environment of continuous learning in which seeking advice or help is considered a strength and rewarded. In a high-functioning team environment, team members will hold significant responsibility and accountability. To foster success rather than stress, the team must establish transparent and measurable expectations related to roles and responsibilities, for each individual member and for the team as a whole.

Organizational factors that enable establishing and maintaining clear roles include

providing time, space, and support for interprofessional education and training, including explicit opportunities to practice the skills and hone the values that support teamwork.
facilitating communication among team members regarding their roles and responsibilities.
redesigning care processes and reimbursement to reflect individual and team capacities for the safe and effective provision of patient care needs.

Regardless of a team’s setting, size, or member characteristics, roles and responsibilities must be clear and accountability expected. Yet, despite the best of intentions, teams are not immune to the inherent norms of health care delivery systems. Even effective teams with clear roles and responsibilities may experience the emergence of silos of care, decreased teamwork, or delayed engagement of needed personnel or resources within their group. A team with well-articulated roles and responsibilities grounded in the values of honesty, discipline, creativity, humility, and curiosity fosters an environment where any team member feels safe bringing such concerns to the forefront for discussion, proactive improvement, and prevention.

Mutual Trust

Team members earn each other’s trust, creating strong norms of reciprocity and greater opportunities for shared achievement.

Trust is the current that flows through the team, allowing team members to rely upon each other personally and professionally and enabling the most efficient provision of health care services. Achieving a team with norms of mutual trust requires establishing trust, maintaining trust, and having provisions in place to address questions about or breaches in trust. When a strong trust fabric is woven, team members are able to work to their full potential through relying on the assessments and information they receive from other team members, as well as the knowledge that team members will follow through with responsibilities or will ask for help if needed. The BRIGHTEN team explained that actively developing trust in team members allows them to learn from and build on each other’s assessments and conclusions and permits nonduplication of work.

Establishing and maintaining trust requires that each team member hold true to the personal values of honesty, discipline, creativity, humility, and curiosity, which together support the creation of an environment of mutual continuous learning. The Mount Sinai palliative care team emphasized the importance of setting the stage for trust as early as the hiring process. Using shared values as the basis for selecting team members is critical to ensuring that the norms that support a trusting environment are upheld. This team finds that “shoehorning” someone into the team can be very harmful. The hiring process has been carefully amended to ensure that professional and personal values and skills will nurture, and be nurtured by, the team.

In a clinical setting, providing excellent patient care is the direct outcome of implementing personal values in the context of professional skill. At El Rio Community Health Center, a key element of building team members’ trust in each other is documenting the contribution of each team member and professional group to high-quality patient care and outcomes. Making these data transparent to the whole team generated better understanding of and appreciation for team members’ contributions, as well as the potential gains in efficiency and effectiveness possible through leveraging team members’ capacities in purposeful team-based care.

In addition to carrying outpatient care duties professionally, a critical element of trust is understanding and respecting the rules and culture of the team. Many teams said that a critical element to establishing trust among team members is ensuring that all voices on the team are heard equally. At Nellis Air Force Base, the ethos is that, regardless of military rank, everyone is expected to raise questions or concerns. To facilitate a safe and trusting environment in which more junior team members can speak up, incentives are aligned to encourage leaders to listen with open minds and address team members’ questions and concerns.

The importance of personal connections among team members as an instrument for building trust was endorsed by some teams. The BRIGHTEN team refers specifically to their “culture of cake,” in which team members’ significant events are celebrated at meetings, with cake. The cake does not derail the purpose of the meeting—the celebration is part and parcel of the work of the team, while at the same time, team members focus on their joint tasks. The Mount Sinai palliative care team has a monthly birthday celebration for members of their team at which there are no clinical or administrative tasks. Nellis Air Force Base has team- and community-building activities throughout the year—for example, picnics or bowling—so that individuals can get to know each other on a personal level.

Developing and maintaining trust with patients and families may require special consideration, as they may not have the longevity on the team or daily working relationship shared by other team members. Clinician members of the team can develop trust with patients and families by using effective communication to explain the process of developing shared goals and establishing clear roles. By being accountable and following through with these principles, patients and families will come to trust the values of other team members. Clinician members may benefit from learning skills formally to build trust with patients and families. Negotiation and conflict management skills may be particularly valuable. For example, at Cincinnati Children’s Hospital, team members are taught to make themselves “vulnerable” by stepping out of their traditional roles and looking through the eyes of the patient and family in order to find common ground as a starting point for mutual trust.

Organizational factors that facilitate development of mutual trust include

Providing time, space, and support for team members to get to know each other on a personal level.
Embedding in education and hiring processes the personal values that support high-functioning team-based care.
Developing resources and skills among team members for effective communication, including conflict resolution.

Mutual trust enables team members to set clear goals and achieve shared goals in a harmonious, efficient fashion. Fundamentally, mutual trust enables these by setting the foundation for good communication, which is the focus of the following principle. As with each of these principles, mutual trust and effective communication are tightly linked and mutually supportive. Thus, the signs of mutual trust in a team include not only elements of team function, such as equal participation and facilitative leadership style, but also outcomes such as successful quality improvement efforts and redesigned care processes in which team members build on each other’s work. In the preoperative surgery unit at Nellis Air Force Base, the team established continuous note charting in the electronic medical record. The preoperative nurse, surgeon, anesthesiologist, and others use one running note to chart their observations and plans, maximizing the utility of their collaborative work.

Effective Communication

The team prioritizes and continuously refines its communication skills. It has consistent channels for candid and complete communication, which are accessed and used by all team members across all settings.

If the team members are unable to provide information and understanding to each other actively, accurately, and quickly, subsequent actions may be ineffective or even harmful. In the digital age, team communication is not limited to in-person communication, such as in team meetings. It incorporates all information channels—progress notes and electronic health records, telephone conversations, e-mail, text messages, faxes, and even “snail mail.” Many channels of communication may be employed by team members to achieve their purposes. The framing and content of that communication is the core of effective communication. Effective communication should be considered an attribute and guiding principle of the team, not solely an individual behavior. Effective communication requires incorporation of all of the values underlying effective teams: honesty, discipline, creativity, humility, and curiosity. Effective communication also comprises a set of teachable skills that can be developed by each member of the team and by the team as a whole. The teams we interviewed employed a number of strategies and skills for developing and employing effective communication.

First, setting a high standard for, and ensuring, consistent, clear, professional communication among team members is a core function of a high-performing team. The BRIGHTEN program employs the Rush University Medical Center Geriatric Interdisciplinary Team Training Program guide to the fundamentals of effective teamwork. The guide outlines individual and team communication practices that support effective teamwork. [36] For example, team members should speak clearly and directly in a succinct manner that avoids jargon, while drawing upon their professional knowledge. They should tend toward discussing verifiable observations rather than personal opinion. Team members should listen actively to each other and show a willingness to learn from others. The need for these strategies is highlighted by the fact that many of the teams we interviewed indicated that allowing everyone an equal voice in the room is a core practice. At Park Nicollet, interprofessional care is facilitated when all are encouraged to attend team meetings and encouraged to ask questions and share ideas equally. The skills outlined are also critical for the University of Pennsylvania Transitional Care Team, which works with the patient, family, inpatient care team, and outpatient providers to ensure that the patient’s care plan is followed while ensuring that all providers’ roles and responsibilities are honored.

Second, effective communicators are deep listeners—actively listening to the contributions of others on the team, including the patient and family. Individuals on the team need to be able to listen actively and model this for others on the team by clarifying or elaborating key ideas, reflecting thoughtfully on value-laden or controversial “hot-button” issues. Team members may need to help each other improve this skill either through team exercises or individual conversations. Patients and families often participate more as listeners on the team; their contributions may need to be facilitated through the active listening of other team members. Team members may need to coach each other, including patients and families, in succinct and clear contributions. Team members should recognize that questions are a valuable way to clarify and to learn from each other. Teams that perform patient- and family-centered rounds at Cincinnati Children’s Hospital engage listening at many levels. First and foremost, central to rounds is the elicitation, on the first day, of the patient and family’s preference for participation (or nonparticipation) in team rounds. Whatever option patients and families choose, the plan of care and daily work are defined by the goals and concerns expressed by the patient and family. Active listening—with confirmation of information transfer —is fundamental to the rounds. Pediatric interns who present the events of the past 24 hours to the team are taught to confirm the report with the patient and family. Since orders are entered into the computer during rounds, a final step is an official “read-back” of those orders, ensuring accuracy and preventing errors.

Finally, team communication requires continual reflection, evaluation, and improvement. Recognizing signs of tension and unspoken conflict can serve as a trigger to reexamine the communication patterns of the team.

Both individual and team communication skills are teachable and learnable. [37,38] Individuals should be able to use a wide range of effective communication techniques, recognize when their own or the team’s communications are not functioning well, and act as a facilitator. One or more individual team member may act as a coach for patients and families not accustomed to or comfortable with active team membership and communication. (For more information, visit http://www.ama-assn.org/resources/doc/ethics/research-ambulatory-patient-safety.pdf.) Fundamentals of effective team communication include the active membership of the patient and family and the willingness and capability of team members to be clear and direct and communicate without technical jargon. Information sharing is the goal of communication, and all team members need to recognize that this includes both technical and affective information.

Organizational factors that sustain effective communication include

providing ample time, space, and support for team members to meet—in-person and virtually—to discuss direct care as well as team processes.
ensuring that team members are trained in shared communication expectations and techniques.
utilizing digital capacity—including the electronic medical record, e-mail, Web portals, personal electronic devices, and more—to facilitate easy, continuous, seamless, transparent communication among team members, with a special focus on inclusion of patients and families.

As an example of this last factor, at MD Anderson Cancer Center, patients can access their full medical records and communicate virtually with team members through the myMDAnderson Web portal. The uptake of this service has been enormous and patient and provider satisfaction with the service is high.

Measurable Processes and Outcomes

The team agrees on and implements reliable and timely feedback on successes and failures in both the functioning of the team and achievement of the team’s goals. These are used to track and improve performance immediately and over time.

High-functioning teams, by definition, have embraced or at least integrated the principles of team-based care noted above. The high-functioning team has agreed upon shared goals for delivery of patient-centered care. Clear roles and responsibilities have been shared across the team and team members have committed to shared accountability. High-functioning teams recognize the importance of trust in all interactions, and actively work to build and maintain a respectful and trusting environment. Effective communication is at the core of the team’s work and is apparent in all encounters among team members, patients, and other participants in the care process.

Once they employ these principles, how do teams know they are high-functioning? How can teams that are initially forming assess their progress? How can teams that have been disrupted or lost some functionality understand what efforts are needed to regain it? And, how can teams know that they are improving care and outcomes while controlling costs to the best of their ability? Only through rigorous, continuous, and deliberate measurement of the team’s processes and outcomes can potential barriers be identified and strategies developed to overcome them. Measurement of team effectiveness is not a new science. Other industries which employ highly educated, strongly motivated professionals with complimentary or overlapping responsibilities in high-pressure, high-risk situations like aviation, nuclear power, and the armed services have developed a significant body of literature on measuring the effectiveness of teamwork. Only recently, with higher levels of attention given to patient safety and high-quality care, has health care begun explicitly to create and measure team-based health care delivery.

Measures for team-based health care fall into two categories: processes/outcomes and team functioning. The teams we interviewed considered three types of processes and outcomes: patient outcomes, patient care processes that lead to improved patient outcomes, and value outcomes. Improved patient outcomes provide one of the most important measures of any type of health care, and the number of validated measures has grown exponentially in recent years. The National Quality Measures Clearinghouse currently lists thousands of clinical quality measures from the National Quality Forum (NQF), the Ambulatory Care Alliance, the Physician Consortium for Performance Improvement, the Joint Commission, the National Committee on Quality Assurance (NCQA), health professional organizations, federal agencies, insurers, and many more. Patient outcome measures should and do vary between teams, reflecting the patients and populations served, as well as the unique strengths, challenges, and improvement initiatives of the team. For the hospital-based teams we interviewed, readmission to the hospital within 30 days was commonly cited as a relevant measure. Safety measures were also cited as important outcomes for patients. In some cases, teams track process measures that are linked to improved patient outcomes. The Vermont Blueprint for Health has adopted a comprehensive approach to patient outcomes by committing to achieve recognition of each of its Advanced Primary Care Practices as NCQA patient-centered medical homes, among other requirements. Finally, teams assess their outcomes by integrating quality and cost data. Increased capacity for delivering care, using the skillsets of diverse individuals in communicating effectively to the patient, caregivers, and the rest of the team, may decrease the cost of health care. [28] Leaders at MD Anderson have developed a framework for integrating information about the health outcomes of their patients with the costs of the care provided, resulting in a reproducible, trackable analysis of the value of their team care model. [39] The MD Anderson approach is illustrative of how the impact of a team can be measured. Currently, many measures that are tied to clinician performance refer to the work of a single clinician, typically a physician. [40] This perception of one individual’s accountability for clinical outcomes possibly undermines the effectiveness of the team, or, at least, does not provide an incentive to accelerate team-based care.

In addition to more traditional process and outcome measures, and reflecting a current national quality trend, all teams interviewed said that they measure satisfaction—formally or informally—of the patients and families they serve as well as that of the other team members. Satisfaction reflects the relational components of care, including rapport, respectful communication, and trust. It is unclear whether the patient and family’s perception of care is related to clinical effectiveness. Still, patient satisfaction is used as a proxy for, and if well-designed may truly reflect, patient-centeredness and patient engagement in care. Members of the team at Cincinnati Children’s Hospital say they know they have succeeded when, on the day of discharge, the patient and family say: “You’ve answered all my questions, covered all the bases, taken good care of me, and treated me like an equal. Thank you.” Similarly, a favorite informal measure of satisfaction mentioned by Hospice of the Bluegrass is public commemoration of the services provided by the hospice team in the patient’s obituary. Many teams we interviewed also emphasized the importance of measuring satisfaction among other team members as a way of tracking team function. The El Rio Community Health Center has implemented 360-degree evaluations which include measures of employee satisfaction. At the University of Pennsylvania, in addition to patient and cost outcomes, a critical measure of success is the satisfaction of team members, which is linked to staff retention—a critical element for team functioning. The Vermont Blueprint has a qualitative component to its evaluation, including focus groups, individual interviews, and a planned statewide implementation of the Consumer Assessment of Healthcare Providers and Systems Patient-Centered Medical Home (CAHPS PCMH) survey in order to ascertain patient and practice experiences with team-based care.

In addition to measuring the satisfaction of patients and other team members (which are indirect measures of team functioning), engaging in routine, frequent, meaningful evaluation of team function per se allows team members to improve their skills to fulfill the other principles of team-based care. A number of tools have been developed to directly assess the functionality of teams. Two measures mentioned by teams we interviewed include the Team Development Measure (teammeasure.org) and TeamSTEPPS questionnaires. Valentine and colleagues have produced a review of team measurement tools applicable to health care; a summary table of these tools, reproduced with permission, is available in the Appendix. [41] Despite the availability of team measurement tools, there is room for improvement in measurement of teamwork, since current measures look at various aspects of teamwork, few of them are robustly validated, and many are not routinely applied to teams in practice.

Organizational factors that support measurement to improve team function and outcomes include

prioritizing continuous improvement in team function and outcomes and ensuring that electronic systems routinely provide data about the measures that matter to the teams providing care and can be immediately updated as indicated by frontline teams.
developing routine protocols for measurement of team function, aimed at continuous improvement of the processes of team-based care.
providing ample time, space, and support for team members to engage in meaningful evaluation of processes and outcomes together.

In summary, measurement of team-based care should include both measures of the processes and outcomes that derive from team functioning and measures of team functioning itself. There is a deficiency in the availability of validated measures with strong theoretical underpinnings for team-based health care. Improved measurement will enable teams to grow in their capacity to fulfill the principles, facilitate the spread, improve the research, and refine evaluation of the high-value elements of team-based care.

Implications of the Team-Based Health Care Principles and Values

To examine the implications of the principles and values of team-based health care outlined here, members of the Best Practices Innovation Collaborative met on February 28, 2012. Participants at the meeting provided feedback about the principles and values described here and considered the timeliness of the framework, including bridges to ongoing activities in related sectors. From those discussions, four themes emerged to guide the immediate activities of those working to accelerate high-value team-based health care:

Ensuring that the patient and family are at the center of the team requires careful planning and execution.
Targeting of team-based care—matching resources to patient and family needs—is essential to maximize value.
Building bridges to ongoing activities related to team-based care is critical to ensure efficiency.
Defining a coordinated research agenda for team-based care is necessary to achieve continuously improving, high-value team-based health care.

Making Patients and Families Active Members of the Team

The requirement that patients and families be at the center of care is espoused by most health care reform and improvement processes, including the patient-centered medical home, care coordination, interprofessional education, and more. Ensuring that patients and families are active members of the health care team is the next critical step toward high-value health care. Mitchell and colleagues describe a social compact between health professionals, patients, and society intended to strengthen the connections between patient-centered care and team-based care, with a call for patients to be active members of health care teams. [34] The codes of ethics of health professional societies have long argued that shared decision making is an ethical obligation, and that the legal and ethical notion of informed consent is built on the fundamental rights of patients to participate in decisions that affect their well-being. [42,43] Moreover, people who are involved in their own care have better health outcomes and typically make more cost-effective decisions. [44] In reality, the practice of putting patients and families on health care teams is daunting. Patients are often ill-prepared to participate on health care teams and health professionals are often ill-equipped to practice collaboratively with patients for many reasons—imbalance of power in relationships, poor communication, non-intuitive systems, payment structures that reward volume over value, lack of workforce preparation, and more. The solution to many of these problems requires restructuring the culture and practices of health care, including promoting transparency of information in an understandable fashion, orientation of people to health care team practices, predictability, and development and spread of readily-available tools for knowledge sharing, self-care, and patient-clinician–team communication. [37] There is also a role for measuring the performance of organizations in creating a practice environment that supports shared decision making. [45]

Targeting of Team-Based Care

High-quality team-based health care is costly to implement. As described by those we interviewed, teams are complex systems that require substantial investment to function at their highest capacity. Thus, the use of teams should be targeted to situations in which the transactional costs of team care are outweighed by the benefits in terms of health outcomes. Targeting is an ongoing process in which the needs of the patient and family are assessed repeatedly, with the expectation that needs are personal and will change over time and based on the situation. Health professionals must, as part of their professional responsibilities, ensure that assessments and reassessments are completed and call upon other health professionals and community services as indicated by patient/family needs. Figure 1 presents a schematic of the relationship between complexity of patient needs and the complexity of the corresponding team-based care. The exact composition of the team and services mobilized should be tailored according to patient/family needs and local resources.

Building Bridges to Activities Related to Team-Based Care

Team-based care and activities related to teams are increasing in many health care sectors. Building bridges between these activities can help ensure synergy and efficiency. Here, we highlight connections between team-based care and three areas in particular: interprofessional education and workforce development, health informatics, and care coordination.

Interprofessional Education

Health education groups in the United States and abroad have called for improved interprofessional education in the preclinical and clinical settings. A U.S. effort—the Interprofessional Education Collaborative—is led by a coalition of academic associations, foundations, and government agencies. In 2011 the group released a report on the core competencies of interprofessional education to stimulate effective team-based practice. These core competencies harmonize with the principles outlined in this paper and are critical for guiding the education, evaluation, and certification of health education programs and members of the modern health care workforce. We believe that the values and principles described in this paper supplement the core competencies and should be used to guide selection of candidates for the health professions, their training, their licensure and certification, and their ongoing evaluation by employers, patients, and society. Many team training tools currently exist in practice to help health professionals—and, ideally, patients and families—continue to develop and maintain values and skills to support their teamwork. One of the best-known programs, TeamSTEPPS, has recently expanded from the acute care to the ambulatory care setting.

Health Informatics and Technology

The explosion of digital capacity and stimulation of infrastructure development through policy have created opportunities for promotion and facilitation of team-based care. Health informatics has the capacity to support the work of teams (e.g., communication, process improvement, group training, shared work) while allowing required documentation within the regulatory and medico-legal environment. For example, an electronic health record designed with teams in mind can enable team charting, and informatics-driven simulation training systems can provide a safe, effective means of improving teamwork, particularly for rare or high-stakes situations. Furthermore, informatics can help teams make sense of vast amounts of data that can be captured to maximize continuous learning, monitor population health, and promote safety and quality without overwhelming team members.

High-functioning teams and their organizations must consider the transformative impact of Web-based, digital, and mobile technology on health and health care delivery. Technological innovations such as telehealth monitoring devices, behavior sensing mobile applications, and diagnostic tools on smartphones are already engaging patients and practitioners in new ways and expanding the continuum of care beyond traditional settings. The Internet is democratizing medical knowledge by providing unprecedented access to health-related content, research, and patient-to-patient communities such as CureTogether and PatientsLikeMe. The rapid emergence of innovative technologies, expanded access, and broad adoption is poised to disrupt how teams manage health and illness as well as how patient-centered care is delivered and received. [46]

Care Coordination

According to the NQF, “care coordination helps ensure a patient’s needs and preferences for care are understood, and that those needs and preferences are shared between providers, patients, and families as a patient moves from one health care setting to another. Care among many different providers must be well-coordinated to avoid waste, over-, under-, or misuse of prescribed medications, and conflicting plans of care.” [4,47] Additionally, the forthcoming IOM discussion paper “Communicating with Patients on Health Care Evidence” reports that 64 percent of people strongly agree (and 92 percent of people agree overall) that health care providers should work as a team to coordinate care and share health information. For patients with chronic conditions, 72 percent strongly agreed (and 97 percent agreed overall) that their care ought to be coordinated. These findings strongly support the conclusion that not only should care be coordinated to increase quality, but that patients already expect to receive coordinated care. [48]

Reviewing the myriad activities in the area of care coordination is beyond the scope of this paper; however, the links between team-based care and care coordination are clear. For example, care coordination starts with a written plan of care; team-based care requires an explicit statement of shared goals. These are integrally related activities; the patient’s goals should drive the development of the patient’s care plan. Fundamentally, we see the principles and values of high-functioning team-based care as central to the success—both in terms of efficiency and effectiveness—of care coordination. The NQF publication Preferred Practices and Performance Measures for Measuring and Reporting Care Coordination: A Consensus Report (2010) outlines many of the specific steps that can help patients and clinicians achieve the principles of effective team-based care within the context of practicing care coordination. Many of the NQF-endorsed preferred practices are applicable to all settings in which team-based care is employed [49].

Defining a Research Agenda

To date, research on team-based care has largely focused on describing the successful elements of individual programs. Comparisons of team-based care programs and paradigms have been hampered by lack of common definitions, shared conceptualization of components, and a clear research agenda. The bulk of this paper attempts to frame the first two elements. Here, we outline suggestions for an approach to the third element—the research agenda. We suggest that the research agenda be divided into two broad categories: targeting team-based care and sustaining effective team-based care.

The first main purpose of research about team-based care is to determine the specific practices that achieve the best outcomes and cost savings for particular patients in a given setting. Simply stated, the research agenda should aim to perfect the science of targeting team-based care. The elements of team-based care to be studied include the who (team composition and roles), what (services provided), where (health care setting, home or community environment, transition between settings), and how (teamwork model employed, including methods of communication, conflict resolution, etc). The measured outcomes should be meaningful to patients and should include improved personal and community health, reduced costs, and the comparative effectiveness of team-based care elements for particular patients in particular settings.

As the science of targeting team-based care is perfected, the second purpose of the research agenda must be to consider elements critical to sustaining targeted team-based care. Areas for consideration include engagement of patients and families (what are the most effective and efficient ways to help patients and families become active participants in their care and as members of the team—including the role of personal technologies and informatics?); the health care workforce (how are the right people selected and trained?); practical tools for team-based care implementation and assessment (how can tools be matched to local needs and uptake of high-quality tools be promoted?); and more.

In conclusion, accelerating the implementation of effective team-based health care is possible using common touchstone principles and values that can be measured, compared, learned, and replicated. This paper provides guidance about the personal values and core principles of high-performing teams as well as the organizational support that is required to establish and sustain effective team-based care. Teams hold the potential to improve the value of health care, but to capture the full potential of team-based care, institutions, organizations, governments, and individuals must invest in the people and processes that lead to improved outcomes. To target expenditures and plan wisely for outcome-oriented team-based care, the top priorities should be the targeting of team-based care to situations in which it promotes the most efficiency and effectiveness and patient engagement (including shared decision making). Given the enthusiasm and activity in team-based care present today, immediate and deep investment in these areas holds profound potential for transformative change in U.S. health care.

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Barnett, M. L., N. A. Christakis, J. O’Malley, J. P. Onnela, N. L. Keating, and B. E. Landon. 2012. Physician patient-sharing networks and the cost and intensity of care in US hospitals. Medical Care 50(2):152-160. https://doi.org/10.1097/MLR.0b013e31822dcef7
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Horwitz, L. I., T. Moin, H. M. Krumholz, L. Wang, and E. H. Bradley. 2008. Consequences of inadequate sign-out for patient care. Archives of Internal Medicine 168(16):1755-1760. https://doi.org/10.1001/archinte.168.16.1755
Williams, R. G., R. Silverman, C. Schwind, J. B. Fortune, J. Sutyak, K. D. Horvath, E. G. Van Eaton, G. Azzie, J. R. Potts III, M. Boehler, and G. L. Dunnington. 2007. Surgeon information transfer and communication: factors affecting quality and efficiency of inpatient care. Annals of Surgery 245(2):159-169. https://doi.org/10.1097/01.sla.0000242709.28760.56
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Gawande, A. A., M. J. Zinner, D. M. Studdert, and T. A. Brennan. 2003. Analysis of errors reported by surgeons at three teaching hospitals. Surgery 133(6):614-621. https://doi.org/10.1067/msy.2003.169
Institute of Medicine. 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary . Washington, DC: The National Academies Press. https://doi.org/10.17226/12750
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Famadas, J. C., K. D. Frick, Z. R. Haydar, D. Nicewander, D. Ballard, and C. Boult. 2008. The effects of interdisciplinary outpatient geriatrics on the use, costs and quality of health services in the fee-for-service environment. Aging Clinical and Experimental Research 20(6):556-561. https://doi.org/10.1007/BF03324884
Boult, C., A. F. Green, L. B. Boult, J. T. Pacala, C. Snyder, and B. Leff. 2009. Successful models of comprehensive care for older adults with chronic conditions: Evidence for the Institute of Medicine’s Retooling for an Aging America report. Journal of the American Geriatrics Society 57(12):2328-2337. https://doi.org/10.1111/j.1532-5415.2009.02571.x
Institute of Medicine. 2001. Crossing the Quality Chasm: A New Health System for the 21st Century . Washington, DC: The National Academies Press. https://doi.org/10.17226/10027
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AAFP, AAP, ACP, AOA. 2007. Joint principles of the patient-centered medical home. Washington, DC. Available at: https://www.aafp.org/dam/AAFP/documents/practice_management/pcmh/initiatives/PCMHJoint.pdf (accessed May 14, 2020).
Bodenheimer, T. 2011. Lessons from the trenches—a high-functioning primary care clinic. New England Journal of Medicine 365(1):5-8. https://doi.org/10.1056/NEJMp1104942
Bodenheimer, T., and B. Y. Laing. 2007. The teamlet model of primary care. Annals of Family Medicine 5(5):457-461. https://doi.org/10.1370/afm.731
Mui, A. C. 2001. The Program of All-Inclusive Care for the Elderly (PACE): An innovative long-term care model in the United States. Journal of Aging & Social Policy 13(2-3):53-67. https://doi.org/10.1300/j031v13n02_05
Naylor, M. D. 2004. Transitional care for older adults: A cost-effective model. LDI Issue Brief 9(6):1-4.
Porter, M. E., and E. O. Teisberg. 2007. How physicians can change the future of health care. JAMA 297(10):1103-1111. https://doi.org/10.1001/jama.297.10.1103
Jones, D. A., M. A. DeVita, and R. Bellomo. 2011. Rapid-response teams. New England Journal of Medicine 365(2):139-146. https://doi.org/10.1056/NEJMra0910926
Wagner, E. H., B. T. Austin, C. Davis, M. Hindmarsh, J. Schaefer, and A. Bonomi. 2001. Improving chronic illness care: translating evidence into action. Health Affairs 20(6):64-78. https://doi.org/10.1377/hlthaff.20.6.64
Wittenberg-Lyles, E. M., and D. P. Oliver. 2007. The power of interdisciplinary collaboration in hospice. Progress in Palliative Care 15(1):6-12. https://doi.org/10.1179/096992607X177764
Naylor, M. D., K. D. Coburn, E. T. Kurtzman, et al. Inter-professional team-based primary care for chronically ill adults: State of the science. Unpublished white paper presented at the ABIM Foundation meeting to Advance Team-Based Care for the Chronically Ill in Ambulatory Settings. Philadelphia, PA; March 24-25, 2010.
Boon, H., M. Verhoef, D. O’Hara, and B. Findlay. 2004. From parallel practice to integrative health care: a conceptual framework. BMC Health Services Research 4(1):15. https://doi.org/10.1186/1472-6963-4-15
Bodenheimer, T. 2007. Building teams in primary care: Lessons learned. San Francisco: California HealthCare Foundation. Available at: https://www.chcf.org/wp-content/uploads/2017/12/PDF-BuildingTeamsInPrimaryCareLessons.pdf (accessed May 14, 2020).
Young, H. M., E. O. Siegel, W. C. McCormick, T. Fulmer, L. K. Harootyan, and D. A. Dorr. 2011. Interdisciplinary collaboration in geriatrics: Advancing health for older adults. Nursing Outlook 59(4):243-250. https://doi.org/10.1016/j.outlook.2011.05.006
The Interprofessional Education Collaborative. 2011. Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, DC. Available at: https://www.aacom.org/docs/default-source/insideome/ccrpt05-10-11.pdf?sfvrsn=77937f97_2 (accessed May 14, 2020).
Cosgrove, D., M. Fisher, P. Gabow, G. Gotlieb, G. Halvorson, B. James, G. Kaplan, J. Perlin, R. Petzel, G. Steele, and J. Toussaint. 2012. A CEO Checklist for High-Value Health Care. NAM Perspectives. Discussion Paper, Washington, DC. https://doi.org/10.31478/201206e
Mitchell, P. H., L. W. Hall, and M. E. Gaines. 2012. A social compact for advancing team-based high-value health care. Health Affairs Blog. Available at: https://www.healthaffairs.org/do/10.1377/hblog20120504.019004/abs/ (accessed May 14, 2020).
Sandra Leal, J. G., R. N. Herrier, and A. Felix. 2004. Improving quality of care in diabetes through a comprehensive pharmacist-based disease management program. Diabetes Care 27(12):2983-2984. https://doi.org/10.2337/diacare.27.12.2983
Principles of successful teamwork and team competencies. 2008. Available at: http://www.pcpci.org/sites/default/files/webinar-related/Successful%20Teamwork%20Principles.pdf (accessed May 14, 2020).
Paget, L., P. Han, S. Nedza, P. Kurtz, E. Racine, S. Russell, J. Santa, M. J. Schumann, J. Simha, and I. Von Kohorn. 2011. Patient-Clinician Communication: Basic Principles and Expectations. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/201106a
Levinson, W., C. S. Lesser, and R. M. Epstein. 2010. Developing physician communication skills for patient-centered care. Health Affairs (Millwood) 29(7):1310-1318. https://doi.org/10.1377/hlthaff.2009.0450.
Feeley, T. W., H. Albright, R. Walters, and T. W. Burke. 2010. A method for defining value in healthcare using cancer care as a model. Journal of Healthcare Management/American College of Healthcare Executives 55(6):399-411.
Bitton, A., and E. C. Schneider. 2011. Home is where the laboratory is: The PCMH as a laboratory for performance measure development. http://qualitymeasures.ahrq.gov/expert/printView.aspx?id=34158 (accessed February 14, 2012).
Valentine, M. A., I. M. Nembhard, and A. C. Edmondson. 2011. Measuring teamwork in health care settings: A review of survey instruments. Harvard Business Review. Boston, MA. https://doi.org/10.1097/MLR.0b013e31827feef6.
AMA. Opinion 8.08—Informed Consent. Code of medical ethics of the American Medical Association: Current opinions with annotations. Available at: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/codemedical-ethics/opinion808.page (accessed June 14, 2012).
Berg, J., P. Appelbaum, C. Lidz, and L. Parker. 2001. Informed consent: Legal theory and clinical practice. 2nd ed. New York: Oxford University Press.
Greene, J. 2012. Why does patient activation matter? An examination of the relationships between patient activation and health outcomes. Journal of General Internal Medicine 27(5):7. https://doi.org/10.1007/s11606-011-1931-2
Wynia, M., M. Johnson, T. McCoy, G. L. Passmore, and C. Osborn. 2010. Validation of an organizational communication climate assessment toolkit. American Journal of Medical Quality 25(6):8. https://doi.org/10.1177/1062860610368428
Topol, E. 2012. The creative destruction of medicine: How the digital revolution will create better health care. New York: Basic Books.
Care Coordination Practices & Measures. 2012. Available at: http://www.qualityforum.org/projects/care_coordination.aspx (accessed June 29, 2012).
Alston, C., L. Paget, G. Halvorson, B. Novelli, J. Guest, P. McCabe, K. Hoffman, C. Koepke, M. Simon, S. Sutton, S. Okun, P. Wicks, T. Undem, V. Rohrbach, and I. Von Kohorn. 2012. Communicating with Patients on Health Care Evidence. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/201209d
National Quality Forum. 2012. Preferred practices and performance measures for measuring and reporting care coordination: A consensus report. Washington, DC. Available at: qualityforum.org/Publications/2010/10/Preferred_Practices_and_Performance_Measures_for_Measuring_and_Reporting_Care_Coordination.aspx (accessed May 14, 2020).

https://doi.org/10.31478/201210c

Suggested Citation

Mitchell, P., M. Wynia, R. Golden, B. McNellis, S. Okun, C.E. Webb, V. Rohrbach, and I. Von Kohorn. 2012. Core principles & values of effective team-based health care. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/201210c

Author Information

Pamela H. Mitchell is Past-President of the American Academy of Nursing and the Robert G. and Jean A. Reid Dean in Nursing (Interim) at the University of Washington. Matthew K. Wynia is Director of The Institute for Ethics at the American Medical Association. Robyn Golden is Instructor and Director of Older Adult Programs at Rush University Medical Center. Bob McNellis is Vice President, Science and Public Health at the American Academy of Physician Assistants. Sally Okun is head of Health Data Integrity and Patient Safety at PatientsLikeMe. C. Edwin Webb is Associate Executive Director and Director, Government and Professional Affairs at American College of Clinical Pharmacy. Valerie Rohrbach is Senior Program Assistant at the Institute of Medicine. Isabelle Von Kohorn is Program Officer at the Institute of Medicine.

Acknowledgments

The authors are deeply grateful for the insights and assistance of health care teams at the following institutions: BRIGHTEN at Rush University; Cincinnati Children’s Family- and Patient-Centered Rounds; El Rio Community Health Center; Hospice of the Bluegrass; MD Anderson Cancer Center; Mike O’Callaghan Federal Medical Center; Mount Sinai Palliative Care Team; Park Nicollet; University of Pennsylvania Transitional Care Model; Veterans Affairs Patient-Aligned Care Teams; and Vermont Blueprint for Health.

The views expressed in this discussion paper are those of the authors and not necessarily of the authors’ organizations or of the Institute of Medicine. The paper is intended to help inform and stimulate discussion. It has not been subjected to the review procedures of the Institute of Medicine and is not a report of the Institute of Medicine or of the National Research Council.

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What is Teamwork in Nursing? (With Examples, Importance, & How to Improve)

Are you a nurse searching for ways to build strong relationships, improve patient care, and promote a good work environment? If so, the key to making this happen is teamwork. Perhaps you know teamwork is essential but find yourself asking, "Where can I start, and what are some ways to know how to improve teamwork in nursing?” In this article, I will share some insight from my nursing career, including 15 expert tips to improve teamwork in nursing. As you read further, you will find reasons why teamwork is so important in nursing and learn the consequences of lack of teamwork. I’ll also share some sample scenarios using teamwork in nursing with examples of poor teamwork and good teamwork.

What is Teamwork in Nursing?

5 reasons why teamwork is so important in nursing, 1. teamwork in nursing results in better patient care, which improves patient outcomes., 2. teamwork and collaboration in nursing help build strong professional relationships., 3. when nurses work together as a team, there is a reduced risk to patient safety., 4. the increased efficiency in patient care due to effective teamwork in nursing leads to lower healthcare costs., 5. teamwork in nursing promotes efficiency in patient care, conducive to a healing environment for patients, and job satisfaction for nurses., what are the 7 key elements of good teamwork in nursing, 1. communication:, 2. collaboration:, 3. coordination:, 4. accountability:, 5. integrity:, 6. sharing ideas with one another:, 7. being supportive of others:, examples of poor teamwork vs. good teamwork in nursing, 1. scenario: demonstrating leadership in teamwork, poor teamwork:, good teamwork:, 2. scenario: collaborative teamwork to reduce patient anxiety, 3. scenario: unusually heavy patient load, how to improve teamwork in nursing, 1. learn effective communication skills., 2. give credit to others for a job well done., 3. avoid trying to micro-manage other team members., 4. two ears, one mouth., 5. volunteer to be a mentor., 6. adopt and promote a patient-centered mindset., 7. grow your skills., 8. be willing to be the first person to promote teamwork between yourself and your colleagues., 9. embrace the diversity that makes up your team., 10. understand the role and responsibilities of each team member., 11. practice integrity., 12. encourage others to grow and expand their professional skills., 13. be willing to accept change., 14. make personal connections with your team members., 15. promote a holistic approach to patient care., 4 consequences of poor teamwork in nursing, 1. increased stress in the workplace:, 2. increased risk of errors in patient care:, 3. conflict among team members:, 4. poor management of time and resources:, useful resources to improve teamwork in nursing, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. will lack of teamwork impact my nursing career, 2. usually, how long does it take for a nurse to improve their teamwork skills, 3. do all types of nurses require good teamwork skills, 4. are nurses with good teamwork skills happier.

Related Programs

Leadership strategies for evolving health care executives, related articles, reinvigorate your health care system: build meta-leadership into your practices and thinking, approaching diversity, equity, and inclusion through a future-oriented lens, change management: why it's so important, and so challenging, in health care environments, how to build, manage, and maintain strong teams in the modern health care space.

Shot of a team of doctors having a meeting in a hospital

by Katherine J. Igoe

The working world post-COVID-19 looks a lot different, both in terms of how we work and what we do—which means that managers in leadership positions need to adapt to this new environment.

“Everything’s changed. There’s a tremendous amount of burnout in the industry. We’re on the other side of the Great Resignation. We’re seeing a lot of hybrid and fully remote work. And we’re obviously seeing a total shift in our work culture. So we need to be thinking about building strong teams in our new world,” says Louise Keogh Weed , program director of the Leadership Strategies for Evolving Health Care Executives program, instructor in the Department of Health Management at the Harvard T.H Chan School of Public Health, and the director of leadership training at the Harvard Medical School Center for Primary Care.

So how, exactly, can leaders build—and maintain—better teams in the modern age?

How a Health Care Team Needs “Norming” First

The first step, according to Keogh-Weed, is to create norms for the team (“norming”) by identifying ground rules for how its members will work together and interact. This is particularly important when a group operates in a Zoom environment instead of in person, since the remote aspect can lead to disconnection. One example of norming, in fact, is establishing Zoom etiquette, such as agreeing to keep one’s camera on unless absolutely necessary to indicate one’s transparency in meetings.

“Norming brings mutual agreement and interconnectedness into your group,” says Keogh-Weed. “And it essentially democratizes the responsibility for how the team will function because we’ve all agreed on how we want to work together. Anyone on the team can say, ‘We aren’t adhering to our norms right now.’ And to some extent, it removes the pressure on the leader, since we’ve created an interdependence.”

Health care organizations can be hierarchical and entrenched in a top-down method of leadership—so, building a functional team can often mean changing preexisting working dynamics. Norming can remove some of the rigidity out of this framework, allowing ideas to come from all members without fear of retaliation. In other words, says Keogh-Weed, “how are we creating spaces where people feel comfortable, where people feel like they can speak up or otherwise write out feedback? Norming allows us to indicate to everyone, ‘you’re safe in this space.'”

Optimizing a Team With Transparency, Processes, and Change Management

Obviously, a team can look different based on its functions and members, but (unless it’s already functioning well) norming will involve necessary change. As a result, members may bristle at being told to do things a new way or feel a sense of loss over changes in the group’s dynamics. This is a normal—and necessary—part of the process, explains Keogh-Weed. “By committing to transparency in these processes, by taking anything that’s implicit and making it explicit, we are telling people what it’s going to be like to work here. And people have a choice about whether they want to be on the team or not.”

After a manager creates norms and begins to build trust, Keogh-Weed notes that there are several questions they should keep in mind:

What processes are we using, and for what?
Who’s responsible for what, in the macro and micro sense?
How do I facilitate professional bonding for the group and establish trust between them?
How are we going to make decisions that concern the whole team?
How do we get and give feedback? How do we respond to it productively?
How do we respond and adapt when something’s not working?
How do we increase transparency around processes, roles, and responsibilities?
How do I manage at the individual and team level?

Committing to the process will also mean evolving norms throughout the team’s evolutions—when people leave or are hired, when new best practices are put in place, and so on. Keogh-Weed explains that these evolutions can look like mini change management cycles and that the leader can actually bring the team together in that cycle, such as involving them in the interview process when a new employee is brought on board, for example.

Moving Forward With the Team in Mind

Ultimately, leaders hoping to do this work must focus on controlling what they can control while leading from a grounded, vulnerable place that enables feedback and growth. This process also allows the team to become more than the sum of its parts: a system in its own right, changeable while still functional and strong. Members can do their work effectively, speak up when they need to, and feel empowered to make decisions that benefit the whole. “When we create transparent processes and expectations and roles and responsibilities, we all know exactly how we’re engaging—exactly how we’re showing up for other people,” says Keogh-Weed.

Harvard T.H. Chan School of Public Health offers Leadership Strategies for Evolving Health Care Executives , an on-site program designed to develop skills in conflict resolution, operational analysis, employee management, and quality management to achieve individual and organizational goals.

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Team-Based Care Toolkit

This toolkit shares best practices and real-life examples of successful team-based clinical care models that include internal medicine physicians working with Nurse Practitioners (NPs) and Physician Assistants (PAs) and other members of the clinical care team. The resources below can help you foster productive and purposeful internal medicine teams.

Why should we practice in teams, what is team-based care, steps to optimal team-based care framework.

Learn More About NP’s and PA’s

Case Studies and Real-life Models of Team-Based Care

Adding an np or pa to your practice, utilize and train existing team members, partnering in team-based care with patients, change management and sustainable teams, 5 quick wins for team-based care.

High functioning clinical teams are essential for the delivery of high value healthcare and have been associated with:

Decreased workloads
Increased efficiency
Improved quality of care
Improved patient outcomes
Decreased clinician burnout/turnover

Source: Implementing Optimal Team-Based Care to Reduce Clinician Burnout – from the National Academy of Medicine

A team-based model of care strives to meet patient needs and preferences by actively engaging patients as full participants in their care, while encouraging and supporting all health care professionals to function to the full extent of their education, certification, and licensure.

Actively engaging patients as full participants in their care, while encouraging and supporting all health care professionals to function to the full extent of their education, certification, and licensure.

Health care teams are defined as two or more health care professionals who work collaboratively with patients and their caregivers to accomplish shared goals. For example, an internist and an NP working together to transition a patient with diabetes to insulin therapy.
A health care team may involve a wide range of team members in various settings. For example, a small ambulatory health care team may include an internist and medical assistant working together to improve the rates of influenza vaccination in their practice. A large inpatient team might include a nurse case manager, social worker, clinical pharmacist, physician assistant, several medical residents, several medical students, an attending physician and unit nurse manager meeting daily to run the list of patients on a floor.
Potential members include physicians, nurse practitioners and physician assistants, medical assistants, pharmacists, social workers, trainees, patients and their families, and others identified as persons necessary to help achieve shared goals.

Access these resources to help you define the team and understand general principals behind team-based care:

Cambridge Health Alliance Model of Team-Based Care Implementation Guide and Toolkit - The Cambridge Health Alliance Model of Team-Based Care Implementation Guide and Toolkit provides information and resources on team-based care, the role of each team member, and sample huddle strategies.
Creating Patient-centered Team-based Primary Care – A proposed blueprint for patient-centered team-based care and strategies to provide patient-centered team-based care.
Foster mutual trust and physical and psychological safety
Clarify roles and expectations
Practice effective communication
Track a set of shared measurable goals

Access these resources to help build this framework and ensure clinical and administrative systems support team members in their defined work:

IOM Core Principles & Values of Effective Team-Based Health Care – This discussion paper presents basic principles and personal values that characterize interprofessional team-based care. Developed by individual participants from the IOM’s Best Practices Innovation Collaborative, the authors identified key findings from health care literature, and used interviews with eleven teams located across the United States to clarify how these factors shape effective team-based care.
Team-Based Care – This module from the AMA Steps Forward explores how to improve patient care and team engagement through collaboration and streamlined processes. It will help you define elements that constitute the model of team-based care, describe how to implement team-based care in your practice, and identify benefits of implementing team-based care in your practice.
Advancing Team Culture: Workforce Effectiveness During COVID-19 and Beyond – This playbook from Vizient sheds light on significant developments in clinical teamwork during 2020 and shares proven strategies for fostering effective teams.
Implementing High-Quality Primary Care: Rebuilding the Foundation of Healthcare – Chapter 6 of this report from the National Academy of Medicine, entitled “Designing Interprofessional Teams and Preparing the Future Primary Care Workforce”, focuses on key design elements of interprofessional teams and highlights the roles that extended care team members can play in delivering high-quality primary care.

Learn More About NPs and PAs

The term 'Advanced Practice Providers' refers to both Physician Assistants and Nurse Practitioners.

An improved understanding of the various roles, training requirements, and scope of work may help internists who are interested in building, expanding, or improving team-based care in their practices. The term “Advanced Practice Providers” refers to both Physician Assistants and Nurse Practitioners. NPs and PAs have very different requirements for both basic science education and clinical experience. In addition, their scope of practice and integration into the healthcare workforce varies significantly by state.

The resources below may help you with your decision to add an NP or PA to your team or more effectively incorporate the APP’s on your team:

NPs vs PAs; What’s the Difference? - This short article summarizes how NPs and PAs are alike and how they are different. It covers differences in the focus of their education, certification and licensure, and in state law mandating physician involvement in practice. It even includes a handy set of key questions to ask prior to hiring an APP.
PAs & NPs: Similarities and Differences – This infographic presents the similarities and differences between NPs and PAs in an easy-to-read infographic.
Physician Assistant Scope of Practice - This state law chart from the AMA outlines several aspects of state laws regulating physician assistant practice including prescriptive authority, requirements for collaborative or supervisory arrangements, regulation, and scope of practice determination.
PA Scope of Practice – This resource from the AAPA explains more about the scope of practice of PAs.
Nurse Practitioner Practice Authority – This state law chart from the AMA outlines nurse practitioner practice authority by state.
PAs and Team Practice - This resource from the AAPA highlights the important role of PAs in team practice.

Real-life examples of successful team-based care in Internal Medicine showcase ways in which team-based care involving nurse practitioners, physician assistants, pharmacists, and others are working together with patients and caregivers in both inpatient and outpatient settings.

Webinar Video Recording of the Virginia Mason Kirkland Medical Center case study
Watch this 3-minute video that describes how they have implemented effective team based primary care at Emory Patient Centered Primary Care.
Team-Based Care – This TCPi Team-Based Care power pack highlights Union Square Family Health Center, a Family Medicine site of the Cambridge Health Alliance in Boston, MA and how they successfully implemented a team-based care model as a sustainable solution to overwork.
Video on Interdisciplinary Rounds – This video features a patient care team at Christiana Care's Wilmington Hospital intensive care unit that demonstrates the patient and family centered care practice of interdisciplinary rounds at the bedside.
Leveraging Advanced Practice Providers during a Crisis: Lessons Learned from Top Healthcare Systems – This white paper from the American College of Healthcare Executives shares crisis strategies from APP leadership across the nation during the COVID-19 pandemic and showcases the innovative ways APPs met unprecedented demands.
Integrating Advanced Practice Providers into value based care strategies: One organization’s journey to achieve success through interprofessional collaboration – This case study from the Journal of Interprofessional Education and Practice showcases an urban academic pediatric hospital that enhanced the use of Advanced Practice Providers (APPs) to optimize care.

During the hiring process, defining team members’ roles can help you empower your team. Oversight and management of a team of advance practice providers is also essential to a highly functioning team.

These job descriptions and other hiring resources can help you facilitate decisions about which patients see which team members, and the best ways to optimize outcomes while having everyone work at the top of their scope.

The Business Case for Hiring a Nurse Practitioner – this article outlines estimated expenses, potential revenue generation and potential profits to expect after the addition of an NP to your practice.
Sample APRN Job Description – Sample APRN job description for an outpatient internal medicine clinic.
Sample Physician Assistant Job Description – Sample PA job description for an inpatient setting.
Sample Core and Specialty Privileges for PAs – Resource from the AAPA.
PAs: Credentialing, Privileging, and Assessing Competency (FPPE & OPPE) – Resource from the AAPA.
Third-Party Reimbursement for PAs – Resource from the AAPA.
Strategies for Recruiting NPs and PAs - In this article from the ACP Hospitalist , two hospitalists share their program’s model for outreach, screening, and interviews.

Hiring new staff is not always necessary to make the most of team-based care. By compensating and valuing the team you already have in place, you can decrease staff turnover and make more a more successful practice.

Remember the importance of the front desk staff and their role on the team
Medical assistants are often overlooked but crucial members of the team
Engage all team members in workflow redesign to get buy in and assure that the new process makes sense
Some examples: standing orders for influenza vaccination during flu season increase rates of vaccination without need for physician involvement; MA’s and LPN’s take patient portal review shifts to decrease response time and clinician burden; uptrain MA’s to scribe encounters in the EHR so that clinicians can focus on patient centered communication and clinical decision making
Clarify roles

Patients, families, and other caregivers need a clear understanding of the roles of the interprofessional care team with explanations of which role will serve which purpose in their care. The health care team should provide information to patients, families, and other caregivers so they can make informed healthcare decisions in partnership with their care team.

The following resources can help patients understand the different roles that make up the interprofessional health care team and how they might interact with each:

Who’s Who on the Healthcare Team: An Interdisciplinary Approach - This article provides a brief introduction to the educational background and role of the different professionals a patient might typically encounter in a hospital.
Your Health Care Team - This article provides a brief description of the roles of the different professionals a patient might typically encounter in a hospital.
Your PA Can Handle It – This patient-facing resource explains more about the physician assistant role on the healthcare team.

Physicians, clinicians, non-clinical staff and patients may have some difficulty adapting to team-based care models. Change management principles may ease adoption by stakeholders and help sustain the team and its members over the long term. Ongoing, structured communication and feedback are essential to optimize team performance and help to sustain teams over time. Relatedness and the ability for team members to enjoy each other’s company at work should be nurtured and encouraged. High functioning teams have been associated with reduced clinician burnout and improved patient outcomes.

These resources address how team-based care can reduce burnout and how to sustain team-based care models in the long term.

ACP’s Well-being and Professional Fulfillment Resources – These resources from ACP can help physicians and their teams reduce burnout and find ways to enhance professional satisfaction and wellbeing.
Team-based Care and Flexible, Adaptable Leadership - This menu of recommendations can help you get started with developing a plan for effective team-based communication and leadership in your practice.
Physician Assistant Burnout Resources – These resources from the AAPA help support the well-being and professional satisfaction of physician assistants.
Mini but Mighty Appreciative Inquiry – Appreciative Inquiry is an organizational development model that takes a positive approach to systems change. This webinar, developed by Kerri Palamara, MD, FACP, Director of the Center for Physician Well-being at Massachusetts General Hospital and Physician Coaching Services Lead for ACP, and presented by North Carolina Well-being Champion Marion McCrary, MD, FACP, guides you through using the AI approach in your practice and teaching others to do the same.

To put the Steps to Optimal Team-Base Care into action, here are five easy-to-implement examples that any care team can put into place:

1. Hang pictures of team members on the wall 2. Invite patients/families to join the clinical team

Both help foster mutual trust and physical and psychological safety

3. Hang a ribbon from each staff person’s badge that states their role 4. Include team members and their roles into the new patient visit

Both help clarify roles and expectations

5. Start each clinical session with a short team huddle

Emphasizes the practice of effective communication

These ideas help to enhance team-based care by optimizing the team you already have, and working with intention to involve everyone consistently on the care team.

2.3 Tools for Prioritizing

Prioritization of care for multiple clients while also performing daily nursing tasks can feel overwhelming in today’s fast-paced health care system. Because of the rapid and ever-changing conditions of clients and the structure of one’s workday, nurses must use organizational frameworks to prioritize actions and interventions. These frameworks can help ease anxiety, enhance personal organization and confidence, and ensure client safety.

Acuity and intensity are foundational concepts for prioritizing nursing care and interventions. Acuity refers to the level of client care that is required based on the severity of a client’s illness or condition. For example, acuity may include characteristics such as unstable vital signs, oxygenation therapy, high-risk IV medications, multiple drainage devices, or uncontrolled pain. A “high-acuity” client requires several nursing interventions and frequent nursing assessments.

Intensity addresses the time needed to complete nursing care and interventions such as providing assistance with activities of daily living (ADLs), performing wound care, or administering several medication passes. For example, a “high-intensity” client generally requires frequent or long periods of psychosocial, educational, or hygiene care from nursing staff members. High-intensity clients may also have increased needs for safety monitoring, familial support, or other needs. [1]

Many health care organizations structure their staffing assignments based on acuity and intensity ratings to help provide equity in staff assignments. Acuity helps to ensure that nursing care is strategically divided among nursing staff. An equitable assignment of clients benefits both the nurse and client by helping to ensure that client care needs do not overwhelm individual staff and safe care is provided.

Organizations use a variety of systems when determining client acuity with rating scales based on nursing care delivery, client stability, and care needs. See an example of a client acuity tool published in the American Nurse in Table 2.3. [2] In this example, ratings range from 1 to 4, with a rating of 1 indicating a relatively stable client requiring minimal individualized nursing care and intervention. A rating of 2 reflects a client with a moderate risk who may require more frequent intervention or assessment. A rating of 3 is attributed to a complex client who requires frequent intervention and assessment. This client might also be a new admission or someone who is confused and requires more direct observation. A rating of 4 reflects a high-risk client. For example, this individual may be experiencing frequent changes in vital signs, may require complex interventions such as the administration of blood transfusions, or may be experiencing significant uncontrolled pain. An individual with a rating of 4 requires more direct nursing care and intervention than a client with a rating of 1 or 2. [3]

Table 2.3. Example of a Client Acuity Tool [4]

Read more about using a client acuity tool on a medical-surgical unit.

Rating scales may vary among institutions, but the principles of the rating system remain the same. Organizations include various client care elements when constructing their staffing plans for each unit. Read more information about staffing models and acuity in the following box.

Staffing Models and Acuity

Organizations that base staffing on acuity systems attempt to evenly staff client assignments according to their acuity ratings. This means that when comparing client assignments across nurses on a unit, similar acuity team scores should be seen with the goal of achieving equitable and safe division of workload across the nursing team. For example, one nurse should not have a total acuity score of 6 for their client assignments while another nurse has a score of 15. If this situation occurred, the variation in scoring reflects a discrepancy in workload balance and would likely be perceived by nursing peers as unfair. Using acuity-rating staffing models is helpful to reflect the individualized nursing care required by different clients.

Alternatively, nurse staffing models may be determined by staffing ratio. Ratio-based staffing models are more straightforward in nature, where each nurse is assigned care for a set number of clients during their shift. Ratio-based staffing models may be useful for administrators creating budget requests based on the number of staff required for client care, but can lead to an inequitable division of work across the nursing team when client acuity is not considered. Increasingly complex clients require more time and interventions than others, so a blend of both ratio and acuity-based staffing is helpful when determining staffing assignments. [5]

As a practicing nurse, you will be oriented to the elements of acuity ratings within your health care organization, but it is also important to understand how you can use these acuity ratings for your own prioritization and task delineation. Let’s consider the Scenario B in the following box to better understand how acuity ratings can be useful for prioritizing nursing care.

You report to work at 6 a.m. for your nursing shift on a busy medical-surgical unit. Prior to receiving the handoff report from your night shift nursing colleagues, you review the unit staffing grid and see that you have been assigned to four clients to start your day. The clients have the following acuity ratings:

Client A: 45-year-old client with paraplegia admitted for an infected sacral wound, with an acuity rating of 4.

Client B: 87-year-old client with pneumonia with a low-grade fever of 99.7 F and receiving oxygen at 2 L/minute via nasal cannula, with an acuity rating of 2.

Client C: 63-year-old client who is postoperative Day 1 from a right total hip replacement and is receiving pain management via a PCA pump, with an acuity rating of 2.

Client D: 83-year-old client admitted with a UTI who is finishing an IV antibiotic cycle and will be discharged home today, with an acuity rating of 1.

Based on the acuity rating system, your client assignment load receives an overall acuity score of 9. Consider how you might use their acuity ratings to help you prioritize your care. Based on what is known about the clients related to their acuity rating, whom might you identify as your care priority? Although this can feel like a challenging question to answer because of the many unknown elements in the situation using acuity numbers alone, Client A with an acuity rating of 4 would be identified as the care priority requiring assessment early in your shift.

Although acuity can a useful tool for determining care priorities, it is important to recognize the limitations of this tool and consider how other client needs impact prioritization.

Maslow’s Hierarchy of Needs

When thinking back to your first nursing or psychology course, you may recall a historical theory of human motivation based on various levels of human needs called Maslow’s Hierarchy of Needs. Maslow’s Hierarchy of Needs reflects foundational human needs with progressive steps moving towards higher levels of achievement. This hierarchy of needs is traditionally represented as a pyramid with the base of the pyramid serving as essential needs that must be addressed before one can progress to another area of need. [6] See Figure 2.1 [7] for an illustration of Maslow’s Hierarchy of Needs.

Maslow’s Hierarchy of Needs places physiological needs as the foundational base of the pyramid. [8] Physiological needs include oxygen, food, water, sex, sleep, homeostasis, and excretion. The second level of Maslow’s hierarchy reflects safety needs. Safety needs include elements that keep individuals safe from harm. Examples of safety needs in health care include fall precautions. The third level of Maslow’s hierarchy reflects emotional needs such as love and a sense of belonging. These needs are often reflected in an individual’s relationships with family members and friends. The top two levels of Maslow’s hierarchy include esteem and self-actualization. An example of addressing these needs in a health care setting is helping an individual build self-confidence in performing blood glucose checks that leads to improved self-management of their diabetes.

So how does Maslow’s theory impact prioritization? To better understand the application of Maslow’s theory to prioritization, consider Scenario C in the following box.

You are an emergency response nurse working at a local shelter in a community that has suffered a devastating hurricane. Many individuals have relocated to the shelter for safety in the aftermath of the hurricane. Much of the community is still without electricity and clean water, and many homes have been destroyed. You approach a young woman who has a laceration on her scalp that is bleeding through her gauze dressing. The woman is weeping as she describes the loss of her home stating, “I have lost everything! I just don’t know what I am going to do now. It has been a day since I have had water or anything to drink. I don’t know where my sister is, and I can’t reach any of my family to find out if they are okay!”

Despite this relatively brief interaction, this woman has shared with you a variety of needs. She has demonstrated a need for food, water, shelter, homeostasis, and family. As the nurse caring for her, it might be challenging to think about where to begin her care. These thoughts could be racing through your mind:

Should I begin to make phone calls to try and find her family? Maybe then she would be able to calm down.

Should I get her on the list for the homeless shelter so she wouldn’t have to worry about where she will sleep tonight?

She hasn’t eaten in a while; I should probably find her something to eat.

All these needs are important and should be addressed at some point, but Maslow’s hierarchy provides guidance on what needs must be addressed first. Use the foundational level of Maslow’s pyramid of physiological needs as the top priority for care. The woman is bleeding heavily from a head wound and has had limited fluid intake. As the nurse caring for this client, it is important to immediately intervene to stop the bleeding and restore fluid volume. Stabilizing the client by addressing her physiological needs is required before undertaking additional measures such as contacting her family. Imagine if instead you made phone calls to find the client’s family and didn’t address the bleeding or dehydration – you might return to a severely hypovolemic client who has deteriorated and may be near death. In this example, prioritizing emotional needs above physiological needs can lead to significant harm to the client.

Although this is a relatively straightforward example, the principles behind the application of Maslow’s hierarchy are essential. Addressing physiological needs before progressing toward additional need categories concentrates efforts on the most vital elements to enhance client well-being. Maslow’s hierarchy provides the nurse with a helpful framework for identifying and prioritizing critical client care needs.

Airway, breathing, and circulation, otherwise known by the mnemonic “ABCs,” are another foundational element to assist the nurse in prioritization. Like Maslow’s hierarchy, using the ABCs to guide decision-making concentrates on the most critical needs for preserving human life. If a client does not have a patent airway, is unable to breathe, or has inadequate circulation, very little of what else we do matters. The client’s ABCs are reflected in Maslow’s foundational level of physiological needs and direct critical nursing actions and timely interventions. Let’s consider Scenario D in the following box regarding prioritization using the ABCs and the physiological base of Maslow’s hierarchy.

You are a nurse on a busy cardiac floor charting your morning assessments on a computer at the nurses’ station. Down the hall from where you are charting, two of your assigned clients are resting comfortably in Room 504 and Room 506. Suddenly, both call lights ring from the rooms, and you answer them via the intercom at the nurses’ station.

Room 504 has an 87-year-old male who has been admitted with heart failure, weakness, and confusion. He has a bed alarm for safety and has been ringing his call bell for assistance appropriately throughout the shift. He requires assistance to get out of bed to use the bathroom. He received his morning medications, which included a diuretic about 30 minutes previously, and now reports significant urge to void and needs assistance to the bathroom.

Room 506 has a 47-year-old woman who was hospitalized with new onset atrial fibrillation with rapid ventricular response. The client underwent a cardioversion procedure yesterday that resulted in successful conversion of her heart back into normal sinus rhythm. She is reporting via the intercom that her “heart feels like it is doing that fluttering thing again” and she is having chest pain with breathlessness.

Based upon these two client scenarios, it might be difficult to determine whom you should see first. Both clients are demonstrating needs in the foundational physiological level of Maslow’s hierarchy and require assistance. To prioritize between these clients’ physiological needs, the nurse can apply the principles of the ABCs to determine intervention. The client in Room 506 reports both breathing and circulation issues, warning indicators that action is needed immediately. Although the client in Room 504 also has an urgent physiological elimination need, it does not overtake the critical one experienced by the client in Room 506. The nurse should immediately assess the client in Room 506 while also calling for assistance from a team member to assist the client in Room 504.

Prioritizing what should be done and when it can be done can be a challenging task when several clients all have physiological needs. Recently, there has been professional acknowledgement of the cognitive challenge for novice nurses in differentiating physiological needs. To expand on the principles of prioritizing using the ABCs, the CURE hierarchy has been introduced to help novice nurses better understand how to manage competing client needs. The CURE hierarchy uses the acronym “CURE” to guide prioritization based on identifying the differences among Critical needs, Urgent needs, Routine needs, and Extras. [9]

“Critical” client needs require immediate action. Examples of critical needs align with the ABCs and Maslow’s physiological needs, such as symptoms of respiratory distress, chest pain, and airway compromise. No matter the complexity of their shift, nurses can be assured that addressing clients’ critical needs is the correct prioritization of their time and energies.

After critical client care needs have been addressed, nurses can then address “urgent” needs. Urgent needs are characterized as needs that cause client discomfort or place the client at a significant safety risk. [10]

The third part of the CURE hierarchy reflects “routine” client needs. Routine client needs can also be characterized as “typical daily nursing care” because the majority of a standard nursing shift is spent addressing routine client needs. Examples of routine daily nursing care include actions such as administering medication and performing physical assessments. [11] Although a nurse’s typical shift in a hospital setting includes these routine client needs, they do not supersede critical or urgent client needs.

The final component of the CURE hierarchy is known as “extras.” Extras refer to activities performed in the care setting to facilitate client comfort but are not essential. [12] Examples of extra activities include providing a massage for comfort or washing a client’s hair. If a nurse has sufficient time to perform extra activities, they contribute to a client’s feeling of satisfaction regarding their care, but these activities are not essential to achieve client outcomes.

Let’s apply the CURE mnemonic to client care in the following box.

If we return to Scenario D regarding clients in Room 504 and 506, we can see the client in Room 504 is having urgent needs. He is experiencing a physiological need to urgently use the restroom and may also have safety concerns if he does not receive assistance and attempts to get up on his own because of weakness. He is on a bed alarm, which reflects safety considerations related to his potential to get out of bed without assistance. Despite these urgent indicators, the client in Room 506 is experiencing a critical need and takes priority. Recall that critical needs require immediate nursing action to prevent client deterioration. The clientin Room 506 with a rapid, fluttering heartbeat and shortness of breath has a critical need because without prompt assessment and intervention, their condition could rapidly decline and become fatal.

In addition to using the identified frameworks and tools to assist with priority setting, nurses must also look at their clients’ data cues to help them identify care priorities. Data cues are pieces of significant clinical information that direct the nurse toward a potential clinical concern or a change in condition. For example, have the client’s vital signs worsened over the last few hours? Is there a new laboratory result that is concerning? Data cues are used in conjunction with prioritization frameworks to help the nurse holistically understand the client’s current status and where nursing interventions should be directed. Common categories of data clues include acute versus chronic conditions, actual versus potential problems, unexpected versus expected conditions, information obtained from the review of a client’s chart, and diagnostic information.

Acute Versus Chronic Conditions

A common data cue that nurses use to prioritize care is considering if a condition or symptom is acute or chronic. Acute conditions have a sudden and severe onset. These conditions occur due to a sudden illness or injury, and the body often has a significant response as it attempts to adapt. Chronic conditions have a slow onset and may gradually worsen over time. The difference between an acute versus a chronic condition relates to the body’s adaptation response. Individuals with chronic conditions often experience less symptom exacerbation because their body has had time to adjust to the illness or injury. Let’s consider an example of two clients admitted to the medical-surgical unit complaining of pain in Scenario E in the following box.

As part of your client assignment on a medical-surgical unit, you are caring for two clients who both ring the call light and report pain at the start of the shift. Client A was recently admitted with acute appendicitis, and Client B was admitted for observation due to weakness. Not knowing any additional details about the clients’ conditions or current symptoms, which client would receive priority in your assessment? Based on using the data cue of acute versus chronic conditions, Client A with a diagnosis of acute appendicitis would receive top priority for assessment over a client with chronic pain due to osteoarthritis. Clients experiencing acute pain require immediate nursing assessment and intervention because it can indicate a change in condition. Acute pain also elicits physiological effects related to the stress response, such as elevated heart rate, blood pressure, and respiratory rate, and should be addressed quickly.

Actual Versus Potential Problems

Nursing diagnoses and the nursing care plan have significant roles in directing prioritization when interpreting assessment data cues. Actual problems refer to a clinical problem that is actively occurring with the client. A risk problem indicates the client may potentially experience a problem but they do not have current signs or symptoms of the problem actively occurring.

Consider an example of prioritizing actual and potential problems in Scenario F in the following box.

A 74-year-old woman with a previous history of chronic obstructive pulmonary disease (COPD) is admitted to the hospital for pneumonia. She has generalized weakness, a weak cough, and crackles in the bases of her lungs. She is receiving IV antibiotics, fluids, and oxygen therapy. The client can sit at the side of the bed and ambulate with the assistance of staff, although she requires significant encouragement to ambulate.

Nursing diagnoses are established for this client as part of the care planning process. One nursing diagnosis for this client is Ineffective Airway Clearance . This nursing diagnosis is an actual problem because the client is currently exhibiting signs of poor airway clearance with an ineffective cough and crackles in the lungs. Nursing interventions related to this diagnosis include coughing and deep breathing, administering nebulizer treatment, and evaluating the effectiveness of oxygen therapy. The client also has the nursing diagnosis Risk for Skin Breakdown based on her weakness and lack of motivation to ambulate. Nursing interventions related to this diagnosis include repositioning every two hours and assisting with ambulation twice daily.

The established nursing diagnoses provide cues for prioritizing care. For example, if the nurse enters the client’s room and discovers the client is experiencing increased shortness of breath, nursing interventions to improve the client’s respiratory status receive top priority before attempting to get the client to ambulate.

Although there may be times when risk problems may supersede actual problems, looking to the “actual” nursing problems can provide clues to assist with prioritization.

Unexpected Versus Expected Conditions

In a similar manner to using acute versus chronic conditions as a cue for prioritization, it is also important to consider if a client’s signs and symptoms are “expected” or “unexpected” based on their overall condition. Unexpected conditions are findings that are not likely to occur in the normal progression of an illness, disease, or injury. Expected conditions are findings that are likely to occur or are anticipated in the course of an illness, disease, or injury. Unexpected findings often require immediate action by the nurse.

Let’s apply this tool to the two clients previously discussed in Scenario E. As you recall, both Client A (with acute appendicitis) and Client B (with weakness and diagnosed with osteoarthritis) are reporting pain. Acute pain typically receives priority over chronic pain. But what if both clients are also reporting nausea and have an elevated temperature? Although these symptoms must be addressed in both clients, they are “expected” symptoms with acute appendicitis (and typically addressed in the treatment plan) but are “unexpected” for the client with osteoarthritis. Critical thinking alerts you to the unexpected nature of these symptoms in Client B, so they receive priority for assessment and nursing interventions.

Handoff Report/Chart Review

Additional data cues that are helpful in guiding prioritization come from information obtained during a handoff nursing report and review of the client chart. These data cues can be used to establish a client’s baseline status and prioritize new clinical concerns based on abnormal assessment findings. Let’s consider Scenario G in the following box based on cues from a handoff report and how it might be used to help prioritize nursing care.

Imagine you are receiving the following handoff report from the night shift nurse for a client admitted to the medical-surgical unit with pneumonia:

At the beginning of my shift, the client was on room air with an oxygen saturation of 93%. She had slight crackles in both bases of her posterior lungs. At 0530, the client rang the call light to go to the bathroom. As I escorted her to the bathroom, she appeared slightly short of breath. Upon returning the client to bed, I rechecked her vital signs and found her oxygen saturation at 88% on room air and respiratory rate of 20. I listened to her lung sounds and noticed more persistent crackles and coarseness than at bedtime. I placed the client on 2 L/minute of oxygen via nasal cannula. Within five minutes, her oxygen saturation increased to 92%, and she reported increased ease in respiration.

Based on the handoff report, the night shift nurse provided substantial clinical evidence that the client may be experiencing a change in condition. Although these changes could be attributed to lack of lung expansion that occurred while the client was sleeping, there is enough information to indicate to the oncoming nurse that follow-up assessment and interventions should be prioritized for this client because of potentially worsening respiratory status. In this manner, identifying data cues from a handoff report can assist with prioritization.

Now imagine the night shift nurse had not reported this information during the handoff report. Is there another method for identifying potential changes in client condition? Many nurses develop a habit of reviewing their clients’ charts at the start of every shift to identify trends and “baselines” in client condition. For example, a chart review reveals a client’s heart rate on admission was 105 beats per minute. If the client continues to have a heart rate in the low 100s, the nurse is not likely to be concerned if today’s vital signs reveal a heart rate in the low 100s. Conversely, if a client’s heart rate on admission was in the 60s and has remained in the 60s throughout their hospitalization, but it is now in the 100s, this finding is an important cue requiring prioritized assessment and intervention.

Diagnostic Information

Diagnostic results are also important when prioritizing care. In fact, the National Patient Safety Goals from The Joint Commission include prompt reporting of important test results. New abnormal laboratory results are typically flagged in a client’s chart or are reported directly by phone to the nurse by the laboratory as they become available. Newly reported abnormal results, such as elevated blood levels or changes on a chest X-ray, may indicate a client’s change in condition and require additional interventions. For example, consider Scenario H in which you are the nurse providing care for five medical-surgical clients.

You completed morning assessments on your assigned five clients. Client A previously underwent a total right knee replacement and will be discharged home today. You are about to enter Client A’s room to begin discharge teaching when you receive a phone call from the laboratory department, reporting a critical hemoglobin of 6.9 gm/dL on Client B. Rather than enter Client A’s room to perform discharge teaching, you immediately reprioritize your care. You call the primary provider to report Client B’s critical hemoglobin level and determine if additional intervention, such as a blood transfusion, is required.

Prioritization Principles & Staffing Considerations [13]

With the complexity of different staffing variables in health care settings, it can be challenging to identify a method and solution that will offer a resolution to every challenge. The American Nurses Association has identified five critical principles that should be considered for nurse staffing. These principles are as follows:

Health Care Consumer: Nurse staffing decisions are influenced by the specific number and needs of the health care consumer. The health care consumer includes not only the client, but also families, groups, and populations served. Staffing guidelines must always consider the client safety indicators, clinical, and operational outcomes that are specific to a practice setting. What is appropriate for the consumer in one setting, may be quite different in another. Additionally, it is important to ensure that there is resource allocation for care coordination and health education in each setting.
Interprofessional Teams: As organizations identify what constitutes appropriate staffing in various settings, they must also consider the appropriate credentials and qualifications of the nursing staff within a specific setting. This involves utilizing an interprofessional care team that allows each individual to practice to the full extent of their educational, training, scope of practice as defined by their state Nurse Practice Act, and licensure. Staffing plans must include an appropriate skill mix and acknowledge the impact of more experienced nurses to help serve in mentoring and precepting roles.
Workplace culture: Staffing considerations must also account for the importance of balance between costs associated with best practice and the optimization of care outcomes. Health care leaders and organizations must strive to ensure a balance between quality, safety, and health care cost. Organizations are responsible for creating work environments, which develop policies allowing for nurses to practice to the full extent of their licensure in accordance with their documented competence. Leaders must foster a culture of trust, collaboration, and respect among all members of the health care team, which will create environments that engage and retain health care staff.
Practice environment: Staffing structures must be founded in a culture of safety where appropriate staffing is integral to achieve client safety and quality goals. An optimal practice environment encourages nurses to report unsafe conditions or poor staffing that may impact safe care. Organizations should ensure that nurses have autonomy in reporting and concerns and may do so without threat of retaliation. The ANA has also taken the position to state that mandatory overtime is an unacceptable solution to achieve appropriate staffing. Organizations must ensure that they have clear policies delineating length of shifts, meal breaks, and rest period to help ensure safety in client care.
Evaluation: Staffing plans should be consistently evaluated and changed based upon evidence and client outcomes. Environmental factors and issues such as work-related illness, injury, and turnover are important elements of determining the success of need for modification within a staffing plan. [14]
Oregon Health Authority. (2021, April 29). Hospital nurse staffing interpretive guidance on staffing for acuity & intensity . Public Health Division, Center for Health Protection. https://www.oregon.gov/oha/ph/providerpartnerresources/healthcareprovidersfacilities/healthcarehealthcareregulationqualityimprovement/pages/nursestaffing.aspx ↵
Ingram, A., & Powell, J. (2018). Patient acuity tool on a medical surgical unit. American Nurse . https://www.myamericannurse.com/patient-acuity-medical-surgical-unit/ ↵
Kidd, M., Grove, K., Kaiser, M., Swoboda, B., & Taylor, A. (2014). A new patient-acuity tool promotes equitable nurse-patient assignments. American Nurse Today, 9 (3), 1-4. https://www.myamericannurse.com/a-new-patient-acuity-tool-promotes-equitable-nurse-patient-assignments / ↵
Welton, J. M. (2017). Measuring patient acuity. JONA: The Journal of Nursing Administration, 47 (10), 471. https://doi.org/10.1097/nna.0000000000000516 ↵
Maslow, A. H. (1943). A theory of human motivation. Psychological Review , 50 (4), 370–396. https://doi.org/10.1037/h0054346 ↵
“ Maslow's_hierarchy_of_needs.svg ” by J. Finkelstein is licensed under CC BY-SA 3.0 ↵
Stoyanov, S. (2017). An analysis of Abraham Maslow's A Theory of Human Motivation (1st ed.). Routledge. https://doi.org/10.4324/9781912282517 ↵
Kohtz, C., Gowda, C., & Guede, P. (2017). Cognitive stacking: Strategies for the busy RN. Nursing2021, 47 (1), 18-20. https://doi.org/10.1097/01.nurse.0000510758.31326.92 ↵
ANA. (2024). Principles for nurse staffing. Retrieved from https://www.nursingworld.org/practice-policy/nurse-staffing/staffing-principles/ ↵

The level of patient care that is required based on the severity of a patient’s illness or condition.

A staffing model used to make patient assignments that reflects the individualized nursing care required for different types of patients.

A staffing model used to make patient assignments in terms of one nurse caring for a set number of patients.

Prioritization strategies often reflect the foundational elements of physiological needs and safety and progress toward higher levels.

Airway, breathing, and circulation.

Pieces of clinical information that direct the nurse toward a potential “actual problem” or a change in condition.

Conditions having a sudden and severe onset.

Have a slow onset and may gradually worsen over time.

Nursing problems currently occurring with the patient.

A nursing problem that reflects that a patient may experience a problem but does not currently have signs reflecting the problem is actively occurring.

Conditions that are not likely to occur in the normal progression of an illness, disease or injury.

Conditions that are likely to occur or anticipated in the course of an illness, disease, or injury.

Nursing Management and Professional Concepts 2e Copyright © by Chippewa Valley Technical College is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

Healthcare Project Management: Essential Guide & Best Practices

Table of contents.

Are you ready to revolutionize healthcare project management ? Dive into our comprehensive guide tailored to simplify the complexities of overseeing healthcare projects. From optimizing workflows to enhancing team collaboration, we’ve got you covered with practical strategies and expert insights. Discover how to navigate budget constraints, streamline communication, and ensure timely project delivery in the dynamic healthcare landscape. Stay ahead of the curve by mastering essential project management skills specific to the healthcare industry.

Understanding Project Management

Effective healthcare project management is crucial for ensuring the successful delivery of healthcare services. It plays a vital role in enhancing patient care , streamlining processes , and achieving organizational goals . Project management directly impacts patient outcomes by ensuring that projects are completed on time, within budget, and meet quality standards.

The significance of project management in healthcare lies in its ability to improve healthcare delivery by optimizing resource allocation , enhancing communication among stakeholders, and promoting collaboration across different departments. A well-managed project can lead to better patient experiences, increased efficiency in service delivery, and ultimately contribute to improved health outcomes for individuals and communities.

Healthcare organizations rely on effective project management practices to navigate the complex landscape of the healthcare industry. Managing healthcare projects involves dealing with unique challenges such as strict regulatory requirements , rapidly evolving technologies, and the need to balance clinical excellence with operational efficiency . The success of healthcare projects hinges on the ability to address these complexities while maintaining a focus on delivering high-quality patient care.

Managing healthcare projects presents a myriad of challenges that require a delicate balance between meeting patient needs and achieving project objectives. Healthcare project managers must navigate through intricate processes while adhering to regulations, managing risks, and ensuring stakeholder engagement . The complexity of healthcare project management stems from the dynamic nature of the healthcare environment and the diverse range of stakeholders involved.

Balancing quality patient care with project requirements is one of the primary challenges faced in healthcare project management. Project managers must prioritize patient safety and well-being while also meeting project deadlines and budget constraints. This delicate balance requires careful planning , effective communication , and continuous monitoring to ensure that both clinical outcomes and project goals are achieved successfully.

The regulatory demands imposed on healthcare organizations further add to the complexity of managing healthcare projects. Compliance with various regulations and standards is essential to ensure that projects meet legal requirements and industry best practices. Healthcare project managers must navigate through these regulatory frameworks while maintaining a focus on delivering high-quality care to patients.

Stages Overview

In healthcare project management, several key stages are essential for ensuring project success . These stages typically include initiation , planning, execution , monitoring & control , and closure . Each stage plays a critical role in guiding the project from conception to completion by providing a structured framework for managing resources, timelines, risks, and stakeholder expectations.

Initiation marks the beginning of a healthcare project where objectives are defined, stakeholders are identified, and initial planning activities take place. Planning involves developing a comprehensive roadmap that outlines project scope, deliverables, timelines, budgets, and resource requirements. Execution focuses on implementing the plan while monitoring & control involve tracking progress against milestones, managing risks, and making necessary adjustments to ensure project success.

A systematic approach is crucial throughout all stages of healthcare project management to maintain alignment with organizational goals and ensure efficient resource utilization. By following a structured methodology from initiation to closure, healthcare organizations can enhance transparency, accountability, and overall project performance.

Methodologies

Various project management methodologies are utilized in healthcare settings to effectively manage projects based on specific requirements. Agile methodology emphasizes iterative development cycles that allow for flexibility in responding to changing priorities or stakeholder needs. Lean methodology focuses on eliminating waste and improving efficiency by streamlining processes and reducing unnecessary steps.

Waterfall methodology follows a sequential approach where each phase of the project is completed before moving onto the next stage. While Agile is suitable for projects requiring adaptability and frequent feedback loops, Waterfall is ideal for projects with well-defined requirements and limited changes expected during implementation.

Selecting the right methodology is crucial in determining the success of healthcare projects as it influences how tasks are organized, resources allocated, risks managed, and progress monitored. By choosing an appropriate methodology tailored to specific project needs, healthcare organizations can enhance collaboration among team members, improve decision-making processes, and increase overall project efficiency.

High Stakes in Healthcare

Patient well-being.

Healthcare project management is crucial for ensuring optimal patient well-being and care delivery efficiency. The precise coordination of tasks directly influences patient outcomes and satisfaction levels. Error-free project execution is imperative in healthcare settings to prevent any adverse impact on patients’ health. Patient-centric project management approaches prioritize the needs and safety of individuals receiving medical care.

Cost Concerns

Managing costs effectively throughout a healthcare project is essential to ensure financial sustainability and affordability of services. Budgeting plays a critical role in controlling expenses and allocating resources efficiently. Strategies such as cost tracking and resource optimization help in maintaining financial stability during the project lifecycle.

Regulation Impact

Regulations play a significant role in shaping healthcare project management practices, requiring strict adherence to compliance standards. Challenges related to regulatory requirements necessitate thorough planning and monitoring to mitigate risks effectively. Staying updated with industry regulations is vital to avoid penalties and legal implications that could jeopardize project success.

Industry Changes

The dynamic nature of the healthcare industry constantly introduces new trends, technologies, and methodologies that impact project management practices. Adapting to these changes is crucial for ensuring the successful implementation of healthcare projects. Flexibility and innovation are key components in managing projects amidst evolving industry landscapes.

Project Management Stages

The initiation phase in healthcare project management is crucial as it sets the foundation for the entire project. Defining project scope and objectives accurately ensures alignment with stakeholders’ expectations. Thorough planning during initiation helps in identifying potential risks and developing mitigation strategies.

Key steps in the initiation phase include conducting a feasibility study to assess project viability, defining clear objectives, and establishing a project team. Engaging key stakeholders from the beginning ensures their input is considered in shaping project goals. The initiation phase lays the groundwork for successful project outcomes.

Planning plays a critical role in ensuring the success of healthcare projects by setting a roadmap for execution. Creating detailed project plans and timelines helps in organizing tasks effectively and allocating resources efficiently. Involving stakeholders during the planning phase ensures their buy-in and commitment to project goals.

Effective planning involves identifying project deliverables, defining roles and responsibilities, and establishing communication channels. Developing contingency plans for potential risks enhances project resilience. Stakeholder involvement fosters collaboration and ensures that diverse perspectives are considered in decision-making processes.

The execution phase involves implementing the project plan while monitoring progress closely to ensure milestones are met timely. Monitoring progress allows project managers to identify deviations from the plan and take corrective actions promptly. Addressing issues proactively minimizes disruptions and keeps the project on track.

Effective communication is essential during the execution phase to keep all team members informed about progress, changes, and challenges. Regular meetings, status updates, and feedback sessions facilitate smooth coordination among team members. Transparent communication builds trust and fosters a collaborative working environment.

Proper project closure is vital in healthcare to ensure that outcomes meet quality standards and stakeholder expectations. Wrapping up a healthcare project successfully involves completing all deliverables, obtaining approvals, and transitioning any remaining tasks or responsibilities. Documenting outcomes and lessons learned provides valuable insights for future projects.

Steps involved in closure include conducting a final project review , obtaining feedback from stakeholders, and celebrating achievements. Archiving project documentation ensures that information is accessible for future reference or audits. Reflecting on successes and challenges encountered during the project offers opportunities for continuous improvement.

Methodologies Tailored for Healthcare

Agile approach.

Agile project management in healthcare involves iterative development and constant collaboration among team members. This approach allows for flexibility and quick adaptation to changing project requirements. Healthcare organizations benefit from Agile’s ability to deliver value-driven results efficiently. For example , implementing electronic health records (EHR) using Agile has shown significant improvements in patient data accessibility .

Lean Methodology

Lean methodology focuses on reducing waste and improving efficiency in healthcare project management. By applying Lean principles, healthcare projects can streamline processes, enhance quality, and optimize resource utilization. In real-world scenarios , hospitals have successfully used Lean techniques to minimize patient wait times and enhance overall operational efficiency.

Waterfall Model

The Waterfall model follows a sequential approach where each phase must be completed before moving on to the next. In healthcare projects , this model is suitable for well-defined, stable requirements without much expected change. One advantage of the Waterfall model is its clear structure, ensuring each stage is thoroughly completed before progressing. However, limitations arise when changes are needed mid-project, making it challenging to backtrack without affecting timelines.

Unique Challenges Faced

Rising costs.

Healthcare projects often grapple with escalating costs , posing a significant challenge to project managers. The increasing expenses can impact the overall budget and timeline of the project. To address this issue, effective cost management strategies are crucial. Project managers must closely monitor expenses, identify cost-saving opportunities, and prioritize resource allocation efficiently. Cost control measures such as budget tracking, financial forecasting, and vendor negotiations play a vital role in managing rising costs in healthcare projects.

Heavy Regulation

The heavy regulation surrounding healthcare projects adds another layer of complexity to project management. Compliance with stringent healthcare regulations is imperative but can be daunting for project teams. Navigating through regulatory requirements demands meticulous planning and adherence to legal frameworks. Establishing robust regulatory frameworks within project management processes is essential to ensure compliance and mitigate risks associated with non-compliance.

Litigation Risks

Healthcare projects are susceptible to litigation risks , which can arise from various sources such as medical malpractice, contractual disputes, or regulatory violations. Project managers need to proactively identify potential legal pitfalls and implement strategies to mitigate these risks effectively. By integrating risk management practices into project planning and execution, teams can safeguard against legal challenges and ensure smooth project delivery in healthcare settings.

Diverse Stakeholders

Managing diverse stakeholders in healthcare projects presents a unique set of challenges for project managers. Stakeholders may include healthcare providers, patients, regulatory bodies, insurers, and community members, each with distinct interests and priorities. Effective stakeholder engagement is critical for project success, requiring clear communication channels, active involvement, and tailored approaches to meet stakeholder needs. Building strong relationships with stakeholders fosters collaboration, enhances project outcomes, and promotes stakeholder satisfaction throughout the project lifecycle.

Best Practices for Success

Effective communication.

Effective communication is vital in healthcare project management to ensure all team members are aligned. Clear and concise communication strategies help in avoiding misunderstandings and delays in project timelines. It is crucial to establish a communication plan outlining the frequency and mode of communication.

Implement regular meetings to provide updates and address any concerns promptly.
Utilize various communication channels such as emails, project management tools , and face-to-face discussions.
Encourage an open-door policy for team members to raise issues or seek clarification.

Integrating project management software facilitates seamless communication among team members by centralizing project information. Gantt charts assist in visualizing project timelines, while collaboration platforms enable real-time collaboration on tasks and documents. Leveraging technology enhances efficiency and transparency in project communication.

Budgeting Techniques

In healthcare project management, utilizing various budgeting techniques is essential for financial sustainability. Accurate budget estimation at the onset of a project helps in allocating resources effectively. Continuous monitoring of expenses against the budget ensures that the project stays within financial constraints.

Importance of Budgeting

Proper budgeting allows for resource allocation based on priority areas.
Monitoring expenses helps in identifying cost overruns early for timely corrective actions.
Budgeting plays a crucial role in ensuring the overall financial health of the project.

Stakeholder Relations

Maintaining positive stakeholder relations is key to the success and sustainability of healthcare projects. Engaging stakeholders throughout the project lifecycle fosters trust and support from key decision-makers. Effective communication strategies with stakeholders help in managing expectations and addressing concerns proactively.

Strategies for Engagement

Regularly update stakeholders on project progress and milestones achieved.
Seek feedback from stakeholders to incorporate their input into decision-making processes.
Address stakeholder concerns promptly to maintain their confidence in the project.

Skills for Project Managers

Essential skills.

Project managers in healthcare need a diverse set of project management skills to succeed. Leadership is crucial for guiding teams towards common goals and fostering collaboration. Effective communication ensures clear instructions, updates, and feedback among team members. Problem-solving skills are essential for addressing issues promptly and keeping projects on track. emotional intelligence plays a vital role in understanding team dynamics and managing conflicts within diverse project teams.

Adaptation Strategies

Adapting to changes is key in healthcare project management. Being flexible allows project managers to adjust plans swiftly in response to evolving circumstances. Agility enables them to navigate unexpected challenges with ease, ensuring project continuity and success. For instance, when faced with budget constraints, a successful adaptation strategy could involve reallocating resources or renegotiating contracts to meet project goals.

Risk Management Solutions

Effective risk management is critical in mitigating project risks in healthcare settings. Proactive approaches involve identifying potential risks early on, assessing their impact, and developing mitigation strategies. Integrating risk management into every phase of the project lifecycle enhances preparedness and minimizes disruptions. For example, conducting regular risk assessments and implementing contingency plans can help project managers anticipate and address potential obstacles before they escalate.

Career in Healthcare Project Management

Becoming a manager.

Transitioning from a project team member to a project manager in healthcare involves taking on leadership roles and overseeing projects. As a manager, individuals are responsible for planning, executing, and monitoring healthcare projects. Effective project managers in healthcare need strong communication, organizational, and problem-solving skills .

To excel as a project manager in healthcare, professionals must possess the ability to lead teams , manage budgets , and ensure project timelines are met . The transition from team member to manager offers career growth opportunities such as advancement into senior management roles . However, it also comes with challenges like handling complex projects and balancing various stakeholders’ needs.

Salary Outlook

Healthcare project managers enjoy a favorable salary outlook due to the industry’s demand for skilled professionals. Factors influencing project manager salaries in healthcare include experience level , educational background , and the size of the organization. With the potential for career advancement, project managers can expect competitive compensation packages that reflect their expertise and contributions.

The salary outlook for healthcare project managers is promising, with ample opportunities for growth and development within the field. Competitive compensation packages are offered to attract top talent in healthcare project management. This reflects the industry’s recognition of the critical role that project managers play in ensuring successful project outcomes.

The job growth prospects for healthcare project managers are robust, driven by the increasing demand for skilled professionals who can oversee complex projects within the healthcare sector. As healthcare organizations continue to prioritize efficiency and quality improvement initiatives, there is a growing need for experienced project managers to lead these efforts.

In the dynamic healthcare industry, project managers have access to diverse career opportunities and job stability due to the sector’s continual growth and evolution. The demand for skilled project managers is expected to rise steadily, offering professionals in this field long-term career prospects and stability.

Benefits of Effective Management

Improved outcomes.

Effective management enhances healthcare outcomes by ensuring streamlined processes and optimal resource allocation . It improves patient care through efficient project execution. Successful projects like the implementation of electronic health records have significantly improved patient care quality.

Cost Reductions

Strategies for achieving cost reductions in healthcare projects include efficient budgeting, resource management, and process optimization. Implementing cost-effective solutions leads to significant savings without compromising the quality of care provided. Efficient project management ensures resources are utilized effectively, reducing unnecessary expenses.

Enhanced Stakeholder Relations

Enhancing stakeholder relations is crucial in healthcare projects to ensure successful outcomes. Positive relationships with patients, staff, and external partners foster collaboration and trust. Strong stakeholder relations positively impact project success rates and enhance the organization’s reputation.

Final Remarks

In the dynamic realm of healthcare project management, understanding the intricacies and nuances is paramount. High stakes demand meticulous planning and execution at every stage. Tailored methodologies, coupled with best practices and honed skills, pave the way for success amidst unique challenges. A career in healthcare project management offers a fulfilling path, with benefits extending beyond professional growth.

Embrace the opportunities to excel in this field. Equip yourself with the right tools, knowledge, and mindset to navigate the complexities of healthcare project management. Your journey towards impactful project delivery starts now.

Frequently Asked Questions

What are the key stages of healthcare project management.

Healthcare project management typically involves stages such as initiation, planning, execution, monitoring and controlling, and closing. Each stage is crucial for ensuring successful project completion within the healthcare industry.

What methodologies are commonly used in healthcare project management?

Popular methodologies tailored for healthcare projects include Lean, Six Sigma, Agile, and Waterfall. These approaches help streamline processes, improve efficiency, and ensure quality outcomes in healthcare project management.

What unique challenges do healthcare project managers face?

Healthcare project managers often encounter challenges like regulatory compliance, stakeholder communication, budget constraints, technology integration, and risk management due to the complex nature of the industry. Overcoming these hurdles requires specialized skills and strategic planning .

Why are effective management practices important in healthcare projects?

Effective management practices in healthcare projects lead to improved patient outcomes , cost savings , streamlined operations, enhanced team collaboration, and overall project success. By implementing best practices and strategies, healthcare organizations can achieve their project goals efficiently.

What skills are essential for a career in healthcare project management?

Critical skills for a successful career in healthcare project management include leadership abilities, communication skills, problem-solving expertise, adaptability to change, organization skills, risk management proficiency, and knowledge of healthcare regulations. Developing these skills is vital for managing complex projects effectively.

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Nurse Manager-Referral Coordination Team

The Nurse Manager (NM) is the designated first-line supervisory authority and is responsible and accountable for the 24/7 operation of their assigned units and provides coverage for other NMs as needed. The NM is responsible and accountable for the direction and supervision of specific orientation, training, development of staff, and evaluation of individual staff performance.

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$78,105 - $177,798 per year

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Upon assignment to this position, the incumbent's salary will include two additional steps for assignment to a Nurse Manager position. The NM functions as a role model, educator, practitioner, and supervisor providing leadership to the team. They enhance care outcomes by collaborating with members of the interdisciplinary team to remove barriers and implement new evidence-based cutting-edge programs/processes. The NM engages in professional organizations to enhance leadership and career growth. They adhere to ethical principles in decision-making, fostering accountability at personal, organizational, and staff levels. They equip staff with tools for culturally competent care and promotes a culture of accountability for high-quality, cost-effective outcomes. They cultivate alliances across the care continuum, building trust through active listening, engagement, and emotional intelligence. The NM contributes to the development of care delivery models and environmental design, ensuring evidence-based, accessible, affordable, and equitable patient care. Ensures compliance with accreditation and regulatory standards. Aligns nursing/clinical objectives with organizational strategic outcomes, participating in strategy planning and execution. They promote an inclusive workplace valuing diversity to achieve the organizations vision and mission. The NM maintains knowledge and ensures compliance with all regulatory and accreditation standards, Directives, policies, and standard operating procedures (SOP). VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases, potential for performance awards Paid Time Off: 50 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year) Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement) Licensure: 1 full and unrestricted license from any US State or territory Work Schedule: 0730-1600/0800-1630. Responsible for 24/7 operations. Telework: Not Available Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS) : Not Authorized

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Nurse I, Level I	Delivers fundamental, knowledge-based care to assigned clients while developing technical competencies.	An Associate Degree (ADN) or Diploma in Nursing, with no additional professional nursing required.
Nurse I, Level II	Demonstrates integration of biopsychosocial concepts, cognitive skills and technically competent practice in providing care to clients with basic or complex.	An ADN or Diploma in Nursing 1 year of specialized nursing experience equivalent to Nurse I, Level 1 ; a Bachelor of Science in Nursing (BSN) with no additional professional nursing experience required.
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Nurse III	Executes position responsibilities that demonstrate leadership, experience and creative approaches to management of complex client care beyond the immediate practice setting.	MSN and 2 years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; a Master's degree in related field with BSN and two years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III; a Doctoral degree in Nursing with and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III; a Doctoral degree in a related field with a BSN and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III.

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This job opportunity announcement may be used to fill additional vacancies. This position is in the Excepted Service and does not confer competitive status. VA encourages persons with disabilities to apply. The health-related positions in VA are covered by Title 38, and are not covered by the Schedule A excepted appointment authority. Pursuant to VHA Directive 1193.01, VHA health care personnel (HCP) are required to be fully vaccinated against COVID-19 subject to such accommodations as required by law (i.e., medical, religious or pregnancy). VHA HCPs do not include remote workers who only infrequently enter VHA locations. If selected, you will be required to be fully vaccinated against COVID-19 and submit documentation of proof of vaccination before your start date. The agency will provide additional information regarding what information or documentation will be needed and how you can request a legally required accommodation from this requirement using the reasonable accommodation process. If you are unable to apply online or need an alternate method to submit documents, please reach out to the Agency Contact listed in this Job Opportunity Announcement. Under the Fair Chance to Compete Act, the Department of Veterans Affairs prohibits requesting an applicant's criminal history prior to accepting a tentative job offer. For more information about the Act and the complaint process, visit Human Resources and Administration/Operations, Security, and Preparedness (HRA/OSP) at The Fair Chance Act .

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Health workforce policy in the Russian Federation: How to overcome a shortage of physicians?

Russia looks for ways to overcome a shortage of physicians. Health workforce policy is focused on training an additional number of physicians. The current efforts have reduced some areas of the shortage but failed to solve the problem due to many factors that reproduce the deficit. A distorted structure of service delivery with weak primary care generates demand for outpatient specialists and hospital doctors and requires a perpetual increase in their number. The lack of long-term labor planning results in the oversupply of some specialties and the shortage of others. The regulation of post-graduate training is not enough to improve the allocation of physicians across specialties and health system sectors. We argue that an extensive increase in the number of physicians without changing their composition will hardly change the situation. A more active structural policy is required with a focus on strengthening primary care and improving planning and regulation of health workforce structure.

Introduction

The ability of health systems to respond to new challenges is heavily dependent on the deployment of an adequate supply of health professionals in sufficient numbers, operating in the right areas of service delivery, and with appropriate scope for professional development. This is particularly true for many post-Soviet countries that face inadequate health funding and the legacy of the “Semashko” model. Russia is among the world leaders in the physicians-population ratio: 4.2 physicians per 1,000 population vs. the average of 3.6 for OECD countries ( 1 ). However, the country now faces a serious problem of physician shortage, particularly in primary care. The Federal Ministry of Health (MoH) reports that around 20% of physicians' positions in polyclinics were unfilled in 2019 ( 2 ).

The coexistence of a relatively high number of physicians and their shortage is a phenomenon that can be accounted to many factors. Partly, this is the result of special health care needs due to country-specific factors such as harsh climate in many regions, low density of large rural population, and high incidence of cardiovascular diseases and accidents ( 3 ). The major causes for the Russian health worker supply imbalance, however, are evident in our former research ( 4 ) that indicates the important contribution of a deficit of primary healthcare physicians, unequal income opportunities for certain physician specialties, physicians are not adequately supported by nurses, and allied health personnel. The paradoxical situation of “too many too few” requires a special set of workforce policy interventions. Their analysis is relevant for countries that face similar problems.

Following the break-up of the Soviet Union in 1991, the Russian health system has undergone a significant transition to mandatory health insurance (MHI) but has retained its chronic underfunding. Public health expenditures have not exceeded 3.5% of GDP over the last decades ( 5 ). The institutional structure of service delivery has not changed much. Most of the facilities are state-owned. Primary health care (PHC) in urban areas is provided by multispecialty polyclinics—separate clinics for adults and children; each has a catchment area and a patient list managed by district therapists, district pediatricians, and general practitioners (GPs)—all of which are collectively referred to as ‘district physicians' (DPs). The catchment population of urban polyclinics ranges from 30,000 to 120,000 people. Big entities employ 15–20 categories of specialists. According to the legislation, PHC is practically the equivalent of outpatient care. Hospitals vary in size, the structure of specialties, and the number of patients ( 6 ).

To cope with the problem of physician shortage, the government has started a number of policy activities. The presidential decree of May 2012 set the task to increase the salary of physicians to the level of 200% of the average remuneration in the economy of the corresponding regions, and the salary of nurses to 100%. These targets have been reached in most of 85 regions of the country ( 7 ). But this important measure was not enough to eliminate the shortage. Additional measures have been taken, of which the most important is a national program “Providing medical organizations with qualified personnel” (further program) for 2018–2024 ( 2 ).

The objective of this paper is to explore the activities and outcomes of this program and some other policy activities. The major research questions: What are the major policy interventions? What are the factors driving the health labor imbalances? What should be done to solve this problem? We analyze the main developments over the last 10 years with a focus on the period of the program implementation.

The analysis is based on a review of the Russian and international literature, as well as materials of the federal and regional health authorities. The official statistical data are supplemented by our estimates and comparisons with OECD countries.

Policy options and implications

The program major activities.

The major objective of the program is to reduce the shortage of physicians and nurses with focus on primary care. While the government recognizes the existence of a critical imbalance in the health workforce, there is an inadequate study and debate on how best to improve the scope and impact of the program's interventions and investments.

The program is focused on increasing the number of physicians. The admission of students to medical universities increased from 2018/2019 to 2020/2021 by 20% in general medicine specialties [( 8 ), p. 117]. It is expected to raise the number of physicians in state medical organizations from 37.4 per 10,000 population in 2017 to 40.7 by 2024 ( Table 1 ).

Indicators and targets of the federal program “Providing medical organizations with qualified personnel” in Russia, 2017–2024.


Physicians working in state medical organizations (persons per 10,000 population)	37.4	37.9	38.4	38.9	39.5	40.1	40.7
Medical nurses working in state medical organizations (persons per 10,000 population)	86.2	86.8	87.8	89.1	90.4	92.3	95.1
Outpatient care physicians working in state medical organizations (persons per 10,000 population)	20.7	20.9	21.1	21.4	21.7	22.9	22.5
Per cent of filled physicians positions in units providing outpatient care (individuals with a multiple job-holding coefficient of 1.2)	79.7	81.0	83.0	86.0	89.0	92.0	95.0
Per cent of filled nurses positions in units providing outpatient care (individuals with a multiple job-holding coefficient of 1.2)	88.8	90.0	91.0	92.0	93.0	94.0	95.0
The share of outpatient care physicians in the total number of physicians, %	55.3	55.2	55.0	55.0	55.1	55.2	55.3
Medical nurses-physicians ratio	2.3	2.3	2.3	2.3	2.3	2.3	2.3

Source: ( 2 ).

To achieve these indicators, a so-called “target enrollment” of students is expanding. It provides for the involvement of regional governments in the admission of students to medical universities, including post-graduate training. Regional policymakers are supposed to assess the demand for specific medical specialists in their regions, contract universities, and make commitments to financial subsidies for the education of students and the employment of graduates. The share of such targeted enrollments in the total number of admissions to medical universities is to increase from 57% in 2018 to 62% by 2024 ( 9 ).

Policies to facilitate health worker employment are being implemented with regional health employment centers established. These centers are to search for medical personnel in the labor market, attract physicians from other regions, and collect information on job vacancies for public distribution. The centers are also to promote the development of a so-called “shift method”, that is the employment of health workers for temporary work in local areas with an acute shortage of medical personnel ( 10 ).

To attract medical professionals, some financial benefits have been introduced, including a partial compensation of utilities. Since 2012, a special program has been implemented in rural areas and small towns. Physicians who choose the work in rural settings are provided with a lump sum to buy a house or an apartment.

To improve the quality of medical personnel qualifications, new professional standards and accreditation procedures are being introduced. They are to cover all medical workers in 2022. On contrary to this objective, the so-called “simplified accreditation” of medical university graduates was introduced in 2016. They are allowed to work as district therapists and pediatricians without passing post-graduate training—an approach unknown internationally ( 6 ).

Some outcomes indicators

These several policy interventions yield some important progress, but much more is to be accomplished. The number of physicians fell in 2010–2017 and then increased by 4.6% in 2018–2020. Physician–population ratio had the same trend. The increase in the last years was the result of additional enrollment of medical students. However, the supply of nurses had a downward tendency—both in absolute and relative terms ( Table 2 ).

Physicians and nurses in Russia, 2010–2020.


Physicians, thousands	716	673	704	715	737
Physicians per 10,000 of population	50.1	45.9	47.9	48.7	50.4
Nurses, thousands	1,509	1,550	1,491	1,491	1,490
Nurses per 10,000 of population	105.6	105.8	101.6	101.6	102.0

Source: [( 8 ), p. 114, 116].

To assess the shortage, the program established an indicator of staffing full-time positions of physicians and nurses. It is planned to increase the share of filled outpatient physician positions from 79.7% in 2017 to 95% by 2024. Nearly the same progress is planned for nurses ( Table 1 ).

Using this indicator, the MoH estimates a 39% decrease in the total shortage of physicians and a 37% decrease in the shortage of outpatient physicians over 2016–2019. The size of the latter in 2019 (before the start of the pandemic) was estimated at the level of 8.4%. Among the most wanted outpatient specialties are dentists, radiologists, orthopedic dentists, dermatologists, neurologists, surgeons, and ophthalmologists ( 2 ).

The declared strategy of PHC priority is not being realized. The total number of district physicians fell in the period 2010–2017 but then increased only by 1.1% in the period 2018–2021 ( Table 3 )—partly due to the influx of graduates from medical universities without post-graduate training. As a result, their capacity for high-quality health outcomes is constrained.

District physicians in Russia, 2010–2021.


1	District therapists, thousands	37,835	35,442	36,215	37,380	38,406
2	District pediatricians, thousands	26,723	25,932	28,161	28,722	28,416
3	General practitioners, thousands	8,983	9,520	11,358	10,505	9,839
4	Total number of district physicians, thousands. (1+2+3)	73,541	70,894	75,734	76,607	76,661
5	Total number of physicians in the system managed by the MoH, thousands	625,671	543,604	551,502	557,303	563,608
6	Share of district physicians in total number of physicians,% (4:5)	11.7	13.0	13.7	13.7	13.6
7	Share of GPs in total number of district physicians, % (3:4)	12.2	13.4	14.9	13.7	12.8

Sources: Author's estimates based on ( 8 ).

The COVID-19 pandemic has aggravated the shortage of PHC physicians and limited their accessibility. The number of vacant doctor positions doubled in 2021 ( 11 ). According to a national population survey in October 2021, 70.1% of respondents reported “the inability to make an appointment with the doctor at first attempt” ( 12 ). The pandemic has revealed additional labor shortages, including the lack of infectious disease specialists, rehabilitators, nurses, and social workers. The qualification of many DPs was not enough to manage new cases. The government has mobilized hospital doctors. They took on the major burden of the pandemic.

In the hospital care sector, there is an oversupply of physicians. According to the official estimate, this surplus increased by 21% in the period 2016–2019. The oversupplied specialties include gynecologists, psychiatrists, surgeons, therapists, pediatricians, and radiologists. But at the same time, there is a deficit of hospital resuscitators, ophthalmologists, ultrasound specialists, and psychotherapists ( 10 ).

The special program for rural areas has started successfully. In 2012, 7,713 physicians and paramedics settled in rural areas as beneficiaries of the program. However, their influx has slowed down to the level of 5,338 physicians in 2018 ( 10 ). Financial benefits work relatively well but their funding is insufficient. The share of recipients of housing and utility allowances in the total number of physicians is only 5.8% ( 10 ). An additional limitation is the lack of rural physicians' professional communication with urban medical centers.

The results of the workforce policy, however, are highly dependent on the methodology of the shortage estimates. The official indicator of the occupied positions does not account for multiple job-holding by professionals. This is particularly true for primary care physicians. With a federal norm of 1,700 residents served by each district therapist, the actual average catchment area in 2019 was 2,690 residents, in some regions-−3,000–4,000 ( 13 ). According to the survey of physicians, 67% of Russian physicians occupy 1.5 or more positions ( 14 ). This phenomenon of multiple job-holding contributes to a substantial gap between the official estimates of the share of occupied positions and the estimates of the actual number of physicians. For example, in Karelia region, the former is 92.8% (nearly all positions are filled), while the latter is only 64.8% ( 15 ).

Our estimate of the actual shortage of district therapists, based on the norm of 1,700 adults per physician, is 32%, much higher than the official estimate ( 13 ).

While modest gains in reducing the supply shortages of certain types of physicians, the situation of ”too many too few“ has not changed much. The factors that create structural imbalances in the Russian health workforce are still in place.

Why is the physician shortage reproduced?

Service delivery disproportions.

They cause the imbalances in the health workforce in the following directions. First, primary care is still the weakest sector of the health system. The task profile of district therapists and pediatricians is limited, they manage only the easiest cases and refer nearly half of patients to outpatient specialists, while their European counterparts manage from 80 to 95% of cases without referrals to specialists ( 13 , 16 ). The institute of general practitioners with wide clinical and coordinating functions is poorly developed: the share of GPs in the total number of district physicians is only 12.8% and falling ( Table 3 ). This acts as the major driver generating demand for specialists. Meeting this demand is not easy; therefore, the shortage of some specialists is as acute as the deficit of generalists.

Second, a traditional hospital-centered model of service delivery remains in its major features. The number of bed-days per capita is still 70–75% higher than in the EU ( 6 ). The work in a hospital is very attractive for the graduates, and their annual influx has generated an oversupply of some hospital doctors. The MoH recognizes this oversupply, but the program does not provide for the redistribution of physicians to polyclinics: the share of outpatient care physicians in the total number of physicians in 2024 will be the same as in 2018, i.e., 55% ( Table 1 ).

Third, the level of physicians' specialization in Russia is very high: there are 92 specialties and subspecialties. Many routine diagnostic tests are performed by specific categories of specialists. Specialization of primary care has reached the point when specialists in polyclinics account for two-thirds of physician positions, while district physicians have lost their primary role. Specialists of polyclinics are usually not involved in inpatient care; therefore, the country needs two categories of specialists—for inpatient and outpatient care. For example, outpatient urologists do not do any surgery. This process of excessive specialization creates demand for an additional number of physicians and increases the number of unfilled positions.

Fourth, the physician shortage is reproduced by a deeply rooted division of labor between physicians and other medical personnel. The nurse-physician ratio in Russia is 2.3 to 1 and is not planned to increase by 2024 ( Table 1 ), while in the USA, Japan, and EU countries, 2.8–4.7 nurses to one physician ( 1 ). Nurses' clinical functions are traditionally low in Russia ( 6 ). No serious attempts have been made to reduce the demand for physicians by extending the functions of nurses.

Health labor planning patterns

Labor imbalances begin with a reliance on weak labor forecasting and planning systems at the regional and federal levels. A long-term vision of the structure of physicians' specialties is needed. In Western countries, in the early 2010s, there were long-term plans for the demand and supply of physicians and nurses in 2030 and even later. These plans were based on the assessment of epidemiological, socio-demographic, and technological factors ( 17 ). In Russia, such plans are unavailable. Post-graduate students' enrollment is based on the current assessment of the unfilled positions with a high probability of the graduates' supply not matching demand for specific specialties in the period of 8–10 years.

Regional target enrollment increases the responsibility of regional governments for the employment of graduates but does not reduce the probability of future disproportions across physician specialties. Contracting with medical universities is based on the estimate of current needs, rather than a strategic understanding of future demand and supply for the coming decades. Our analysis of the websites of several regional health authorities shows that not a single region posted estimates of the long-range need for personnel, broken down by individual medical specialties.

The federal MoH has developed a planning methodology, which is based on health care utilization and the number of physicians and nurses per unit of the volume of care ( 8 ). But this methodology also suffers from its focus only on current supply and distribution needs. Furthermore, the focus on utilization often provides distorted estimates. For example, a decreasing number of visits to PHC physicians per resident (the recent trend in Russia) results in a decreasing need for the number of primary care physicians. This is contrary to the current objective to strengthen primary care. Other supply factors not addressed include patterns in demographic, trends in disease incidence, and general labor conditions for housing, income, and lifestyle.

Inadequate regulation of physicians post-graduate training

The federal MoH develops quotas for the annual admission to post-graduate training in individual specialties, which are then distributed among medical universities based on their applications. The biggest quotas are for the specialties in short supply. However, there is a gap between quotas and the actual applications of medical universities ( 18 ). The latter are interested in increasing the number of students who pay for their training. These are the students in the most popular specialties of gynecologists, urologists, and dentists who provide services mostly for out-of-pocket payments. A chronic underfunding of medical universities from public sources aggravates the structure of training: it is shifting to specialties with a high “financial return”. Also, medical universities are slow to adjust their capacity to new needs. Only 3 % of them have units for training GPs ( 19 ).

Actionable recommendations

An extensive increase in the number of physicians does not solve the problem of their shortage. It is necessary for federal and regional policymakers to strengthen the policy focus on the structural parameters of human resources and the elimination of their imbalances . The experience of many OECD countries provides good examples of such policies. A range of levers is used, including providing incentives to encourage more doctors to choose a general practice and to foster the take-up of certain specialties that are expected to be in short supply in the future; to expand the roles of nurses and other non-physician providers to reduce pressures on physicians. In post-graduate training, there is a search for a new balance between general practitioners and specialists. For example, in France, 48% of medical graduates go to residency in general practice ( 20 ). These trends are very relevant to Russia.

Also, the mechanisms to overcome the hospital-centered model of service delivery are needed. We can suggest (a) strengthening control over opening new positions of hospital doctors, (b) increasing the capacity of outpatient departments in hospitals and staffing them with oversupplied doctors, and (c) retraining some specialists to general practitioners.

Strengthening health labor planning . First, to develop middle- and long-term plans for 2030 and 2035, respectively. Second, to account for a complex of factors (future morbidity and mortality, changes in medical technology, possible reconfiguration of physicians' and nurses' roles, and shifts in service delivery structure). Third, to use the indicators of shortage that take into account the multiple job-holding and plan its reduction.

Strengthening regulation of postgraduate training structure . To overcome the orientation of medical universities to expand training in oversupplied, well-paying ”commercial“ specialties, it is necessary to increase public funding for medical education. The quotas for post-graduate training should be developed not 1.5 years before the start of admission (as it is now), but 3–4 years before. Universities should have time to change their structure to accommodate the growing number of highly wanted professionals. These quotas should be based on the indicators of strategic forecasts and recruitment plans that may extend up to 10 and 20 years in the future.

Increasing the share of GPs in the total number of physicians from the current 13% to the average for the “new” EU countries −29% ( 19 ) by 2030. Use financial and nonfinancial incentives for doctors who choose general practice. Cancel the current practice of ”simplified accreditation” of primary care physicians and take a course on modern postgraduate training of GPs. This will strengthen the capacity of PHC and decrease the demand for specialists.

The health workforce policy in Russia has recently been activated to overcome the shortage of physicians in the situation of serious labor imbalances. Physicians training is expanding, the regions of the country are increasingly contracting medical universities for post-graduate training of specific specialists, and some financial incentives are used. However, the severity of the problem remains high, mostly in primary care. The main reasons for the reproduction of physicians' deficit are the following: a distorted structure of service provision, the lack of medium- and long-term labor planning, the insufficient regulation of post-graduate training structure across specialties, and the underestimate of the general practitioner's role in reducing demand for outpatient specialists. The major lesson learned is that an extensive increase in the number of physicians without changing their composition does not solve the problem. A structural policy is needed to ensure that the workforce structure is in line with the needs of the health system for the coming decade.

Author contributions

The author confirms being the sole contributor of this work and has approved it for publication.

The article was prepared in the framework of a research grant funded by the Ministry of Science and Higher Education of the Russian Federation (Grant ID: 075-15-2022-928).

Conflict of interest

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Acknowledgments

The author is grateful to Professor S. Shishkin and Ms. S. Sazhina for valuable comments and kind assistance.

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