American College of Physicians: Internal Medicine — Doctors for Adults ®

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All together now: Office teamwork

From the February ACP Internist, copyright 2009 by the American College of Physicians

The individuals in a practice, all of them, make up the team that supports clinical work. A cohesive and efficient team can make all the difference between a practice limping along and one that is willing to try new ideas and work flows.

Survey staff members using a written tool to learn their ideas. Some practices hold weekly or monthly staff meetings. Try rotating roles within the meeting (leader, scribe, timekeeper) so that the meeting is not always led by the same person. Keep track of generated ideas and who is responsible for next steps for those ideas.

It is not uncommon for physicians to receive productivity bonuses, but do other staff members also have this opportunity? One solo practitioner in Vermont gives his staff a percentage of net increase in profits. This dangling incentive motivated the team to find ways of responsibly cutting costs (turning off all computer power strips at the end of the day) and finding more efficient ways of running the practice (making two pharmacy calls each day rather than placing a call for each prescription).

Have a team “huddle” at the beginning of each day. Huddles are brief meetings during which all of the patients scheduled that day are discussed, making sure that charts are pulled and reviewed for topics such as patients who need catch up immunizations and preventative screenings. Huddles provide the team with a clear vision of what to anticipate that day, making it easier to stay on track when unexpected situations arise.

Make sure the individual members of the team work to the highest level of their licensure/certification/training. For example, does your medical assistant prepare patients with diabetes for a foot check, or does the assistant perform the foot check? Give an update form to all patients who arrive for an appointment. Let the medical assistant compare patient answers on this form to information in the chart and update the medical record. Or, if your state allows medical assistants to give vaccinations, prepare standing orders so these vaccinations can be given when the patient gets into the exam room.

Individual “ownership” of particular tasks helps ensure that there is no confusion about who is responsible for that task's completion. Another method is to cross-train staff, which keeps work flow moving smoothly in the event of an employee's absence.

The Center for Practice Improvement and Innovation produced videos covering eight topics about small practices. To watch how some real practices use teamwork to improve their practices, go online.

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