In many cases, chatting about the day’s agenda over coffee has ended. Specialists in different fields don’t always share office space, removing opportunities to check in.
Still, physicians can maximize teamwork, even when they aren’t on the same campus.
Successful collaboration begins with sharing information about status, treatments and health history. This is especially true with medically complex cases, and a universal electronic health record (EHR) is then a particularly important asset. “We have to be able to organize around the same set of plans, just as if we were working on an architectural project,” said David Batinelli, MD, Northwell Health’s senior vice president and chief medical officer. “If you don’t have that, then how do you even start?”
Thomas McGinn, MD, senior vice president of ambulatory services and deputy physician-in-chief, cited a critical example: a man who takes medication for his enlarged prostate and also uses drops to relieve pressure in his eyes. Both blood pressure medications, taken together, can be dangerous.
“If we rely on the patient to accurately report everything he or she is taking, we run the risk of missing something,” Dr. McGinn said. “And a urologist might not ask about eye drops. The EHR means we can just look at a patient’s chart and see everything he’s prescribed.”
A universal EHR eliminates the need for a phone call or email for basic information. Northwell’s internal Health Information Exchange connects data from different EHR platforms throughout the system so all providers can see comprehensive patient information any time.
Great collaboration hinges on a point person. Even on teams that are stacked with talent, leaders are vital. According to Bernard Bass’ Transformational Leadership, a leader sets the tone for:
It’s true in business and in health care, especially because it positively influences experiences.
“Today, our biggest complaint with complicated patients with multiple doctors is that, try as they might, neither they nor their family can figure out who is in charge,” said Lawrence Smith, MD, the health system’s executive vice president and physician-in-chief, and dean of the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.
For medically complex cases, a single physician oversees care and organizes and connects specialists. “It’s a model that existed for a hundred years, but is less common today,” said Dr. Smith.
The physician-in-charge can be any team member, but most often is a generalist or internist who sees the patient frequently, understands the care team’s goals for the patient and coordinates buy-in on those goals.
“It’s about one person coordinating all of the care and communicating the plan to the whole team, including the patient,” said Dr. Smith. “It’s not about a bunch of people adding perfect specialty expertise in a vacuum.” The latter approach results in conflicting accounts about what’s likely to happen and erodes their trust, he added.
It takes effort to maintain communication for fruitful collaboration.
“The social context between physicians is really changing,” said Dr. Battinelli. “You have to be flexible.”
“Written communications, conversations in person or phone, and personal relationships with clinicians on the patient team are all critical,” said Dr. Smith. “At the end of the day, you have to talk to people.”
The “quarterback” should set the tone and create opportunities for team members to communicate. “Sometimes you just have to make people talk,” said Dr. McGinn. “Usually there’s much less issue when you talk to people than when you’re dealing through an electronic communication. I’ll send an email saying, ‘We’re going to have a call at 5 p.m. to discuss Mrs. Jones,’ and for the most part, people show up. You have to create these situations.”
Though doctors today may not bump into each other in the parking lot, they can still collaborate. Balancing EHR, email and videoconference with connecting with colleagues in real life go far toward successful teamwork.