By Barry P. Chaiken, MD, MPH
With healthcare complexity increasing daily, traditional models of delivering care fail to offer a framework capable of delivering high-quality care at a reasonable cost. The rapid expansion and evolution of medical knowledge makes it impossible for any single healthcare professional to assimilate and retain the up-to-date information necessary to properly treat patients. Healthcare information technology can help manage this body of knowledge, and by placing the patient at the center of the care delivery team, workflows can be constructed that best leverage the skills of each caregiver and the capabilities of information technology tools.
The evolution of physicians from barber-surgeons to doctors created a healthcare practice where society expected physicians to possess a comprehensive satchel of knowledge and skills that superseded the expertise of nurses, pharmacists, therapists, and other clinical professionals. Considering physicians went through the most rigorous selection process and training when compared to these peers, a hierarchy built upon physician leadership of patient care seemed practical. Now that medical knowledge has expanded beyond the human capability to assimilate it, this model no longer provides an effective approach to caring for patients.
Understand skills and knowledge
A 21st-century approach to care delivery requires an understanding of the skills and knowledge of each care team provider. It also requires the development of a patient-centered care model built upon a team approach to a clinical problem rather than a top-down methodology driven solely by the physician.
Each care team member offers a unique perspective on a patient’s health situation. This viewpoint grows from that professional’s training and clinical experiences. In addition, each caregiver spends varying amounts of time with a patient. This allows some clinicians to collect data that might not be readily available to others whose patient interaction time is limited.
For example, among all clinicians, nurses spend the most time with both the patient and the patient’s family. Nurses, then, have more potential information they can collect than any other clinician. Although using this information to formulate and deliver a care plan makes rational sense, structural workflow issues often prevent the information from being used effectively by the other care team clinicians.
Obstacle to sharing information
In addition, the workflow dictated by electronic medical record and other healthcare information technology systems often forms an obstacle to effective patient information sharing. The focus on clinical documentation to satisfy the needs of the electronic record decreases time for effective communication with peers, thus stifling robust collaboration on patient care. Relying on the electronic record to facilitate communication and collaboration overlooks the “needle in the haystack” problem presented by unfocused documentation that is siloed by clinical discipline and responsibility.
Rather than a top-down approach to care team management, care teams should reflect the structure of an orchestra. A conductor directs each of the musicians and has ultimate control over the orchestra, but each player offers input to the conductor and brings nuance to the performance of the music. The sheet music provides each player with a common plan to deliver the symphony to the audience, but each musician creates an individual performance that collectively generates the applause when the music stops.