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How does team-based care work? What are the advantages of team-based care? What is team-based care in health care? What does a nurse practitioner do?
Kevin Hopkins, MD, and Amanda Mitch, MSN, APRN-CNP, from the Cleveland Clinic Primary Care Institute discuss the importance of physician-led care, teamwork, and how mutual respect builds trust and improves patient outcomes. AMA Chief Experience Officer Todd Unger hosts.
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Speakers
- Kevin Hopkins, MD, senior physician advisor, AMA, and vice chief, Primary Care Institute, Cleveland Clinic
- Amanda Mitch, MSN, APRN-CNP, nurse practitioner family medicine, Cleveland Clinic
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Today we're talking about physician-led care and what it looks like in practice. I'm joined today by two members of the care team at the Cleveland Clinic Primary Care Institute in Olmsted Township, Ohio. We'll share how they work together to take care of patients.
Dr. Kevin Hopkins is a family medicine physician and vice chief of the Primary Care Institute. And Amanda Mitsch is an advanced practice registered nurse and certified nurse practitioner. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Hopkins, Amanda, welcome.
Mitsch: Thanks for having us.
Dr. Hopkins: Thank you.
Unger: Well, the concept of physician-led care is fairly straightforward, but how it works in practice can vary. Why don't we just start, Dr. Hopkins, with you to give us a little bit of a high level look at how the two of you work together and share some of your individual roles and responsibilities?
Dr. Hopkins: Sure. Thanks, Todd. So understanding physician-led care really, in my opinion, necessitates an understanding of teamwork, responsibility, and clearly defined roles and responsibilities. Working as a team to deliver great care for our patients really recognizes that there's more work to be done than the capacity of any one person to do it, when we consider the limits of time, attention, and ability.
So a high functioning team really requires a partnership, and that partnership should be based on mutual trust and respect. The physician, as team leader, has ultimate responsibility. And work is delegated and completed by the team member best suited for it, accounting for their unique training, experience, skills and qualifications. The physician leader facilitates by encouraging and elevating each member of the team.
The other principles by which our partnership has succeeded include a shared primary care panel, a shared EHR inbox, consistent clinical collaboration, cooperative development of shared practice standards, clearly defined roles and shared responsibilities. We really aim to have the right patient get the right care at the right time with the right clinician.
Amanda and I have worked together for nine years now. And over this time, she's become more competent and more confident in her skill and clinical judgment. I'm really blessed to have her as a partner. Our collective patients are healthier, because she helps care for them. She's proven herself over and over again to be a valuable teammate. And I'm glad to say that Amanda is not just my colleague, but she's also my friend.
Unger: That's awesome. And that's quite a list of stuff that you read off there. It includes, of course, organization, process, technology, experience, you name it. Amanda, tell us a little bit more about how you developed that process for working together.
Mitsch: Of course. I echo Dr. Hopkins. Our work together relies on mutual respect and trust. We respect each other's clinical judgment. We don't undermine each other in front of patients if standard of care is met. There's an art to medicine, after all, which I think we both practice pretty well. We have a shared responsibility and ownership over our patients.
We have developed shared protocols. I practice to top of license within my scope as a nurse practitioner. And our shared protocols help us take care of chronic disease. This includes predictable timing of follow up appointments, lab work. Then this predictability helps ensure a seamless transition between providers.
Our in-basket work also relies on predictability. We each have areas in the in-basket that are our first priority to ensure that items are completed in a timely manner and that there's not a duplication of work. And we've worked to be interchangeable with our patients. And we have an equal partnership.
Unger: Well, speaking of—
Dr. Hopkins: I'd like to—
Unger: Yeah, go on.
Dr. Hopkins: --just add on to what Amanda was saying, if I could. When we first partnered—we have different practice styles. Of course, we do. We have different personalities. And one thing I think was important for us was not to make one of us like the other, but to embrace our differences, our different styles and our different experiences and even our training, and come to agreement on things that we could have in common and start there as a place to build our partnership for the long haul.
Unger: What do you think the biggest difference is in that styles?
Dr. Hopkins: Amanda, I'll let you speak for yourself. But I tend to be pretty informal with my patients. I have a lot of patients that I've taken care of for a long time, up to two decades. And so I've known them for a long time and have maybe a different level of relationship than somebody new coming into the team.
But I'm glad to say that Amanda has built those same relationships with patients and often, better relationships with different patients than I might have good relationships with. But my style tends to be a little bit more informal, a little bit more relaxed. And Amanda helps to keep me honest and to keep me—
[UNGER CHUCKLES]
--following the rules when sometimes I like to color outside the lines. What would you say?
Mitsch: That's true. So I am a little more of a rule follower. I like predictability. I like patterns. And so I've learned to be more flexible as the years have gone by. And I think we've both grown together.
Unger: That's—that's spectacular. Dr. Hopkins, a lot of practices are trying to implement team-based care and kind of go through that same process that the two of you have, used to kind of learn how this should work properly. What do you think are the key benefits of working this way, especially for patients?
Dr. Hopkins: Well, for me personally, the best part of my job every day is the relationships that I've developed with patients and their families over the last 20 years. That's really where I get a lot of professional fulfillment and where I feel most engaged. And so, when we build and maintain high functioning teams in order to care for those same patients, those relationships that are based on trust and confidence end up being shared across the team.
Both Amanda have probably experienced a situation where we've had patients who will—I've had patients where—who will tell Amanda something that they would have never told me. And we've certainly had that with medical assistants and nurses with whom we've worked over the years, because of them building a relationship with our patients also over time, not just the physician.
So the care we've been able to deliver as a team then has led to much better results for our patients. It's led to higher quality outcomes such as hypertension and diabetes management. It's also led to improved patient safety and enhanced access to care and certainly, better patient experience. And all of that has ultimately then also led to better caregiver and clinician experience.
Unger: Amanda, is there a patient's story that comes to mind that shows this kind of positive impact?
Mitsch: There is. There is. So I think our care team is really unique. And I think our relationships over the years have helped us care for our patients better. We have one patient that I think illustrates how our care team helps manage chronic disease better than if we were by ourselves.
We have a patient who was—is a very uncontrolled diabetic, very hesitant to trust. She was known to actually hang up on nurses if they called, and she wasn't familiar with them. If a nurse groomed her who she didn't know, she wouldn't really talk too much to them.
But we were both able to earn her trust over the years. And we would alternate visits. So we would help her get closer to goals for her diabetes than we would have if we were by ourselves. And I think we both inspired her to take care of herself, that ownership. And so outcomes were improved when both of us were involved.
Unger: All right. Well, I'm going to ask both of you the same question. So many people are trying to replicate this kind of team-based care that we're talking about today. Dr. Hopkins, what's one piece of advice that you would give to physicians on working with other members of the care team?
Dr. Hopkins: Well, I'll say I don't want to speak for all physicians, but I feel like I can speak for a lot of physicians when I say we like to be in charge. We like to be in control. And we also like for things to be done in a certain way. And so just like any other relationship, relationships require time and attention and investment.
And so there's actually two things, I guess, embedded within my statement, and one is to be able and willing to give up some level of control. If we're going to be a team, we have to be a partnership. The second is, in order to build a successful, sustainable team, a physician really has to be willing to invest the necessary time and effort in building those relationships, competencies, confidence and trust. This won't happen overnight. It won't be automatic or instantaneous.
Unger: All right, Amanda, your turn. What is the advice that you would have for members of the care team on how to best work with their physician lead?
Mitsch: I think communication is critical. I think setting time aside for the group to review what's going well, what needs to pivot, bringing solutions instead of just mentioning problems. And I think making time to reevaluate those changes and then pivot as needed, communication is critical.
Unger: Well, I feel the positivity coming from that teamwork that the two of you have developed, and I'm sure your patients do too. Dr. Hopkins, Amanda, thank you so much for joining us and sharing all your insights and advice. The AMA has a wealth of resources on team-based care. And you'll find links to our most popular in the description of this episode. To support our work, become an AMA member at ama-assn.org/join.
That wraps up today's episode. We'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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