Team-based care seems like an obvious and logical concept. There are lots of somewhat cheesy sayings like “Two heads are better than one”, “Less me, more we”, “Teamwork makes the dream work” etc, etc. Yet many of our experiences in healthcare don’t reflect this. We rely on individual doctors to provide us with their expertise and we are expected to follow directions. We often need the advice of more than our family doctors and are referred to specialists and other professionals, yet often these individuals aren’t working together as a team.
Team-based care is defined as:
The provision of comprehensive health services to individuals, families, and/or their communities by at least two health professionals who work collaboratively along with patients, family caregivers, and community service providers on shared goals within and across settings to achieve care that is safe, effective, patient-centered, timely, efficient, and equitable. (Source: IHI)
Greg didn’t experience team-based care. Greg had concerns that were not addressed by the people who were on his care team. Anyone who provided care was part of Greg’s team. Some may have only contributed for a short period, for a specific task, but everyone played a vital role in Greg’s healthcare journey. Yet everyone acted as individuals, didn’t work together and Greg was rarely included. For example:
- Two days after surgery, when Greg’s level of pain was increasing and he was experiencing further
swelling in his legs, we were unable to reach his surgeon and did not know how to reach out to anyone on Greg’s care team. Dad and Greg decided their only option was to go to the Emergency Room. The doctor in the emergency room didn’t reach out to Greg’s surgeon, even though (we found out later) he was the urologist on-call at the time.
- One of Greg’s doctors left the clinic without clearly communicating this to Greg or to his radiologist who was an essential part of the team at the time. The radiology report was not addressed for a week during an extremely critical time in Greg’s care and was only picked up when Greg called the clinic asking for an update.
- Greg was told that he would hear from an oncologist even before his pathology results were back. The urologist had a discussion with an oncologist directly but outside of the normal process and the plan that was developed during the conversation was not communicated to the entire team.
The value of shared information
Part of the value of team-based care is that it opens the channels of communication, information is shared and a single unified care plan can be developed, shared and referenced by the team. There were so many days where Greg was left waiting, not knowing what was happening, feeling his symptoms escalating but was told to sit wait for the next phone call. Greg did his own investigations and research that ultimately were dismissed or not addressed.
- Greg had concerns about an increase in his blood pressure (we later found the receipts you get when you take your blood pressure at Shoppers Drug Mart) and swelling in his legs (he was wearing old basketball shorts because he didn’t fit into his clothes) but his concerns were not taken seriously.
- Greg spent an extensive amount of time researching alternative treatment options including surgery
but was brushed off by the urologist and told even if they wanted to go that route the surgeon that would do it was out of town.
Think of the last time you or a family member required care beyond your family doc, how was information shared? Was the information that was given consistent or contradictory?
Enabling communication and team-based care
How different would Greg’s experience and outcome have been if he had a way to communicate with his team? What if the members of his team enabled Greg to participate and included him in their conversations? Secure communication tools exist that allow care teams (including the patient) to share information.
- Relevant information is securely shared with all members of the care team. In the same way you would cc: several people on an email. Everyone has has ready access to necessary, potentially lifesaving, information they need.
- As members of the team are added or no longer required they are included or not included in the message stream.
- Patients can raise concerns or ask questions to one or all of the team members.
- The team can discuss the treatment plan so everyone has a common understanding of the next steps – including the patient and any family members or people in their support network that they choose.
As mentioned in the last post these tools exist and are being used successfully in parts of the healthcare system today.
Today, April 5, 2017 would have been Greg’s 36th birthday. He left a huge hole in our lives and we will continue to push for the change that we know is possible, changes that will help to prevent other families from going through what we have.