Primary care with a relay team

Lezak's finish     The 2008 summer Olympics had one of the most amazing team finishes in history! Jason Lezak chased down the Frenchman Bernard in an unbelievable final leg to the men’s 400m freestyle for a team gold! He also helped crush the world record. The US women’s soccer team had another awesome finish that year. Gold! These were both great wins by two very different types of teams. As a pilot, when I think of teamwork I remember a mission planning room filled with aircrew and intelligence airmen collaborating in small groups to prepare for an urgent international mission. I think of the aircrew that took off the next day and made that mission successful. These are vastly different types of teams and teamwork but all are committed to the win.

ShermMissionPlanningInChina1944     I completed my first month of my primary care rotation on Friday at a large internal medicine outpatient clinic. Just like a swimming relay team, the care at the clinic was very sequential. A patient might call and speak to a nurse practitioner prior to a visit. Upon arrival they work with the front desk staff to check-in and sort copays. Soon a medical assistant collects them from the lobby, asks a few questions, does some measurements and then leaves the patient in an exam room. Finally the physician would enter the room, get the patient’s story and determine a plan for the patient. The patient might then pass to another provider or leave. Usually the only time two providers worked with the patient at once was if a student like myself was involved. Usually each of us played our role in turn during the patient’s visit.

4-ship flyover     In many care settings this sequential team might be best. I suspect it must vary based on patient needs and clinic capabilities. Each type of team has strengths and limitations. Four F-15Es can fluidly pass enemy bandits or targets amongst each other and crush the enemy’s forces as a team. Unfortunately, if one person is talking too much or too little or if a wingman loses sight of their leader the mission can fall apart. A team of aircraft massed together has a better chance of hitting the target than sending one aircraft at a time. While Lezak swam home a gold, both the U.S. men’s and women’s 400m track teams that year were eliminated in qualifying rounds despite being the world favorites. The relay team falls apart if a runner is slow or if a baton hand-off is fumbled. The anchor runner is left to fix all of the problems that occurred earlier. Sometimes they can but often they, and the team, lose.

Understanding what type of team has been chosen to help a patient population is a critical step to improving care. Different types of teams require different interactions and training. A swimmer or runner doesn’t have to work with others for most of their race but individually can help win or lose. A relay team spends their time each trying to get faster and practicing the hand-off together. In comparison, a soccer team spends time scrimmaging together. If primary care clinics choose to use the relay model then their training must focus most on individual skills. There should be extra practice and mandatory processes for passing the patient from one provider to the next. The hand-offs were often poorly done between the front staff, MAs and physicians at my clinic. This minimized the potential of the MAs and placed a greater burden on the attending physicians. Different types of teams require distinct assessment metrics, pay models, communication tools and coaching. The clinic leadership must tailor their management to the model of team they are leading.

blood pressure     I strongly believe that teams can provide better healthcare. Each clinic and system should consider what team model they can use to best help their patient populations. Primary care clinics might continue to find that this is the relay model or they may decide to build bigger exam rooms and get more providers engaged at one time. Either way, the leaders must adapt their training and management to coach the best out of their teams.


2 thoughts on “Primary care with a relay team

  1. Great point; we definitely have room to grow and improve and to help providers practice to the top of their scope. Hope you had a good experience at the Lowry Clinic!


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