Marketplace, public, and government voices have converged to tell medicine they want quality, safe patient care delivered by well-coordinated, high-functioning teams of professionals. Whether it leads to better patient care, the team model (basis for patient-centered medical homes and accountable care organizations) is oftentimes easier to endorse than to realize. Contributors to the June issue examine some of the many obstacles to truly collaborative team-based care: leadership must be redefined and clinicians trained as leaders, interprofessional education must be developed, practice style differences must be resolved. And at every stage, resistance to the new must be surmounted.
Is this a conflict over a team member’s practice style or is it a breach professional boundaries? Is it appropriate for team members to make this judgment, or should it instead come from the team leader?
Many team members such as nurses and medical assistants have key roles in meeting practice goals but receive little if any performance-based compensation. In part, nursing union rules create a barrier by inhibiting trials of productivity-based pay or shared-risk models.
Daniella M. Schocken, Aliye Runyan, MD, Anna Willieme, MFS, and Jason Wilson, MD
Distinctions in garb worn by health care professionals have their drawbacks, to the degree that reinforcing the differences between team members can reinforce rigid role divisions and hierarchical inequities that undermine teamwork.