In 2012 and beyond, the health care field faces rapid-fire change that will require broad reforms in care delivery. Changing demographics, increasing rates of chronic disease, skyrocketing costs, and the short- and long-term impacts of the Patient Protection and Affordable Care Act all will drive reform. As health care financing moves from volume-based to value-based payments, clinicians will need to work in interprofessional teams, coordinate care across settings and promote greater efficiency. The health care system needs to adapt to these reforms and providers need to work more closely together than ever before.

While health care has established team-based care delivery in certain areas, such as rapid-response and surgical teams, a broader approach has been slower to emerge. However, primary care practices increasingly are using patient-centered medical home and chronic care models that emphasize team-based care, and hospitals are improving collaboration through inpatient teams and service-line comanagement.

Recognizing that better collaboration is critical to improving health care delivery and that hospitals employ approximately 20 percent of physicians, the American Hospital Association board of trustees looked to the field to identify engagement strategies specifically for physicians working closely with hospitals. In 2011, the AHA's Physician Leadership Forum was launched with educational offerings, resources and leadership development opportunities for physicians, as well as options for input on issues of public policy and advocacy.

As part of its educational outreach, the PLF hosted a learning session in conjunction with the Health Forum/AHA Leadership Summit to hear from three organizations about their approaches to fostering team-based care:

• AtlantiCare Health System in Atlantic City, N.J., shared the success of the Special Care Center, a patient-centered medical home developed for individuals with chronic conditions.

• Boston's Brigham and Women's Hospital developed its Interdisciplinary Team Unit to increase time for learning among residents, improve communication and reduce costs.

• Marquette (Mich.) General Health System representatives spoke about its transition from traditional medical departments to comanaged service lines encompassing a broad spectrum of staff.

While each organization embraced a different approach, several common themes emerged. First, change is hard, regardless of the change made; but knowing that they were working to provide better care helped to focus the teams. Second, to be effective, teams need to be inclusive and designed from the bottom up, but rely on strong leadership support to manifest fully. Making sure the right team members are in place echoed across the examples. Third, data and communication were both a challenge and highlight. Extracting accurate data across the care continuum proved challenging but, when available, data helped cement the team toward a common goal. Information exchange was improved greatly through team training, but communication outside of the group sometimes proved difficult. Finally, the most important lesson may be the simplest — if you can reach what makes people passionate, you can motivate them.

In late January, the PLF published a guide on fostering team-based care, including in-depth reviews of these three examples. For more information, please visit

John R. Combes, M.D., is senior vice president of the American Hospital Association.


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