Two recent initiatives aim to get physicians, social workers and other healthcare professionals to work in teams. The projects involve radically different settings and patient populations, but share the aim of improving care and controlling costs.
The Geriatric Interdisciplinary Team Training (GITT) project, under way at eight sites nationally, aims to teach collaboration in treating patients 85 and older. The institutions recently received grants from the New York-based John A. Hartford Foundation.
One of those efforts, a collaboration between University Hospitals Health System in Cleveland and Henry Ford Health System in Detroit, is creating "learning cycles" in which teams try to improve an aspect of care. Its other goals include communicating through information systems and bringing clinic managers into the teams.
In Northern California, Permanente Medical Group recently decided to adopt a team approach for all its adult services by the end of 1998. The group covers 2.5 million Kaiser HMO enrollees with more than 3,300 physicians.
Permanente hopes the approach will improve patient satisfaction, which has fallen behind that of competitors.
As tested in a pilot project at a Permanente site in Rancho Cordova, Calif., teams will consist of seven or eight physicians, a clinical psychologist, a health educator, a social worker, nurse practitioners and a clerical assistant, each caring for 20,000 patients.
Team members work in the same building, and specialists carry cellular phones so primary-care physicians can consult them during patient visits. The idea is to reduce specialist referrals and increase interaction among healthcare professionals. Group classes on managing such conditions as diabetes, stress and depression are meant to shift the responsibility for education away from the physician.
An evaluation of the pilot has not been completed, but Permanente had enough confidence in the project to implement it throughout Northern California.
Donald Forrester, M.D., the physician-in-charge at the Rancho Cordova Medical Office Building, where the program was piloted, said the team concept was not easy to implement, even though his facility tends to be patient-oriented.
Teamwork contradicts traditional physician training, which stresses total control. Teamwork also can be viewed as a threat to physician incomes.
At the outset of the pilot two years ago, Forrester said, "Most of the docs were ready to kill." But, he said, "once doctors understand it's better care, they'll like it."
Teamwork isn't new to geriatric care, but capitation and other cost pressures could make it more common as providers try to reduce high-tech, acute-care procedures, said Peter Whitehouse, M.D., the GITT program director at UHHS in Cleveland and director of the UHHS Alzheimer Center.
"I think teamwork in general is going to be more present in medicine," he said.