Building an Integrated Team that Works
Feature article: Building an Integrated Team that Works
Grantee Feature: The Healthcare Neighborhood: Jefferson Center
Quick Tips: Effective Team Communication
Featured resource: Essential Elements of the Integrated Team
“No matter how brilliant your mind or strategy, if you’re playing a solo game, you’ll always lose out to a team.” -Reid Hoffman, co-founder, LinkedIn
A high functioning care team is essential to delivering effective integrated primary and behavioral healthcare and achieving the “triple aim” of better care, improved outcomes, and lower costs. But building a team is easier said than done. Team members are often asked to work in unfamiliar ways, and the very act of functioning collaboratively can be an unknown or unused skill.
An integrated care team varies from provider to provider, but includes the client and a mix of professional and paraprofessional providers. Our resource on Building a Clinical Team details the structure and team members common to the collaborative care model.
As defined in the Agency for Healthcare Research and Quality’s Lexicon for Behavioral Health and Primary Care Integration, a “team” is not limited to only those people working in the same practice. Location, organizational affiliation, or particular roles do not define a team; teams are brought together for a particular client at a particular time and agree to communicate and collaborate as clinically needed.
While there is no magic bullet to creating a team that wraps itself seamlessly around the care of a person, our work with hundreds of integrated care teams has taught us that they generally work better when five essential pieces are in place: strong leadership, shared vision, clear roles, shared goal, and continual nurturing.
Strong organizational and leadership commitment is crucial for an integrated care team to become as effective as it can be. For example, it’s not nearly as simple as adding a care manager and psychiatric consultant into a primary care setting – the team needs support. Identifying an implementation leader who can facilitate your integrated care initiative is also extremely important, and it's worth taking the time to decide who best fits this role.
As Yogi Berra said, "If you don't know where you are going, you probably aren't going to get there." Teams without clear direction often experience increased conflict, which can lead to frustration and slow progress. Creating a vision builds a shared understanding within integrated care teams of their common purpose and future goals. A crucial first step in creating a shared vision is describing the healthcare you seek to give. A powerful vision outlines a compelling reason for change, builds team commitment, and motivates people to move out of their comfort zone and away from the status quo.
The success of an integrated care team relies to a great extent on each member understanding his/her role and believing he/she has the knowledge and skills necessary to fulfill that role. Care teams that focus on the functions of team members as opposed to narrowly defined professional titles and roles have a greater ability to navigate work flows, communicate effectively, and tackle unanticipated challenges. Hiring people who are flexible, good communicators, and eager to be part of the team is oftentimes much more important than their academic training.
Effective integrated care creates a team in which all of the providers work together on a single treatment plan. This gives the team a clear focus, particularly when combined with a treat-to-target approach. Focusing on client goals and linking these to medical and behavioral targets can help bring teams of providers together who may experience a culture clash due to their training.
Changing expectations and goals combined with personnel turnover requires continual nurturing of your team and constant evaluation at the operational, process, and interpersonal levels. Consider sharing data regularly at provider meetings and engage the whole organization in quality improvement activities to foster your high functioning integrated care team. Regularly revisiting your shared vision helps orient new team members and reinforces what you’re trying to do.
Q: How do you know if you have an effective team in place?
A: When your clients stop asking why their medical and mental health providers don’t talk with each other.
Remember that breaking down the silos is the ultimate, person-centered goal. When a team is truly collaborative and integrated, team members enjoy working together, and, most importantly, individuals receive better care. The people you serve want to receive seamless, quality care in a setting in which they are already comfortable and with a provider with whom they have a trusted relationship. However, it takes a team to make this happen.
The Healthcare Neighborhood: Jefferson Center for Mental Health
Based on an interview with Dr. Don Bechtold, Medical Director and Vice President of Healthcare and Integration and PBHCI Project Director, Dr. Shannon Tyson-Poletti, Assistant Medical Director and PBHCI Project Manager, and Mindy Klowden, MNM, Director of Office of Healthcare Transformation, Jefferson Center for Mental Health
Jefferson Center for Mental Health, a community mental health center, partnered with Metro Community Provider Network, an FQHC, and Arapahoe House, a substance use disorder treatment provider, to create the Union Square Health Home to address the whole health needs of individuals in the Denver metro area. The health home primarily serves individuals with severe mental illnesses and other co-occurring chronic conditions. Each of the three partners contributes staff, time, and resources to support the health home.
We consider our team to be an internal healthcare neighborhood. The neighborhood consists of anyone who can or will be impacting a person, and tries to provide for as many services as possible in one space. That can include employment, housing, social connectedness, and other factors that contribute to recovery and wellness.
Defining the Team
When we develop a team, we develop it in a way that can meet the whole person’s needs, at the level and at the time they’re needed. Many individuals make up our integrated primary and behavioral healthcare team, from a care coordinator to an administrative assistant, addictions specialist, nurse practitioners, psychiatrist, peer health coach, medical assistants, and senior leadership. Having a peer health coach is essential; they are the key person in making sure that the health goals that are established with the client are getting addressed through actionable strategies.
The whole team meets weekly for one hour on Thursday mornings. Each person in our care has one integrated, collaborative treatment plan. To keep it from being eight pages long, we prioritize the issues the person needs to work on first. In that hour, all of the key providers in the room work together to prioritize what needs to be addressed, identify barriers to care, and collaboratively problem solve.
The Right People
The people who work in the health home have self-selected to be here, they believe in this model. Even so, the responsibility is on the organizations for finding the right fit, in hiring the right person. Not everyone is ready to do this kind of work. Being on an integrated care team requires flexibility, innovation, and openness. Since we’ve been doing this for over a year, it is starting to have a domino effect; now other people see it works, and they are getting on board.
Commitment and Infrastructure
Change is only going to happen if buy-in includes commitment from the highest levels of organization leadership. To build a cohesive team, there needs to be infrastructure that supports the teams. On a very practical level, it is about time, space, and numbers. Providers need to know how much it is going to cost, what their capacity is, etc. We did a lot of research to figure out the specific staff time needed at each level. Discussions between organizations can be a slow process – time for discussion among leadership needs to be allotted adequately.
Physical proximity is important to maintaining team connectivity. Everyone is located on the same floor –– you see each other when you’re walking into the building, into break rooms, or the office just across the hall.
Another challenge is information technology. All three partners are on different EHR platforms; we are finally working with our regional health information exchange to develop a shared platform which will facilitate health information sharing across providers within the health home.
If clients aren’t getting better, then we don’t have a cohesive team. To gauge success, we look at the health indicators, make sure the care plans are done and approved of, and the key team members are included. The team members look at workflows on a biweekly basis to assess how they are doing. Our wellness coach and our care coordinator are the two keys to looking at if the team is functioning properly. When they see that there is communication missed, they will figure out what can be done to address any gaps. We also collect client satisfaction data.
Within a team-based approach, you’re going to learn something new every day. Teams need the ability to do ongoing quality improvement; to have the capacity to identify what changes need to be made. They cannot be afraid to try something new. If it doesn’t work, then be ready to put something else in its place.
Have an example of strategies to strengthen your integrated care team? Share your story, email firstname.lastname@example.org.
The ability to communicate effectively is an important ingredient to building and sustaining successful care teams. Here are some ways to foster effective communication among your care team.
- Case conferences: Hold regular case conferences or team huddles for all members of a team to meet and discuss challenging cases. This can be a great opportunity to have the whole team commit to a behavioral plan for a case that has been challenging.
- Practice: During provider team meetings, practice interactions that may be new or that need work. For example, have primary care providers and other medical staff practice introducing their behavioral health team using a warm hand-off role play.
- Use Health Information Technology (HIT): Use messaging capabilities within electronic health records for concrete tasks, such as changes in medication or need for follow up.
- Define how certain information should be conveyed: Just as you can recommend using HIT to communicate certain tasks, clarify that more nuanced conversations should be handled in person, over the telephone, or during a team huddle or case conference.
- Debrief: Gather the team to review a particular case and discuss what was learned and what can be done better next time. Debriefing allows the team to figure out opportunities for improvement.
More resources on teams can be found on CIHS’ Team Members page.
CIHS’ Essential Elements of Effective Integrated Primary Care and Behavioral Health Teams reviews team development within effective integrated primary and behavioral healthcare teams, identifies four essential elements for effective integrated behavioral health and primary care teams, and provides a roadmap for organizations designing their own teams, using examples from these best practices.
SAMHSA is accepting applications for FY2014 Minority AIDS Initiative Continuum of Care Pilot-Integration of HIV Medical Care into Behavioral Health Programs through June 4. The grant will fund programs that provide coordinated and integrated services for racial/ethnic minority populations at high risk for behavioral health disorders and high risk for or living with HIV. Funds are used for screening; substance abuse and HIV prevention; substance abuse, mental health, and co-occurring treatment; creation of infrastructure to provide integrated care; HIV and hepatitis screening and testing, and hepatitis vaccination.
The Evaluation of the SAMHSA Primary and Behavioral Health Care Integration (PBHCI) Grant Program: Final Report provides information about the grantees’ implementation of the PBHCI program, consumer outcomes, and program features associated with consumer-level processes and outcomes of care. Check out the RAND blog post, Improving Physical Health Care for Adults with Serious Mental Illness, that reflects on their evaluation findings.
The 2014 National Health Service Corps (NHSC) New Site Application Cycle is open through June 16, 2014. NHSC can help you recruit and retain qualified healthcare providers, including behavioral health professionals, in communities with limited access to care. To help you understand and capitalize on the opportunities provided through the program, check out the manual and presentation from CIHS.
Local and State Education Authorities can apply for one of 120 grants to support Mental Health First Aid training to help teachers and others who work with youth to understand, recognize, and respond to signs of mental illness or substance abuse in children and youth. Read a summary of the requirements at “Now is the Time” Project AWARE State Educational Agency Grants (NITT-AWARE-SEA) and “Now is the Time” Project AWARE Local Educational Agency Grants (NITT-AWARE-LEA).
Two new fact sheets from the Tobacco Control Legal Consortium explain how the Mental Health Parity and Addiction Equity Act and the Affordable Care Act impact coverage for tobacco cessation treatment. How the Affordable Care Act Affects Tobacco Use and Control summarizes main provisions of the Affordable Care Act that impact tobacco use and control, and The Mental Health Parity and Addictions Equity Act and the Affordable Care Act: Implications for Coverage of Tobacco Cessation Benefits addresses some frequently asked questions about insurance coverage for tobacco cessation.
Help spread the word about National Prevention Week, May 18-24, 2014! Explore the National Prevention Week website to learn more about how you can get involved, get sample tweets, tips for planning a community event, and how to participate in the “I Choose” Project.
Join CIHS in June for Building Organizational Infrastructure to Treat Chronic Pain and Prevent Dependence, to review the innovative approach of Project ECHO for addressing pain management; to discuss tools and resources available, including non-opioid options; and to learn about the workforce considerations for addressing chronic pain.