Integrated care is a team-based model of care, based on the blending of numerous provider disciplines’ expertise to treat a shared population through a collaborative treatment plan with clearly defined outcomes. The client and their family play a vital role as members of the team, providing input on personalized health outcomes and preferences in treatment approach. The precise mix of providers in each setting is determined in part by the clinical setting, the population needs, funding, and pre-determined outcomes. Workforce development in integrated care has unique needs and challenges, including a focus on expansion and flexibility in provider function and roles; changes in traditional healthcare provider culture and provider training; and development of an effective and efficient team.
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The nine core competencies capture the diversity of skills integrated care team members require. Careful review of these competencies can assist organizations and individual professionals in thinking about the specific skill acquisition required in development of team members.
The National Council for Behavioral Health produced a series of brief instructional videos in partnership with the New York State Delivery System Reform Incentive Payment (DSRIP) program that demonstrate actions you can take to implement best practices within an integrated care setting, such as a warm handoff and a morning team huddle.
Check out the April 2014 edition of eSolutions which focuses on the essential elements of building a high functioning care team.
The Essential Elements of Effective Integrated Primary Care and Behavioral Health Teams summary reviews team development within effective integrated primary and behavioral healthcare teams. The full review 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.
Primary Care Workforce Competencies, are essential competencies for preparing health care professionals across disciplines and skill level for practicing in team-based, coordinated care models such as patient-centered medical homes. Developed by the Patient-Centered Primary Care Collaborative.
The University of Washington AIMS Center Five-step Team Building Tool guides the process of creating an effective clinical team, including clearly defining team member roles and creating an effective shared workflow.
The TeamSTEPPS® training module for primary care practices teaches health care providers and staff to improve patient safety by learning how to improve communication, work more effectively, and make a greater commitment to teamwork. TeamSTEPPS is an evidence-based training curriculum jointly developed by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD).
The Team Training in Healthcare and TeamSTEPPS at Johns Hopkins webinar reviews the current state of team training in healthcare, discusses TeamSTEPPS' role in the current state of team training in healthcare, and shares examples from the implementation of TeamSTEPPS at Johns Hopkins.
AHRQ’s Care Coordination Measures Atlas lists existing measures of care coordination, with a focus on ambulatory care, and presents a framework for understanding care coordination measurement. The Atlas aims to improve care coordination and is for quality improvement practitioners and researchers studying care coordination.
Developed by participants from the Institute of Medicine’s (IOM) Best Practices Innovation Collaborative, the Core Principles & Values of Effective Team-Based Health Care presents basic principles and personal values that characterize inter-professional team-based care. The principles and values are intended to help guide clinicians, clients, administrators, and other stakeholders in healthcare seeking high-value team-based care that focuses on the goals and priorities of clients and their families.
The Institute of Medicine Global Forum on Innovation in Health Professional Education held a workshop on the integration of shared understanding into education and practice to promote a transdisciplinary model of professionalism.The workshop summary explores the barriers to transdisciplinary professionalism as well as the impact of an evolving professional context on health system users, learners, and others within the health system.
- HRSA's Coordinating Center for Interprofessional Education and Collaborative Practice provides an infrastructure for leadership, expertise, and support to enhance the coordination and capacity building for interprofessional coordination.
The Cambridge Health Alliance Model of Team-Based Care Implementation Guide and Toolkit provides information and resources on team based care, the role of each team member, and sample huddle strategies.
- Huddle Strategies and Checklist (pg 13)
- Team Huddle Assessment Tool (pg 15)
- Dealing with different types of people/situations in team meeting (pg 33)
- Sample Team Meeting Agenda (pg 38)
CIHS' webinar Bridging the Culture Gap: Approaches to Communications in an Integrated Setting identifies structured approaches to effective communication that close the culture gap between primary care and behavioral health providers. It also describes the application of these approaches in the integrated care setting, how they support improved care and better outcomes.
10 Ways that Behavioral Health Staff can Positively Influence Team Huddles in Primary Care provides useful tips and strategies on how to constructively influence healthcare staff within your organization.
Recommendations gathered by Suzanne Daub, LCSW, Senior Consultant, National Council for Behavioral Health as part of the Philadelphia Integrated Care Network
Huddles: Increased Efficiency in Mere Minutes a Day shares how healthcare practices learned to follow the lead of a football team and now use huddles as a way to save time and increase efficiency.
Team Huddle Examples:
Huddle Checklist by HealthPoint Community Health Center
The Pre-Clinic Huddles in the Patient Centered Medical Home webinar
Featuring Philadelphia FIGHT, an AIDS service organization and community health center. companion article.