Abstract
Objectives: Learning objectives:
Define differences between integrated versus rotating team-based models of care
Identify tools to assess professional fulfillment, burnout, and clinical efficiency
Understand the impact of integrated versus rotating team-based care models on care team members well-being
Project objective/background:
Team-based healthcare improves patient access, billable services, and recruitment/retention (1). The staff roles and tasks impacts working to top of license (2) which likely contribute to professional fulfillment and well-being at work. However, well-being measures comparing team-staffing models have not been described. We compare well-being measures of an Integrated Consistent Care-Team Model (ICCM) with Rotating Care-Team Model (RTM) in pediatric sports medicine clinics. Our hypothesis is that ICCM providers and staff would consistently demonstrate greater professional fulfillment, less burnout, greater clinical efficiency, and more advanced team development compared to RTM providers and staff.
Methods:
We identified an ICCM and RTM model within one healthcare system. The ICCM group includes one core team of pediatric sports medicine providers and staff (n=6), consistently located in the same outpatient practice setting. The RTM includes varying provider and staff team members at varying locations (n=7). All care team members from both models completed three assessments (at 0 and 7 months) of professional fulfillment, burnout, and perception of team development. Metrics used included the Professional Fulfillment Index (PFI), a 16-item survey measuring professional fulfillment and burnout, the Mini-Z_2.0, a 10-item survey measuring burnout via Supportive Work Environment and Practice Efficiency subscales, and the Team Development Measure (TDM), a 31-item survey measuring team development. EMR Data was also analyzed to determine trends in efficiency and practice across the RTM and ICCM groups.
Results:
PFI results taken at both time periods indicated higher rates of Professional Fulfillment in the ICCM group than the RTM Group. A cutoff point of 3.00 or greater is indicative of professional fulfillment and was demonstrated by the ICCM group at both time points (M=3.31, SD=0.33; M=3.37, SD=0.30). RTM team members scored significantly higher (unfavorable) than ICCM team members on PFI Overall Burnout Scale and showed higher scores in Work Exhaustion and Interpersonal Disengagement subscales.
Mini-Z_2.0 results were favorable for ICCM team members on the Supportive Work Environment and Practice Efficiency subscales at both time periods. Overall scaled scores for the ICCM team were greater than the cutoff point of 40 at both time periods, indicating a joyful workplace, in contrast to RTM scores which were below the cutoff points on subscale scores and overall scores at both time periods. ICCM members also trended higher in team development scores on the TDM survey at both time periods. A Welch’s t-test was performed for the Mini-Z and PFI data collection and determined results were statistically significant across both samples and time periods.
Furthermore, ICCM providers yielded better EMR efficiency metrics than their RTM colleagues, including less in basket management, PJ time, clinical review and EMR time on unscheduled days at both time periods. Both groups averaged a similar number of appointments per day at each time point (M=9.51 in January; M=11.61 in August).
Conclusions:
This study describes differences in well-being measures for providers and staff within a pediatric sports medicine ambulatory clinic setting when comparing two different care team models across a 7-month period, suggesting that consistent care-team with core providers and less variability has advantages to provider and staff well-being.
References:
Jerzak, J., Siddiqui, G., & Sinsky, C. A. (2019). Advanced team-based care: how we made it work. The Journal of family practice, 68(7), E1-E8.
Reiss-Brennan B, Brunisholz KD, Dredge C, et al. Association of Integrated Team-Based Care With Health Care Quality, Utilization, and Cost. JAMA. 2016;316(8):826–834.
Panagioti M, Panagopoulou E, Bower P, et al. Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-analysis. JAMA Intern Med. 2017;177(2):195–205.