The Exam Room Team: Where Provider Productivity and Access Begin

In this final segment of a four-part series on productivity that’s included a discussion of the negativity often associated with the word “productivity”, the impact of low productivity on the medical home and five factors that function to hold productivity down, we’ll take a look at the exam room process and why it hasn’t been universally improved through a team approach.

So far we’ve created four separate blogs to look at different facets of productivity. Why are we banging this particular drum so loudly? Because to extend the analogy, in the great symphony that is the contemporary American health system, productivity is one of the most harmonious instruments we have.

Beyond its historical relationship to compensation-related metrics, productivity is the key to primary care access, including (and sometimes especially) acute or same-day appointments which might otherwise end up in urgent care or the ED.  On an even larger scale, the improved access that comes with greater productivity is a key factor in meeting current and future patient demand and consequently, the needs of our healthcare system itself. So how do we help assure that this capability will be in place? The exam room is the place to start.

Getting behind the team

The thing to keep in mind about team-based care is that it’s simple. At least in concept.  The provider’s role in the primary care exam room focuses on what she or he is uniquely qualified to do by way of training and experience. It includes performing exams, determining diagnoses and setting up treatment plans. Virtually everything else from collecting and presenting medical data to supporting the treatment plan and closing the visit, is delegated to one or more “team care assistants” including nurses, medical assistants or other well-trained clinical staff. Like I said, the basics are simple once you get past the misconceptions that are still held.

Three myths about the team care delivery model

Myth #1: Your staff can’t get proficient at the needed skills. With appropriate and adequate training, clear performance expectations and ongoing communications, staff members can effectively handle the required tasks – and can direct more of their time and attention to those activities than a physician could.

Myth #2: Having additional people in the exam room interferes with the patient-provider relationship. What we’ve found over a number of years and in an extensive number of practices is that freeing up the physician to focus entirely on the patient, (without non-clinical distractions), dramatically strengthens that vital bidirectional bond.

Myth #3: Patients don’t want anyone but the doctor in the exam room. Again, experience and related research indicate that patients overwhelmingly appreciate the extra time and attention directed to them by a larger care team.

The real change is cultural

Once again, I would emphasize that the concept of a team-based, patient-oriented exam room isn’t tough to understand or even assemble, especially once you get past those three myths. But waiting on the other side is the single, most substantial challenge to this exam room team – the historical and still potent strain of personal independence and self-assurance that exists among providers, whether they are employed or in private practice. While the potential need for staff hiring, as well as some role realignment and workflow redesign, requires effort and resources, the idea that many providers prefer performing a one-person play in the exam room instead of acting in an ensemble continues as the greatest obstacle.

In an upcoming blog we’ll look at the “Why do what I do best when I can do it all?” clinician culture and what can be done to transform it into an effective foundation for team care.