What is Team-Based Care?

Collaborative Healthcare for Patients and Providers

Team-based care is a model of collaborative healthcare delivery that empowers patients and providers to achieve high-quality care. Implementing team-based care improves clinical outcomes, support for complex patients, patient access and experience, and staff experience and retention.

Implementing team-based care strategies can:

  • Improve clinical outcomes
  • Improve support for complex patients
  • Reduce staff burnout
  • Enhance patient access and experience

How is Team-Based Care Achieved?

Team-based care can be achieved through incorporating the patient as part of the healthcare team, by integrating their healthcare needs and engaging them in their healthcare plan. Below are additional ways you can implement team-based care effectively at your facility.

  1. Leadership Support

    • Provide continuous leadership support
    • Allocate resources for both team members and the patient
    • Encourage all team members to have a voice
  2. Implement Team Training

    • Build team support
    • Ensure that everyone understands the goals, strategies and tasks
    • Build trust and communication
    • Enable staff to work independently
  3. Data-Driven Quality Improvement Strategy

    • Establish and monitor metrics to evaluate improvement efforts and outcomes
    • Ensure the quality improvement strategy includes feedback from patients, families, providers and care team members
  4. Clearly Define Your Teams

    • Identify what a team looks like within each system
    • Determine how many patients each team can manage
    • Design workflows to identify which team member is responsible for which task
  5. Empanelment

    • Assign patients to providers and teams to achieve a balanced patient load. This includes communication with the patient about who is part of their care team
    • Use data and QI to proactively contact, educate and track patients to identify care gaps, risk, community and family needs
  6. Continuous Implementation and Improvement

    • Gradual approach to implementation. Be advised it takes time to fully function as a team
    • Continue to assess ways to optimize the model, including changing patient flow within the clinic, updating workspaces and improving communication management between team members

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