Theme 4: Working together - Team-based Models of Primary Medical Care: What s working in Complex Care Management? Case Studies from Four Countries

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Dominic Norman
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1 Theme 4: Working together - Team-based Models of Primary Medical Care: What s working in Complex Care Management? Case Studies from Four Countries Acknowledge: Australia: Dr. Lucio Naccarella, Susanne LeBoutillier, Amanda Mulcahy Canada: Dr. Louise Nasmith, Dr. Catherine Creede, Sonya Kupka United States: Professor Lloyd Michener, Bobbie Berkowitz, Justine Strand de Oliveira, Jennifer Cook United Kingdom: Professor Matthew Sutton

Session Outline Aim of paper Review & synthesis approach Realist evaluation Multi-country, comparative health systems research approach used

2 Session Outline Aim of paper Review & synthesis approach Realist evaluation Multi-country, comparative health systems research approach used Commentary approach Applied Policy Analysis framework Key Observations Differences & similarities Emerging issues Breakout sessions Key topics & questions Photo

3 My perspective Evidence-based policy means integrating experience, expertise and judgement with the best available external evidence from systematic research (Davies, 1999) My perspective on the concepts of: Team work: A group of professionals associated with treating a particular patient that includes a GP, who are interdependent in their tasks, share responsibility for outcomes, and who work together to meet the changing needs of patients Primary medical care: the system of health care workers (predominantly general practice, nursing and allied health professionals) which provide locally-based first contact care in the community setting Complex chronic management: Complex chronic care or disease management is an umbrella phrase used to describe a diverse array of medical conditions!!

..multiple islands of innovation that move in the direction of integrated, comprehensive primary care team.. (P19, Canada) Interprofessional team work: Right team, right place, right time (P26, US).

4 ..multiple islands of innovation that move in the direction of integrated, comprehensive primary care team.. (P19, Canada) Interprofessional team work: Right team, right place, right time (P26, US)...powerful financial and reputational incentives to find right team composition and size.. (P36, UK)...need to reform financial, organisational and structural systems that underpin the way team work is funded and supported... (P12, Australia) Observations 1

5 Observations...2 All countries in midst of reform processes & reform fatigue Emphasis on PHC system orientation to address health system problems Focus on access, equity and supporting & strengthening multidisciplinary trained PHC workforce Focus on innovations..islands of innovation.. Recognition of limited evaluative implementation evidence informed new models of PHC workforce Terms and concepts definitions & uses from whose perspective? policymakers, practitioners & academics Recognition of need to prepare, support and sustain workforce right place, right time, right place

6 Observations...3 Existing debates / tensions: Drivers for team-based care - Govt drivers (workforce - productivity, sufficiency, efficiency) Vs Patient access, quality, continuity, and coordination of care Construction, identity & function of team-based care - managerial control of professional groups Vs quality improvement of patient care Underpinnings of team-based care - formal relationships/structures Vs informal invisible relationships/networks Under-emphasis on workforce planning to support team-based models for people with complex care needs Regulatory frameworks and their interaction with payment and organisational systems to support / strengthen team-based models for people with complex care needs Team-based care and interface between primary, secondary & tertiary care patient journey for people with complex care needs

Photo Emerging Policy Issues Need coordinated policy levers to prepare, support and sustain workforce to learn and work together in CCM Lack of evaluative implementation evidence Need for comparative

7 Photo Emerging Policy Issues Need coordinated policy levers to prepare, support and sustain workforce to learn and work together in CCM Lack of evaluative implementation evidence Need for comparative effectiveness studies of different delivery models in varied settings Indicative evidence for inter-professional education, training, practice and regulatory strategies Need practice level infrastructure (financial, IT etc) to support team-based care Need to invest in workforce planning - getting the right people with the right skills and competencies in the right place at the right time Need to advocate for cultural shifts in language, policy, strategies, practice and research Need to involve patients, family & community in team-based models of care

8 Thank You Dr Lucio Naccarella, PhD, The Australian Health Workforce Institute, The University of Melbourne. Web:

HEALTH MATTERS. Collaboration in healthcare. Victorian Healthcare Association. citizens juries co-production team-based care federal reform

HEALTH MATTERS. Collaboration in healthcare. Victorian Healthcare Association. citizens juries co-production team-based care federal reform HEALTH MATTERS Victorian Healthcare Association Issue 2 [ SEPTEMBER 2011 ] www.vha.org.au Collaboration in healthcare citizens juries co-production team-based care federal reform This issue 5 Citizens