Jane Anderson, DNP Kylee Funk, PharmD

Transcription

1 A Culture of Team Based Care for Improved Patient Experience Jane Anderson, DNP Kylee Funk, PharmD

2 Objectives 1. Describe an example and impact on patients of nurse practitioners and pharmacists partnering to provide care 2. Understand the role of teams in meeting the quadruple aim 3. Describe a method to measure team culture 2

3 University of Minnesota Health Nurse Practitioners Clinic Small but Mighty! 3

4 University of Minnesota Health Nurse Practitioners Clinic Open 8 am 5 pm Monday-Friday Offers comprehensive primary care Diverse patient population 4

5 The team at our clinic 5

6 The roles of the NP and Pharmacist Jane Anderson, DNP Nurse Practitioner Kylee Funk, PharmD Clinical Pharmacist Leads medical assessment during visit Addresses physical and mental health needs Approaches patients from a holistic perspective Leads medication assessment during visit Optimizes medications Ensures medication regimens are personalized for individual success 6

7 The nurse practitioner-pharmacist team Team visit with NP and PharmD Patient presents to clinic Individual visit with NP Referrals and Consultations Individual visit with PharmD 7

8 The nurse practitioner-pharmacist team visit - example Sue 30 year old female Chief complaint diarrhea History Asthma, seasonal allergies, and depression with psychotic features Nurse practitioner resolves chief complaint through advising discontinuation of recent course of antibiotics since duration was already sufficient 8

9 The nurse practitioner-pharmacist team visit - example Pharmacist then leads assessment of each medication. Reveals Findings - Inhalers inappropriately used - NP probed and found asthma poorly controlled Patient presents to clinic When refills ran out, patient discontinued nasal spray Actions Education on inhalers - Education on ongoing role of nasal spray for allergies - New prescription sent Development of dry mouth after recent increase in medication - Advice to discuss with prescriber (psychiatrist) - Referral to dental 9

10 The nurse practitioner-pharmacist team visit - example At follow up Sue was using inhalers appropriately Sue resumed nasal spray Allergies and asthma symptoms improved, Sue s asthma control improved (no nightimte awakenings) Sue had not yet followed up with psychiatrist or dental referral 10

11 Our patients understand our approach to team based care "My team is who I can get phone calls from. Maybe a pharmacist for one issue and my [nurse practitioner] will call me for something else. Or I can come in to see just my pharmacist because she can see everything that's been done in the past because she's been a part of it-- to help me figure out what might be the next step. - AP 11

12 From Triple to Quadruple Aim: Teams support the fourth aim Better population health Lower costs Better patient experience Quadruple Aim Provider Wellness 12 Ann Fam Med. 2014;12(6):573-6.

13 Teams are important for clinic employees Effective team functioning in health care is associated with greater career satisfaction among clinicians as well as improved quality of care and greater patient satisfaction A strong team culture may protect against exhaustion for both staff and clinicians in primary care 13 J Am Board Fam Med. 2014;27(2):229-38

14 Influencing Culture 14 Business Horizons. 2017;60(3):

15 Our clinic mission and vision incorporates team Make strategy and culture important leadership priorities Mission: Our innovative team delivers a personalized patient experience by providing life-changing, exceptional care and high quality education for all learners. Vision: The University of Minnesota Health Nurse Practitioners Clinic provides authentic, life-changing care through an inspiring, collaborative team and is sought after as a premier primary care clinic by patients, healthcare providers, and community members. 15

16 Our clinic mission and vision incorporates team Make strategy and culture important leadership priorities Tips to build culture: Avoid campaigns Reward behavior that reflects culture Tip to change culture: Use new initiative as a way to draw attention to cultural values 16 Business Horizons. 2017;60(3):

17 Measurement tool for clinic culture Statement Develop a clear understanding of the present culture The group of staff and providers I work with most regularly work well together as a team We have a we are in it together attitude at my clinic I feel unprepared for many of the tasks that I am asked to do every day* My professional skills are used to the fullest at my clinic It is hard to get things to change in my clinic* I can rely on other people at my clinic to do their jobs well We regularly take time to consider ways to improve how we do things at my clinic 17 J Am Board Fam Med. 2014;27(2):

18 Measurement tool for clinic culture Table Discussion 1. What surprised you about your workplace as you reflect on filling out this survey? 2. After completing this survey, what is one change you could recommend at your workplace to improve the team culture? 18

19 The team culture in our clinic Statement Our Clinic Averages from research sample The group of staff and providers I work with most regularly work well together as a team We have a we are in it together attitude at my clinic I feel unprepared for many of the tasks that I am asked to do every day* My professional skills are used to the fullest at my clinic It is hard to get things to change in my clinic* I can rely on other people at my clinic to do their jobs well We regularly take time to consider ways to improve how we do things at my clinic J Am Board Fam Med. 2014;27(2):

20 Role modeling team culture in our clinic Role model desired behavior The example of leaders is one of the strongest shapers of culture Clinic leadership partnered with pharmacist and role modeled team-based care Other influential members of team can serve to role model team-based care 20 Business Horizons. 2017;60(3):

21 Key points Nurse practitioner-pharmacist teams improve patient care Interprofessional teamwork promotes provider wellness Team culture is essential to drive interprofessional teamwork To support team culture, it is critical to first understand the culture of the clinic and to rolemodel and reward team culture 21

22 A Culture of Team Based Care for Improved Patient Experience Jane Anderson, DNP Kylee Funk, PharmD