Team: “A small number of people with complementary skills who are committed to a common purpose performance goals and a common approach for which they hold themselves mutually accountable." (Glen B. Alleman)
The NCQA team-Based care and Practice Organization (TC) Concept is defined by the 2017 NCQA PCMH Standards as: The practice provides continuity of care, communicates roles and responsibilities of the medical home to patient/families/caregivers, and organizes and trains staff to work to the top of their licenses and provide effective team-based care.
There are 5 Core (or Must Pass) criteria associated with the TC Concept. The Patient Centered Medical Home must:
Core Criteria 1- Designate a clinician lead of the medical home and a staff person to manage the PCMH transformation and medical home activities
Core Criteria 2- Define practice organizational structure and staff responsibilities/skills to support key PCMH functions.
Core Criteria -6 Has regular patient care team meetings or a structural communication process focused on individual patient care.
Core Criteria 7- Involves care team staff in the practice's performance evaluation and quality improvement
Core Criteria 9- Has a process for informing patient/families/caregivers about the role of the medical home and provides patients/families/caregivers materials that contain the information
Phases of Team-Based Care Development (Bruce Tuckman 1965)
Forming: This is the stage where the care team members are getting acquainted with one another and there are positive exchanges of ideas and collegiality. A true leader emerges during this stage and it is a good time for the team to begin developing a Mission Statement that will guide them to the desired outcome.
Storming: This stage is where care teams begin to feel friction among members as specific tasks and responsibilities are discussed. Finger pointing may distract from cohesiveness and weaker team members may become discouraged by the behavior of stronger team members. Again, the unifying element of this process is the aforementioned Mission Statement, which should be placed in a highly visible manner and referenced throughout this phase.
Norming:The Care Team has now worked out their differences and a sense of pride over being part of the team begins to emerge. There is a sense of Esprit De Corps and strong desire to accomplish the mission. Leaders begin to engage in motivational management techniques and empower members to use their creative talents to overcome performance obstacles.
Performing: The Care Team is now focused on maximizing their performance and accomplish the mission. While interpersonal friction may occur, it does not distract from the overall desire of the team to move forward toward the mission. Leadership continues to engage in motivational management techniques and uses benchmark performance data in a motivational manner to heighten a sense of accomplishment and pride.
By understanding the application of Team-Care Development, Healthcare Leaders can structure the process so that their teams move more rapidly from Forming to Performing where they take great pride in creating exceptional value for their patients and the organization. Moreover, application of this process can greatly enhance the achievement of Team Based Core (Must Pass) Criteria required for NCQA PCMH Transformation.