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Pitfalls in trying to manage complex care

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Three physicians, writing for NEJM Catalyst, weigh in on the challenges of creating and maintaining clinical teams to manage complex care. Among their observations:

“As clinical leaders who have developed teams in different organizations to navigate complex care environments, we have long maintained that the traditional focus on who captains the ship is misguided. In many complex clinical scenarios, there is often no single right way to do things. Having many different physicians bring their attention to a difficult problem can minimize the chance that something will be missed. Specialists tend to see care from their particular perspectives and, in the absence of collaboration, may not fully appreciate the effects of a therapeutic intervention in areas where they do not usually focus.”


“When surprises are too frequent, many physicians will reflexively micromanage care. This presents an affront to the other clinicians involved, who treasure their independence and competence. It also can create a situation where collaborating caregivers stop thinking about how best to conduct care and instead wait for instructions. If someone is going to change the care plan, why bother to make one? This tendency to micromanage is often accompanied by other dysfunctional behaviors including aggressive or intimidating conduct toward other caregivers that creates an unhealthy working environment by impeding a team’s willingness to communicate freely.”

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