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A plea for small but full-time clinical teams


Dartmouth’s Chris Trimble writes in this Harvard Business Review blog item about a highly effective but overlooked approach to improving healthcare delivery.

“Spurred by new payment models and new incentives, health systems are increasing their commitments to innovation in healthcare delivery. Unfortunately, many systems are overlooking an entire class of innovations that are modest in size, low in risk, and highly likely to deliver wins for both patients and profits.

“These innovations take the form of small but full-time clinical teams that are commissioned to redesign and deliver care to a particular patient population. For example, in 1998, Essentia Health, in Duluth, Minnesota, put in place a small, full-time team to better serve patients discharged from the hospital with congestive heart failure (CHF), a team that initially consisted of just a nurse practitioner and a medical assistant supported by a part-time medical director and an on-call cardiologist.”

“In fact, innovations in the form of small, full-time teams that redesign care are rarely pursued at all because they are typically money losers under fee-for-service reimbursement.”

“The most worthwhile investments in the middle of the spectrum are marked by a crucial choice: the commissioning of small but full-time clinical teams whose job it is to redesign and deliver better care for a particular patient population. Part-time teams are far less effective. A team only gains the flexibility needed to redesign care from scratch — literally, to rethink what each team member does at work each day — if the team is fully released from their existing job responsibilities.”

Mr. Trimble writes: “The typical pushback is that a full-time team, even a small one, is just too expensive. But that thinking may just be the residue of an entrenched fee-for-service mindset, where one simply does not deliver services that are not directly reimbursed. Under any kind of at-risk contract, however, these projects have high likelihoods of delivering both better outcomes for patients and a financial return on investment.”

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