A Well-Functioning Primary Care Team in a Large Group Practice In 1997, Kaiser Permanentes Georgia region (KP/Georgia) developed primary care teams with several goals: increased patient satisfaction, improved Health Employer Data and Information Set scores and lowered costs. This group practice model currently consists of nine primary care offices with 25 teams. Each team has three to five clinicians (physicians, nurse practitioners, or physician assistants), two registered nurses, one to two receptionists or clerks, and six to seven licensed practical nurses or medical assistants providing care to a panel of 8,000 to 15,000 patients. Prior to the rollout of the team structure, clinicians and staff received training in team-oriented care. Patients view their clinician, not the team, as their primary caregiver, but are aware that a nonphysician clinician may provide care for acute problems or if the physician is not available. Eighty-five percent of visits are handled by a clinician on the patients team. The KP/Georgia team has well-defined systems and protocols for all clinical processes, including triaging telephone calls, reviewing and informing patients of laboratory and X-ray results, making referrals, and renewing prescriptions. One registered nurse is the advice nurse, answering patient questions and triaging patients who telephone or drop in. The other registered nurse is the team co-leader, working with the physician co-leader to solve day-to-day problems, ensure that clinical systems are functioning well, and supervise team members. Each team receives a budget based on the number of patients on the teams panel with risk adjustment according to age and disease severity. Initially given limited decision-making autonomy, teams demonstrating effective self-management are allowed flexibility in staffing mix and division of labor. Teams can decide whether they want more physicians, more nonphysician clinicians, or more support staff in their personnel mix. Some teams delegate chronic-care management functions to licensed practical nurses and medical assistants; others are less successful in this redesign. Each team decides how chronic disease registries are used to improve its panels outcome measures. Some use the registries extensively, others minimally. Each team receives a quarterly report on team functioning, patient satisfaction, staff satisfaction, and clinical quality measures, enabling KP/Georgias central leadership to assess each teams functioning and allowing each team to compare itself with other teams.

a) Is the team at Kaiser Permanente of Georgia a successful team? Support your answer by comparing the case details to the common characteristics of successful teams (page 378).

(Page 378)

COMMON CHARACTERISTICS OF SUCCESSFUL TEAMS Hackman (2011) has studied teams for many years, and he has identified six enabling conditions for effectiveness. The team must (1) be real, (2) have a compelling purpose, (3) consist of the right members, (4) establish and follow clear norms of conduct, (5) work under a highly supportive context, and (6) receive well-timed team coaching. Elaine Biech, as cited in Gordon (2002, p. 184), outlines 10 most commonly mentioned characteristics for successful teams:

Clear Goals: Clear goals allow everyone to understand the function and purpose of the team.

Defined Roles: Defined roles allow team members to understand why they are on the team and enable clear individual- and team-based goal setting.

Open and Clear Communication: Effective communication is considered the most important aspect of team building. It hinges on effective listening.

Effective Decision Making: Effective decision making is critical, and for a decision to be effective, the team must be in agreement with the decision and must have reached agreement through a consensus-finding process.

Balanced Participation: Balanced participation ensures that all members are fully engaged in the efforts of the team. Participation is also directly linked to leader behaviors. Effective team leaders should not see their role as authoritarian and should strive to be seen as the teams mentor or coach.

Valued Diversity: The team must recognize each members expertise and value variety of knowledge, skills, and abilities. In the world of teams, diversity is larger than just race or gender.

Managed Conflict: Managed conflict requires that all team members feel safe to freely state their points of view without fear of reprisal. For teams, managed conflict is almost akin to brainstorming, in that conflict allows the team to openly discuss ideas and decide on common goals.

Positive Atmosphere: Positive atmosphere requires that a climate of trust be developed. One way of developing trust is to allow team members to come together in a positive atmosphere. Allowing team members to become comfortable with one another will generate a positive atmosphere, leading to enhanced creativity and problem solving.

Cooperative Relationships: Cooperative relationships are a must, and team members should recognize that they need one anothers knowledge and skill to complete the given task(s).

Participative Leadership: Participative leadership includes having good leadership role models, as well as leaders who are willing to share responsibility and recognition with the team.

I would also add reflection and appreciation inquiry to Biechs list of successful team characteristics. Teams should be encouraged to allocate time for reflection and debriefing on the results of their actions and decisions. Appreciative inquiry can help with this process by encouraging honest communication and analysis by the group (Drew & Coulson-Thomas, 1996). Appreciative inquiry encourages members to identify and reflect on periods of excellence and achievement. By looking at the past, members can develop a vision of what they want to accomplish in the future. They build on what worked best to reach their goal.

b) Explain challenges in building team performance and the influence of dynamics and interaction in team performance.

c) Compare the types of teams and how they are utilized within a health care organization. How can the dynamics of a team help delivery effective patient care?

d) What recommendations would you extend to Kaiser Permanente to contribute to a more successful team?