背景:不列颠哥伦比亚省的专科医生通常在手术室或住院医院等急性护理机构的团队中工作。然而,虽然在初级保健诊所支持实施基于团队的护理(TBC),没有正式机制支持专科医生在其私人门诊办公室采用TBC.采用TBC模型与改善医生经验有关,效率,和病人的经验。
方法:医疗保健改善突破系列研究所指导了一项计划,以支持11名专科医生,代表九个不同的专业,在门诊办公室开发和实施TBC。与会者得到了包括资金在内的资源支持,导师,和学习机会。为了确定该计划是否改善了医生的经验,使用经过验证的MiniZ调查收集定量数据,通过月度报告收集定性数据,半结构化面试,和焦点小组。通过调查和随访收集患者经验数据。
结果:为期15个月的计划成功,11名专家中有10名在其办公室实施TBC。MiniZ结果表明,在整个计划过程中,医生的经验得到了改善,工作满意度得分,工作节奏,以及在电子病历上花费的时间改善最大。与专家的访谈和与专家团队成员的焦点小组支持这些发现,参与者表示TBC调节工作负载,开始影响倦怠,改善工作与生活的平衡,并提高护理效率。患者在接受TBC时报告了积极的经历。在与专家小组协商后,患者不太可能去急诊室,提供者同意,由于新的实践模式,他们的患者不太可能寻求急性护理。
结论:TBC是在不列颠哥伦比亚省执业的专科医生及其医疗保健团队促进福祉的可行模式,工作满意度,和效率,改善患者体验。这些发现可能会引起专家的兴趣,卫生保健提供者,政策制定者,以及希望更好地支持和保留对患者护理不可或缺的专业实践的管理员。
BACKGROUND: Specialist physicians in the province of British Columbia commonly work on teams in acute care settings such as operating rooms or inpatient hospital units. However, while the implementation of team-based care (TBC) has been supported in primary care clinics, no formal mechanisms have supported specialist physicians in adopting TBC in their private outpatient offices. Adopting TBC models is associated with improving physician experience, efficiency, and patient experience.
METHODS: The Institute for Healthcare Improvement Breakthrough Series guided a program to support 11 specialist physicians, representing nine different specialties, to develop and implement TBC in outpatient offices. Participants were supported through resources including funding, mentorship, and learning opportunities. To determine whether the program improved physician experience, quantitative data were collected using the validated Mini Z survey and qualitative data were collected through monthly reports, semi-structured interviews, and focus groups. Patient experience data were collected through surveys and follow-up calls.
RESULTS: The fifteen-month program was successful, with 10 of the 11 specialists implementing TBC in their offices. The Mini Z results demonstrated that physician experience improved over the course of the program, with scores on job satisfaction, work pace, and time spent on the electronic medical record improving the most. Interviews with specialists and focus groups with specialists\' team members support these findings, with participants stating that TBC modulates workloads, begins to affect burnout, improves work-life balance, and increases the efficiency of care. Patients reported positive experiences while receiving TBC. Patients were less likely to visit the emergency department after consultations with specialist teams, and providers agreed that their patients would be less likely to seek acute care because of the new practice models.
CONCLUSIONS: TBC is a viable model for specialist physicians and their health care teams practicing in British Columbia to foster well-being, job satisfaction, and efficiency, and to improve patient experience. These findings may be of interest to specialists, health care providers, policymakers, and administrators looking to better support and retain specialist practices that are integral to patient care.