Every summer, music festivals and other production events bring priceless memories and life changing experiences to millions of attendees. These events (Taste of Chicago, Lollapalooza, etc.) are not only a good time, but also a great display of coordination, regulatory compliance, dynamic teams, and effective use of talented individuals with special social and technical skills. The outcome is a great show, but every show is a complex choreography of action and multi-disciplinary teamwork that at its best becomes invisible, going completely unnoticed by those in attendance.
Production companies are in charge of organizing large teams with a variety of skills to accomplish an intended set of objectives, conducted under a tight set of deadlines and budgets. Healthcare providers similarly requires teams of varying expertise to perform with little margin for error. As care coordination becomes increasingly important to improving patient outcomes, learning how to manage teams to function at their highest capabilities is vital. In this discussion, we explore what can be gained from the production company perspective that could improve performance with medical practitioner teams in healthcare.
What goes on behind the scenes to put on a great show?
Three principles are essential to creating this illusion.
- Longitudinal planning
- On the production site, months before an event, planning teams work out when and where activities will occur by using a series of detailed checklists. In the office, organizers file for permits and policies, negotiate and sign contracts, and find the necessary talent far in advance. As the event nears, contingency plans are created for weather, security, and other unpredictable issues that could cause concern. These steps are all vetted out by multiple managers and coordinators in order to make sure key components are not missing.
- Team utilization
- Once the plan of action is created, production firms identify which individuals in their teams have the necessary skills to execute specific tasks. Not only does this allow for proper alignment of skills to tasks, it also serves to utilize each team member to their highest capacity. That is to say, a painter is not only being given the right jobs, but also tasks commensurate with his or her level of experience.
- While team members are held accountable for specific tasks, managers are allowed to oversee the pace and direction of work. It is key that the individual performing the task is not the one dictating higher-level decisions, as that would impede their ability to utilize their skills as needed. Therefore, decentralizing execution and oversight allows for more effective and efficient work.
So how does this apply to healthcare?
Given the increasing number of insured patients and the looming physician shortage, bringing effective and efficient care coordination to health care is a necessity. While some of the aforementioned steps are employed, here is how the keys to production companies’ success translates into health care success.
Concerning planning, medical teams sufficiently prepare themselves to handle the large of patients and requests that are attended to each day. However, room for improvement exists, evidenced by dissatisfied patients, long waiting times, and the number of errors that occur. Thus, it seems that day-to-day planning can only yield so much efficiency in care coordination. Care teams should instead plan over weekly periods, given that appointments are generally scheduled several days in advance of their occurrence. These planning sessions should include the entire team of physicians and nurse staff, so that teams can align on how they will approach the week’s work. This will allow teams to organize themselves so that they are not reactive on a day-to-day basis, and are rather accounting for the ebbs and flows of effort throughout a longer period.
Regarding team utilization, as the physician shortage continues to be an issue, it is vital that care professionals are allowed to practice at their highest capacity. According to a study for the New England Journal of Medicine, physicians can spend as much as 50% of their time doing non-physician work, including telephone calls, documentation, and e-mails. To mitigate this inefficiency, one of two scenarios needs to occur. The solution that often comes to mind is to increase the nurse to doctor ratio, so that doctors can focus on physician tasks. However, this poses its own problems, in that throwing more individuals at a problem is not any more efficient and that the nurses simply end up being underutilized. A better solution is to build upon the aforementioned weekly meetings by setting aside time to align on exactly who is responsible for which tasks throughout a process, and how the steps are being conducted so that care is seamless.
Finally, with respect to decentralization, it is important to distinguish between task managers and task executors. Physicians often end up playing both roles in critical and non-critical situations, which not only slows down work, but also leads to errors. As such, physicians should allow for nurses to guide the pace and direction of work, so that they can focus on the task at hand. To do so, both groups need to engage in dialogue to determine how nurses will play the guiding role, and run through example situations, ranging from routine clinical visits to complex procedures. This type of decentralization will not only aid doctors though, as it also gives nurses further ownership of processes that occur, leading to a more united team.
While these steps are by no means comprehensive measures to bring effective coordination to health care, they are certainly hallmarks of the type of effective and continuous communication that is needed for excellent care and good entertainment. The steps derive from the key principles used by production companies, which has resulted in some of most fine-tuned showcases of team organization. If health care teams can emulate the high function production companies have displayed, patients will be all the better served for it.