3 keys to smoother physician office workflow using team-based care model

A primary care model that expands the role of medical assistants can help give physicians more time for direct patient care, reduce patient wait times and boost job satisfaction, according to a blog post on the AMA Wire.

After a team-based approach was launched in two clinics at Watertown (Wis.) Regional Medical Center, a study published in The Journal of Family Practice found job satisfaction among clinic workers rose 5 percent, and some physicians reported a 50 percent decrease in after-hours clerical work.

Here are three keys that helped this team-based model work:

1. Extend medical assistant responsibilities. In the clinics' traditional model, the medical assistant would get the patient from the waiting room, conduct an initial assessment in the exam room and leave. Once the physician conducted the exam, the patient would wait again before the medical assistant completed follow-up orders and gave the patient a visit summary.

Under the new model, the clinics adopted a staffing ratio of three medical assistants for each physician, allowing medical assistants to have expanded roles during exam-room entry and discharge.

2. Use a co-visit format. To ensure consistency during the day, the research team created a co-visit workflow that included the whole team. Visual and electronic cues helped coordinate the movements between medical assistants and physicians throughout the workday, including an electronic messaging system in the EHR to show when a patient was ready to be seen and a whiteboard all team members could see that showed lab and radiology requests.

"What we found was it really wasn’t about the scribing," said James Milford, MD, primary care physician and lead study author. "It was about having time to build a relationship, being in there when I am talking to the patient — me being in there when they are talking to the patient and the patient seeing us working as a team and trusting us."

3. Enhance communication. To improve communication, the team-based model had physicians and medical assistants seated at side-by-side workstations, which also allowed for face-to-face handoffs. 

"Everything we have learned to do in medicine — where you are looking face-to-face when you tell a story about a person — is very important," said Dr. Milford.

The changes at the clinic are "an empowering thing," he added. "We all feel genuinely valued and empowered to take on multiple roles and tasks. There's a joy in practice when I come in now."

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