Improving Care Coordination by Improving Relationships

By Leigh Ann Myers  /  09 Sep 2014

I was reading an article last month in The New England Journal of Medicine about care coordination, and it’s been on my mind ever since. Care coordination is becoming even more important as healthcare delivery becomes more complex, and it’s a critical issue for the healthcare industry to address.  In his article, Dr. Matthew Press, a general internist, wrote about his challenge in coordinating care for one of his patients, Mr. K. He wrote:

Over the 80 days between when I informed Mr. K. about the MRI result and when his tumor was resected, 11 other clinicians became involved in his care, and he had 5 procedures and 11 office visits (none of them with me). As the complexity of his care increased, the tasks involved in coordinating it multiplied. I kept a running list and, at the end, created an “instant replay” of Mr. K.’s care. In total, I communicated with the other clinicians 40 times (32 e-mails and 8 phone calls) and with Mr. K. or his wife 12 times. At least 1 communication occurred on 26 of the 80 days, and on the busiest day (day 32), 6 communications occurred.

I walked away from the article thinking: “I want this man to be my doctor.” In my experience, Dr. Press is unique. Most physicians are discouraged by the effort it takes to get ahold of other clinicians, or to keep patients and their families involved in their care. It’s easy to see why. The processes involved in coordinating care can be incredibly frustrating, time-consuming and an inefficient use of time – not to mention that most of the time spent tracking down other clinicians or talking with patients is not reimbursable. And yet, despite all of the frustrations and the hassle, Dr. Press made 52 different communications over an 80-day period for one patient, serving as the quarterback for his patient’s care.

Care coordination is a critical challenge, and it won’t be solved overnight. There are larger, systematic problems that healthcare organizations need to address. But, clinicians and leaders in the C-Suite can take one important step today to move us closer to better coordinated care:

–        For clinicians: Get to know your colleagues. The expanding web of healthcare delivery doesn’t take place in just one hospital room, or wing, or even inside one facility. Healthcare delivery crosses multiple settings, and clinicians are required to coordinate care with one another much more frequently. In this new world of healthcare delivery, relationships are equally as important as processes. It’s always easier to pick up the phone when you have a good rapport with someone, and while those connections often take time to develop, clinicians can begin making an effort today to form relationships with their colleagues. Even small conversations set the stage for better relationships, and better coordinated care 

–        For hospital leaders: Understand your clinicians’ workflow. In my conversations with clinicians, a common theme is their frustration that hospital leadership lacks an understanding of clinician workflow, which makes it difficult to tackle inefficiencies. Hospital leaders should take time today to set up a committee of clinicians who can talk through workflow issues that are making care coordination difficult. By forming this kind of group, hospital leaders can begin to get a better picture of their clinicians’ coordination challenges, and can begin to address those challenges.

Take today to follow Dr. Press’ example: what can you do to deliver better coordinated care for your patients?


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