Team-based care is the solution for healthcare sustainability

With growing calls for action and reform, it’s well-established that primary care in Canada faces a crisis. Family medicine as a specialty is in peril. On each shift I work as an emergency physician, I care for patients who can’t find a family physician, impacting their access to care and follow-up options.Team-based primary care is the often-touted solution. The concept sounds like a good one. Who would disagree that professionals should work as part of a team? But what really is team-based care? How does it provide the solution that is needed?Read: Dr. Adam Chen: Why solo doctors are here to stayThe value of teamwork transcends industries. It is well understood thatdiverse teams offer creativity and innovation. Healthcare is no different.First, what is team-based care not? It isn’t replacing one health profession with another. The recent announcement out of Alberta to create stand-alone nurse practitioner clinics is not the solution to a family physician shortage. It is a simple, ill-thought-out, quick fix to a complex problem.In contrast, the acceleration of Ontario Health Teams and their focus on advancing team-based care in the community holds promise, but it must be done right.When primary care is delivered in a team-based model, a group of health professionals from different disciplines are jointly responsible for delivering primary care to a defined population of patients. Members work together as an interdisciplinary team, relying on each other's strengths and areas of expertise. Unless time is paid to creating and building the team, there is a risk of groups of really smart people working together, alone, and patients not fully benefiting from their collective value.Ideally, team composition is thoughtful and data-informed. Population and public health data about the patients the team members would serve should be mined to identify the ideal members of the team. For instance, in addition to family physicians and nurse practitioners, a patient population living in theinner city who are experiencing housing instability and substance misuse may require social workers and addiction counsellors as members of their team.Meanwhile, a population of seniors living with chronic diseases would likely need a team comprised of chronic disease nurse educators, occupational therapists and pharmacists.Ultimately, the promise that team-based care holds is appropriate and sustainable care. Patients see the right provider at the right time. Patients don’t always need to see the most highly skilled or trained provider; they need to see the team member who can best help them with their problems now.With a shortage of healthcare professionals, this is a more sustainable model. Meanwhile, patients retain access to highly skilled and trained professionals in scarce supply, like family physicians, but ideally, see them when their skill and expertise are required.Healthcare professionals who work in team-based models of care report greater satisfaction in their work. It enables thought-sharing, learning, and growth.Job satisfaction leads to better performance and greater retention. This, too, benefits patients in that they enjoy stabilized longitudinal care.The crisis in primary care didn’t occur overnight, and the solutions won’t be formed overnight either. Team-based care requires not only investment but also intentionality, thought and planning. Time must be spent building the right team, defining roles and ways of working together, providing the team with the necessary tools, and then putting the team into practice. A change management strategy will be essential. There will be growing pains and learnings, which require flexibility, adaptation and course correction. It is a long game worth working towards. Ultimately, team-based care holds great promise for the sustainability of primary care in Canada and the health system we cherish as Canadians.Dr. Kevin Wasko is the chief of emergency medicine at North York General Hospital in Toronto and a former physician executive from Saskatchewan. He is also an Accreditation Canada surveyor and a former Action Canada fellow through the Public Policy Forum.

Team-based care is the solution for healthcare sustainability

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