Redesigning the Care Team Holistically

Almost every organization is piloting some change to their care team model. Since the primary goal of most of these changes is to prevent physician burnout, groups often take a physician-centric approach to the redesign process. As a result, care team redesign often looks like what you see below: Leaders offload tasks from the physician’s plate onto advanced practice providers (APPs). Then, when APPs start feeling burnt out too, they do the same to nurses, and this task shifting continues down the line, setting a trickle-down effect in motion.

Using this approach, physician leaders could historically offset turnover by hiring more staff. But this trickle-down approach is unsustainable for three reasons:

Care team members are still working below top-of-license: Shifting tasks in response to physician burnout means that team members are too often given the tasks that physicians do not want or have time to take on, as opposed to those that are top-of-license. This inadvertently builds gaps and redundancies into the model—and this can be costly even in small doses. For example, even when an RN spends just 15% of their time on tasks that are below top-of-license, that’s still $6,000 worth of work that the RN does that could’ve gone to an MA.

Physicians are an increasingly smaller subset of the workforce: From 2018 to 2028, physician jobs are expected to grow 7%—which is less than the 10-year projected growth rate for other non-physician roles, such as RNs (12%), MAs (23%), NPs2 (26%), and PAs3 (31%). As groups employ more non-physician team members, the total percentage of the workforce—and associated labor costs—made up by physicians will shrink. Therefore, basing care team redesign on the physician at the expense of other team members has diminishing returns.

Non-physician team members are disengaged and burned out: Downshifting tasks to APPs, RNs, and MAs without getting them to top-of-license leads to costly turnover. As one example, 56% of MAs, who are usually at the end of the trickle-down process, plan to leave for another job in health care in the next five years—and worse, 21% plan to leave health care altogether.

To build a care team model that’s sustainable for the future, organizations need to design an ambulatory care team that maximizes the ROI and reduces the burnout of every team member—not just physicians. This requires a shift in mindset from seeing the care team as individual roles to viewing it holistically: looking at how individual care team members come together to work as a single cohesive unit. Rather than piloting changes to one team member at a time, leaders must redesign the entire care team at once to ensure everyone is working at top-of-license and as one high-performing team.

In practice, this means evaluating all tasks the care team needs to perform, and then matching those tasks to the appropriate team member. In other words, rather than starting with the physician and shifting tasks down the line, begin with the tasks and assign them to the right role. The key is completing this exercise for the entire team at once and then rolling out the new roles—again, all at once.

The goal isn’t to create one uniform care team across all providers, but rather, design a blueprint that practices and specialties can adapt depending on their staffing resources, patient populations, and strategic goals. Generally, organizations should strive for a consistent care team model at the practice or specialty level.

This holistic approach to care team redesign often surfaces redundancies and inefficiencies in the care team that you would not have identified using a trickledown approach. For example, one organization who used this holistic approach was able to hire a new scheduler in place of a new RN, resulting in about $35,000 in labor savings.

Specialty and inpatient considerations

Most leaders begin care team redesign in primary care. However, progressive organizations are beginning to refine their approach to team-based care in specialty and inpatient care as well. While roles and responsibilities will likely look different across specialties and sites of care, leaders should consider applying the same holistic redesign principles and process to other care teams.

Population health considerations

Many organizations roll out team-based care with more universally deployed roles first, which is why you’ll see us refer to physicians, APPs, RNs, and MAs frequently throughout this document. However, as organizations hire and deploy more population health-focused roles, such as pharmacists, care managers, and behavioral health specialists, leaders should take a similar holistic approach to integrating them into the care team—or deploying them across several care teams—rather than piloting these roles one-off.

In the past, team-based care pilots were limited to a few practices at a time. Because holistic redesign affects all care teams at once, it requires organization-wide commitment and leadership.

In the following pages, we’ll look at the role that you as a physician leader play in holistic care team redesign and the responsibilities you should allocate to others. We’ll also discuss a critical element of securing buy-in: involving frontline care team members throughout the entire process.