Remember Marcus Welby, M.D.?

If you don't, it's not surprising. We've come a long way from doctors hanging out a shingle and practicing with just one nurse and a receptionist. Back in the days of black and white TV, the doctor did everything, from weighing you to writing down the symptoms (with a pen, not on a computer) and handing you a prescription.

Things have certainly changed. According to the American Medical Association (AMA), fewer than 18 percent practiced on their own in 2013, and even doctors in small practices have nurses, medical assistants, a receptionist and billing people—and that's the simple setting. In a hospital or skilled nursing facility you're likely to meet nurse practitioners, aides, dietitians, physical therapists and social workers even before seeing the doctor. Often, the nurse practitioner, not the doctor, will do the first intake.

And all too often, it feels like a mess. One of my professional colleagues was the contact person for an elderly grandmother with dementia. She would get calls from different people about moving her between facilities—one would say that it was time to move her grandmother; another would call and say she had been moved to the wrong place. It hardly felt to her like a team focused on patient care, never mind a team playing by the same set of rules with the same objectives.

But that is starting to change. Health systems are increasingly focusing squarely on the issue of team medicine—sometimes calling it inter-professional collaboration. In part, this is motivated by cost—the old days of the doctors doing everything meant that too much of the doctor's time was spent on things that others could do at lower cost, and too little on the highly skilled work a doctor is trained to do. But the emergence of team-based care is evidence that how care is delivered is becoming as important as what care is delivered.

In our management consulting practice, we see this in medical homes, (as described by Elizabeth Williams in her May 27 Field Clinic post), but we also see it within the specialist's office and even the operating room. When my own son was considering major spinal surgery, our family spent many hours with the surgeon's physician assistant working through the choices on everything from sources of blood to risk factors to recovery exercises. We could—and did—ask the surgeon questions, but the PA was accessible as things surfaced over time, and that "on the spot" quality made us all a lot less anxious. It also enabled us to make smarter choices.

How can you tell if your hospital, nursing facility, clinic or doctors' office has teams that really work together, rather than a group of professionals acting independently? Here are some things we look for in our work with healthcare organizations, that you can ask in your own experience with your healthcare providers:

  1. Do the healthcare professionals know and show respect for each other?
  2. Do their roles seem clear—to them and to you?
  3. Are they sending you different messages, or are you hearing the same thing from each team member?
  4. Do they seem more focused on you than each other?
  5. Does your team care give you ample opportunities to understand your health problems and discuss choices about treatment?
  6. The bottom line is—are the different professionals actually coordinating your care so you don't have to?

The good news is that true medical teamwork is spreading. Medical colleges, nursing schools, and schools of allied health across the country are starting to train students together so they learn from the start to be part of a team, not independent agents. Teamwork means better care and better health. The ultimate winner is you.


Lynn Oppenheim, Ph.D, MBA is President of CFAR, a consulting firm that helps organizations turn strategy into action.


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