A great conversation on the frontline

Last week, Sean Lind, our Resource Exchange manager, sent an email to our staff:  “Hi folks, the Brookings Institute highlights team-based care in this recent ‘Up Front‘ piece”. This email made me smile.

Embedded in this email was the link to a new report “On the 'Front Lines' of Health Reform: Reinventing Team-Based Care”, featuring the importance of fully engaging the entire health care work force. Brookings supports the development of “frontline health care workers”, representing nearly 50 percent of the estimated 18 million health care workers not typically thought to be a part of the “health care team of professionals.”  This workforce comprises workers who provide routine and essential services in a medical practice or health system, such as medical assistants, administrative assistants, laboratory and pharmacy technicians, community health workers, health educators and home health aides. 

The Engelberg Center for Health Care Reform views this workforce as essential and underutilized team players, important as health systems consider new strategies for addressing health professional shortages, meeting the need for team-based care, and improving quality with lower costs. The center provides a tool kit to support models of success for redesigning the health care team. This resource, Redesigning the Care Team: The Critical Role of Frontline Workers and Models for Success, includes tips, resources and references for new models of teamwork in practice redesign.

Coincidentally, Sean's email arrived the same day I was scheduled to have a conversation with Dr. Kavita Patel, the project lead, and her team, Jeffery Nadel and Mallory West, to discuss this project. Dr. Patel had contacted me to tell me about the frontline effort. It was a great, informative conversation.  And, as I explained the “Nexus’, the concept resonated with her work with front line workers. I really hadn’t thought about it before.

As clinics and practices redesign to incorporate care coordination, huddles and new improvements models, the team roles and responsibilities change. I’ve personally observed workflow in transformed clinics, and to the uninformed, it is like entering a foreign land compared to traditional practices. In one clinic, I observed the front desk receptionist as leading a quality improvement meeting that included physicians, a nurse practitioner, a psychologist, technology manager, among others. For this project, it was essential that the receptionist take the lead because the project involved piloting a new patient scheduling system. It was an extraordinary experience and made me think about how important it is to prepare students and residents who will be rotating and learning in these environments to develop fully the skill sets they need.

Dr. Kavita tells me that even though this workforce is playing an ever-increasing role in care delivery, for the most part, programs that prepare them for practice focus on basic skills rather than incorporating advanced necessary skills, such as care coordination and the context of health care reform. There is a great need for a new “Nexus” between practice and education to prepare frontline workers for their new team roles in care coordination and health care delivery. Additionally, we need to prepare current and future health professionals to accept these frontline workers as full members of their teams.

What made me smile is that my entrée into health care was as a frontline worker when I was barely 21 years old with a freshly minted BA degree. I call this period of my career “my first graduate education” when I learned as an apprentice as an office manager/medical assistant for two internists at Mount Auburn Hospital in Cambridge MA. I was taught many clinical support responsibilities, developed knowledge about managing chronic conditions, learned medical terminology and transcription, and essentially ran the office in a very small practice. I was treated with respect and patience for my capacity to learn and perform team functions. This immersion experience laid the foundation for my “formal” graduate education and led to later faculty roles and academic administration. 

Today we would call my experience “career laddering,” and it prepared me well at the time and for my future. Times have changed; health care is far more complex; and we need to fully embrace all talent to create vibrant teams that include frontline workers, patients, families and communities in order to transform health care in the United States.