Blog Post

Multidisciplinary care takes trust and communication. Here are 2 ways to build it.

By Sebastian Beckmann

October 13, 2020

    Many organizations see multidisciplinary care as a path to better patient outcomes. That's no surprise: Cross-specialty care teams are proven to help ensure appropriate treatment and can drive program growth by meetings patients' demand for coordinated care.

    The solution to rising spinal fusion rates? Multidisciplinary care.

    However, organizations often struggle to get multispecialty care teams off the ground. Spine leaders, for example, commonly design clinical triage protocols and care pathways that are never ultimately used.

    Programmatic elements like these are important to building a multispecialty program, but a culture of open communication is what enables you to implement and use them. Since multidisciplinary programs require building collaboration and overcoming competition between providers that historically operated in siloes, planners can't neglect the need for a communication strategy to underpin their efforts.

    Before you hammer out your program's clinical protocols, consider these two tactics for building the communication and trust that are the bedrock of a collaborative care team.

    1. Understand—and account for—your stakeholders' different needs on an ongoing basis.

    Before you design your program, engage your stakeholders in a dialogue about their goals and preferences for the new structure. The need for a unified approach is often less clear to disparate providers who have their own objectives and obligations to patients, than it is to planners. Primary care  providers, for example, want clear referral processes and patient triage that often leads to non-operative treatment. Surgeons would like to maintain their preexisting referral relationships and see a higher percentage of surgical candidates. Understanding these goals from the outset enables you to make a targeted argument that central management will help your stakeholders achieve their goals.

    It also lets you get ahead of providers' pushback by accounting for their needs in a program's design. Successful organizations have done this by establishing a multidisciplinary steering committee and programmatic subcommittees—which comprises the providers themselves—that meet regularly to design and oversee the program's protocols. The committees should remain active after the program has launched to keep lines of communication open and ongoing.

    Some organizations take an even more active approach. Penn Medicine, for example, has held over 40 "roadshows" with its primary care groups to identify their desires for Penn's multispecialty spine program. These meetings gave PCPs a forum to share their challenges with the referral process and voice their desire to protect preexisting referral relationships from centralized triage. Based on this feedback, Penn consolidated its spine consult orders to ease the referral process for PCPs. It also allowed PCPs to refer patients to physicians by name, which was key to securing physicians' support. Penn continues to hold roadshows to keep its physicians engaged with process improvement on a continuing basis.

    2. Make your communication as data driven as possible.

    Data should color your communication to ground your discussions in evidence. To start, tailor your argument that a unified approach is needed by using data to show the limitations of the current care model. Virginia Mason Medical Center did this by identifying high complications for complex spine patients as the motivation for holding weekly, multidisciplinary spine conferences to assess the appropriateness of surgery.

    Then use data that proves the initiative's effectiveness to help cement providers' support once the program has launched. Virginia Mason touts its threefold decline in complications—from 52% to 16%—as proof that its spine conferences helped achieve the shared goal of improving quality.

    This sort of regular data-sharing can help prevent competition for volume between specialists that provide similar services. Penn Medicine, for example, distributes appointment volume by department to its spine providers each quarter to show that each specialty is benefitting from the volume growth that the multidisciplinary program has generated.

    Ultimately, unlocking the growth potential that multidisciplinary care offers requires that you focus on building collaboration as much as on building the program’s protocols themselves.

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