Integrating and coordinating Integrating and coordinating a team of practitionersa team of practitioners

Reine DuBoisDr Nick BassalDr Anne Small

OutlineOutlineTeam structuresBenefitsPhilosophyEssential elements for a cohesive

teamWorking models of IMCommon pitfallsClues on avoiding them 

Wholistic Medical CentreIn Sydney, opp. Central Railway

station Established in 1977 10 consultation/treatment rooms 4 dispensaries Treated over 47,500 individuals. Over 582,500 consultations and

treatment sessions Rented premisesPty Ltd – co-operative structure

Moonee Ponds MindBody Health Moonee Ponds MindBody Health Centre - Centre - Established 1996Established 1996

Sole ownership – expansive Beautiful space - energetically designed

by experts in Feng Shui, Sacred Geometry & Geomancy.

Think it is the largest Centre in Australia.15 consulting rooms.Treatment room.Reception area.2 meditation areas/one used for

weekend workshops.

Moonee Ponds MindBody Moonee Ponds MindBody Health Centre - Health Centre - Established Established 1996199614 practitioners - all part timeDoctor x 2Psychologist x 2Osteopath x 1Masseur x 1 and Myotherapist x 1Acupuncture x 2Kinesiology x 2Naturopath x 1Bio Mechanist x 1Shiatsu practitioner x 1

Working models of IMWorking models of IMTwo IM models

◦North Coast Medical Centre Model Shared records Corridor ‘catch-ups’ Combined consultations Out-patient – sole ownership

◦Byron Integrated Health - Hospital Model Team coordinator Scheduled meetings Team decisions United treatment plan In-patient – company structure

Common Pitfalls 1Common Pitfalls 11. Patient undermining team

members2. Practitioners undermining other

practitioners3. Practitioners not making time to

attend group meetings4. Practitioner believing their

modality is superior5. Solo practitioners having difficulty

working in a team environment 6. Team decision-making can be

time consuming

Common Pitfalls 2Common Pitfalls 2

1. Not covering costs2. Inequitable sharing of overheads3. Large No. of very P/T practitioners 4. Practitioners remaining separate

5. Lack of inter referral 6. Large turnover of practs. or staff

Common Pitfalls 3Common Pitfalls 3

1.1. Whatever your fears, they will Whatever your fears, they will manifest !manifest !

2.2. Cycles of crisis and stabilityCycles of crisis and stability3.3. Destructive practs. or staffDestructive practs. or staff4.4. Everybody treating everythingEverybody treating everything

Essential elements for an Essential elements for an integrative team integrative team

Shared philosophyShared philosophyWillingness to follow team decisionsTrustEqualitySharing a common languagePatient centred care as opposed to

an ownership approach to the patientUnderstanding of another

practitioner’s scope of practice, their competency and their safety, supports interdisciplinary referrals and an integrated approach

Team collaborationTeam collaborationHave a functional model

combined consultationsGroup meetings

Common goals Clear therapeutic priorities Draw effective conclusions Implement treatment plan Monitor efficacy

Operational systems in place to assist with communication between practitioners

Shared medical records (confidentiality must be considered) especially important for psychologists

Scheduled meeting times

Practitioner to patient Practitioner to patient communicationcommunication

Patient must get a sense that practitioners are working closely together

Provide a consistent and non-contradictory team approach

Information given to the patient must be summarised before being presented to the patient

Patient can access their individual practitioners easily either virtually or physically

How to Avoid ThemHow to Avoid Them1.1. Start small with core of strong practs.Start small with core of strong practs.2.2. Contributions need to reflect earningsContributions need to reflect earnings3.3. Minimum of 3 sessions per week Minimum of 3 sessions per week 4.4. Shared health record Shared health record 5.5. Build and support a team culture Build and support a team culture 6.6. Support practs. to succeedSupport practs. to succeed7.7. Look after good staff, really wellLook after good staff, really well8.8. Emailing staff meeting minutes Emailing staff meeting minutes 9.9. Information about social events Information about social events

More Clues

1.1. Choose new members on theirChoose new members on their personhood not their CV personhood not their CV

2.2. Deliver ‘courageous conversations’ Deliver ‘courageous conversations’ earlyearly

3.3. A smaller No. of strong practs. A smaller No. of strong practs. RatherRatherthan a large No. of mediocre practs. than a large No. of mediocre practs.

4.4. Encourage focus areas and focus Encourage focus areas and focus sub-teamssub-teams

More Clues More Clues

5. Encourage each practitioner to have a free consultation with every other practitioner.

- know how each practitioner and their therapy works.

- know when to refer.- try to have this all organised

within the first 3 months

In Summary …

1.1. I now couldn’t practice any I now couldn’t practice any other wayother way

2.2. I am still learning and loving I am still learning and loving what I dowhat I do

3.3. I would do it all againI would do it all again