Team-based care: who’s on my team?

There are more than 250 different health professions according to one source,[1]  though I would be hard-pressed to list that many.  I do know that the healthcare workforce is diverse and the professions within it have many different roles and responsibilities.  Each person during their lifetime will interact with several of these professions, the number typically increasing with one’s age.  Sometimes professionals work together in teams but, as I describe in this post, teams vary in their membership, and ways of working.  Some may not even function as teams according to accepted definitions.  Healthcare providers refer to team-based care but what does, and should, that mean?

The photograph is of my father who died in 2018 age 93.  Up until the last few months of his life in the UK he was living independently in an apartment that enabled him if necessary to call for help through a personalised alarm system.  He walked each lunchtime to a local pub (hotel) for a meal and did most of his own shopping, with my sister, who lived nearby, helping when necessary.  

His healthcare was provided by his local general practice (family medicine clinic) including his GP of many years, the practice nurses, community nurses, a pharmacist and a podiatrist.  He also had regular interactions with an optometrist and a dentist locally, and less frequent appointments with a doctor in elderly medicine and an ophthalmologist at the hosptial, all of whom he knew by name and responsibilities.  

His main health condition was chronic obstructive pulmonary disease (COPD), a lung condition causing difficulty breathing, usually caused by smoking but in his case due to tuberculosis (TB) as a young man in the 1950s.  My dad spent one year in a sanatorium taking the fresh air treatment and then had an operation in which his chest was opened to permanently collapse one half of the lung that was infected (known as a thoracoplasty):  a drastic remedy that saved his life but left him prone to chest infections which increased in frequency in his older age.  

When his breathing worsened, he went to the nearest emergency department where he interacted with a triage nurse, and then doctors, nurses, and radiographers, none of whom he knew, and some who didn’t explain fully their roles or responsibilities.  When admitted to a ward, he would be in the care of a consultant (senior) doctor, whom he might have met before, and other nurses, doctors and healthcare assistants, plus visits by a physiotherapist, nutritionist and sometimes a social worker.

So, who was part of his healthcare team?

My father’s story (now sometimes referred to as a patient journey) will be familiar to many – consumers and health professionals alike.  

Team-based care can be messy and complex – and difficult to explain to consumers and learners.  

Let’s think of the team at the general practice surgery – also known as the primary care team.  The make-up of this team is similar for each patient in the practice, and members have worked together for many years.  Team members know each other and are likely to trust each other.   Ideally, communication should be relatively easy as the professionals are co-located for at least some of the time.

The other community-based and clinic-based health professionals may be considered part of a wider team communicating to varying degrees with the central primary care team.  Patient interactions are more episodic. Each patient has different needs and therefore team composition will vary for each patient.  Is this a team or a wider collaboration? 

In hospital, there are many overlapping teams whose members rotate in and out, where health professionals in training change frequently and lines of leadership can be blurred.   My father may have been allocated to a multidisciplinary team (MDT) when his health started to deteriorate, and he was admitted following a fall.  Here (but not always) discipline means profession and refers to the different health professions on the MDT.  An MDT’s composition may vary depending on the needs of an individual patient, but some have a stable membership.  One example of a usually well-functioning and stable MDT is a palliative care team, which looks after people who are in the latter stages of a terminal illness. 

How does a patient and the family or other carers navigate amongst these teams? Who is in overall charge?

And how do health professional educators ensure that students and recently qualified health professionals understand the complexities of their health care system and the relationships within it? One way is through interprofessional education.

See my page:

In a later post I will explore the definition of ‘team’ and other ways of describing healthcare practice in action. 

Note: My father’s story is based in the NHS of the UK.  There are a lot of similarities with Australia, New Zealand, and other well-resourced countries.  I acknowledge that in some parts of the world there may be only one or two healthcare workers available for some populations due to resourcing issues and cost amongst other factors. 

[1] Jensen CB. The Continuum of Health Professions. Integr Med (Encinitas). 2015;14(3):48-53. PMID: 26770147; PMCID: PMC4566463.

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