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background resources in PDF |
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some CAM/IM publication links |
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Speed-Dating: Casey Health Institute Method for Building a High Performing Integrative Team |
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Written by John Weeks
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Speed-Dating: A Casey Health Institute Method
for Building a High Performing Interprofessional, Integrative Team
This resource was
developed through a partnership between the Project for Integrative Health and the Triple Aim (PIHTA) and the Casey Health Institute (CHI). The goal of the PIHTA-CHI partnership is to
stimulate understanding of integrative primary care medical homes (PCMH) via a multi-faceted look at the model CHI is creating. PIHTA is an initiative of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC).The partnership has media support from the Integrator Blog News & Reports.
.jpg "Image") Modeling an integrative PCMH
"I think a lot of integrative
practitioners are focused on proving that each individual modality is valid.
The power in integrative medicine is team-based collaboration. I think we will
blow values-based metrics out of the water with our outcomes using a team-based
staff model of care."
Fogel and his co-founder Ilana
Bar-Levav, MD are seeking to model, for the nation, a successful integrative patient-centered medical home (PCMH) that hits on all of the Triple Aim cylinders: better patient experience, better population health, and lower per capita costs.
 Co-founders: Bar-Levav and Fogel
The challenge remains: how can CHI take this multi-disciplinary staff - 4 primary care integrative medical doctors,
1 nurse practitioner, 2 licensed acupuncturists, 1 naturopathic doctor, 2
psychologists, 1 Reiki master/massage therapist, 1 Yoga therapist, 1
nutritionist, and 1 nurse care coordinator - and develop the collagen to fuse these into a quality interprofessional team?
For starters, by design these practitioners work out of a shared "team
room" at the hub of the clinic to foster interprofessional exchanges. Yet all are busy, caught up in their individual care duties. A core strategy at CHI is a surprising sort of multidisciplinary cross-fertilizing: match-making, on the one hand, and medicine and health, on the other, with a foundation in a grass-roots soft-technology for low-cost therapy. Perhaps this pioneering method will be useful to others.
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Speed-Dating in Building High Functioning Clinical Teams:
A Multi-Disciplinary CHI Strategy to Enhance Interprofessional Care
Wikipedia describes speed-dating as "a formalized matchmaking process of a dating
system whose purpose is to encourage people to meet a large number of new
people." Prospective partners sign-up to meet at a common venue where they are
"rotated to meet each other over a series of short ‘dates' usually lasting from
three to eight minutes."
At CHI, clinical leaders chose to apply this emerging social technology to their central mission of
team-building. This is information on how it is structured, and some outcomes.
.jpg "Image") Nicole Farmer, MD: interviewee
When: The hour set is every Thursday morning between 9-10 AM,
immediately following CHI's regular 60 minute staff meeting. The time is protected. The
clinic meeting always transitions from staff business to the speed-dating on the hour. All
practitioners participate, from medical doctors to yoga therapists. CHI began
the practice in early fall of 2014. Because all staff are all salaried, participating
is part of what they are paid to do.
Method-Ideal: Each practitioner
picks a partner to start. The dyad has 4-5 minutes together. There are elements of
co-counseling built in. Optimally, each practitioner has a chance to listen about the other's clinical issue
or patient question for 2-3 minutes. After the 2-3 minute mark, the two switch roles and the second presents an issue while the first listens and offers feedback and ideas. This is repeated multiple times with different
partners during the 60 minutes.
 Partnered with CHI on the IHM-PCMH initiative
Method-in-Practice:
Often one patient or case will take the whole
4-5 minutes and the dyad will not have a chance to switch and let the second introduce a case or question. Similarly, the process creates moments when the discussion grows rich and the two practitioners will ask the other clinicians if they can stay in the same dyad for a second
round in order to finish up something. Says Farmer of the rules for the process in the Thursday morning speed-dating session: "Sometimes we do cheat." (I made a mental note that "cheating" in speed-dating is to stay with your partner.)
Continuing
Dialogue Post Thursday Session: Often, according to Farmer, practitioners will seek each other out after the Thursday session to continue an exploration that left additional questions or thoughts. Farmer appreciates the value of the built structure in which the clinicians work when they are not with patients: "It would be frustrating if we didn't
have the team room." Sitting together, without separating cubicles, facilitates ongoing dialogue if a case needs more
time. Farmer: "These (speed-dating sessions) often produce longer conversations." Then she admits to the curiosity and intrigue that can be stimulated in this interprofessional learning: "We have to police
ourselves. The hours for collaboration can take over!"
Impact on Care? I ask Farmer the basic Triple Aim-type question: sure, it may be a pleasure and interesting for the practitioners, but how are the outcomes for patient care? Farmer responds:
"This has a huge impact. I
frequently will change a treatment plan."
An Example: Learning the Language of the Other Farmer offers an example of value: "Just today I made a point of getting time with the yoga
therapist. I had a new patient at 10:00 and I ended up asking the yoga
therapist to come into the visit with me." She backs up a moment to explain that one particular skill
that she gleans from the speed-dating is that often "it teaches me how to speak
the language of the other [practitioner] when I talk to my patients - this is a major value, teaching me to speak the language of the other professions." Instead of just saying,
for instance, that yoga therapy could be useful for the patient, Farmer learned from the yoga therapist to say that "there is a way through yoga poses and breath work to release the constriction around the diaphragm that will affect the constriction of the esophageal sphincter and get fresh blood to circulate in the abdomen." The more precise language helps both practitioner and patient understand the basis of potential referral.
 Sponsor of the PIHTA project
Possible Value in
Non-Integrative Health and Medicine Settings: The CHI setting is integrative. But would the method be as valuable in a regular PCMH, for instance, or in a hospital environment that has no integrative practitioners? Farmer reflects: "Even if you take out the
integrative component - just the team building - I think this is a great way
for an FQHC [Federally Qualified Health Center] or PCMH to think, for instance, about how to bring in a new
practitioner." Everyone can have a brief moment to learn where teaming
with the new practitioner might be useful.
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Comment: Breakthroughs are famous for coming through surprising and even accidental connections of information and practices from disparate
disciplines- such as engineering and medicine, for instance. Here, to elevate to intervention status a modality and practice that is a growing part of mating rituals in the internet-infused world, CHI merges the "discipline" of speed-dating with the
provision of primary care. In-laid is co-counseling. Three-in-one, then. Brilliant.
Whole person practitioners may recoil from the speed-dating technology's requirement to distill the human being and multiple contributors to a given health situation into a two minute discussion. Yet in truth the practice of synopsizing quickly will serve them in other referral environments - whether via phone message, e-note or quick call. And in the CHI situation, whether in the shared clinic room or hallways, the multiple small fires of interprofessional engagement kindled in 60 minutes every Thursday morning will certainly warm the exchange, and patient care, throughout the week and months ahead. If full-functioning teams are what are desired, this method seems a terrific tool.
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