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Speed-Dating: Casey Health Institute Method for Building a High Performing Integrative Team PDF Print E-mail
Written by John Weeks   

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.

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Modeling an integrative PCMH
"We're spending enormous time and effort to get highly-coordinated processes down to operationalize true collaborative, integrative health."
The comment was made by Casey Health Institute (CHI) co-founder David Fogel, MD in Casey Health Institute: Marrying Integrative Health and Values-Based Medicine in the June 2015 Integrator Round-up. Fogel continued with a provocative assertion:
"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.

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Co-founders: Bar-Levav and Fogel
Fogel shares that the core work is "creating highly functioning teams." Leveraging practitioners out of their siloed, habitual ways of treating patients can seem to require crowbars. One critical choice to support team building was CHI's decision to follow the Mayo Clinic and classic staff model HMO strategy of employing all practitioners. This breaks the perverse incentives that come from each practitioner seeking to maximize income via their own care and procedures. More on this theme another time.

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.

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Nicole Farmer, MD: interviewee
Background on the interviewee
:
The information below is based principally on an interview with Nicole Farmer, MD, one of CHI's integrative medical doctors. I asked Farmer about her interest in integrative medicine: "Like a lot of doctors, I was drawn for a personal health issue." Her husband had multiple sclerosis and "was not benefiting from conventional treatment." Then, recalled Farmer, "we started doing candida diet and saw improvements." Farmer "took a (professional) leap" in 2009 and chose to begin preparing to enter the University of Arizona Fellowship in Integrative Medicine which she completed in 2012. "That was wonderful," said Farmer, "like going to medical school another time - I learned a lot, formed a lot of relationships." She adds that, now in integrative practice, she now "felt compelled to be a part of AIHM (Academy of Integrative Health and Medicine)."
 
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.

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Partnered with CHI on the IHM-PCMH initiative
Preparation for Speed-Dating
: Farmer, one of CHI's four integrative medical doctors, says she keeps a note on her desktop throughout the week on which she adds to a list of ideas that she plans to bring up in what she calls the "speed huddle." Sometimes she and others will enter the speed-dating hour with clinical notes on a particular patient of interest, or will enter with a specific other practitioner in mind. Typically, however, the sharing "does not include any notes or prompts."

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.

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Sponsor of the PIHTA project
Challenges in Application of the Speed-Dating Method
: Farmer says that the practitioners who are "more holistic" and who have a more "energetic" approach in their practices may not get to fully explain the depth of their evaluation of a patient during such a short period of time" in the speed-dating set-up. She suggests this may be true with, for instance, for particularly the clinical psychologists, health coach, and yoga therapist. In truth, Farmer says that the tight time-frames for exchanges can be challenging even for the holistically-minded, allopathically-educated providers, given their desires to treat the whole person, and to have the individual fully understood by the other practitioner.

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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