Team-based models of care – it’s time to make it work for patients

Thursday, October 29, 2020

‘Providing high quality, co-ordinated care for people with complex chronic diseases is an ongoing challenge' says Alison Verhoeven, Chief Executive of the Australian Healthcare and Hospitals Association (AHHA). 'While the need for team-based models of care has been promoted for decades, our health system is still facing challenges in operationalising them’. 

‘The COVID-19 pandemic has really tested our health system’s capacity to provide person-centred, proactive and co-ordinated care for people with complex chronic diseases. Yet this need to do things differently has demonstrated just what can be achieved when team-based care is enabled. It’s good for patients, good for care providers, and good for the system.

‘Published this morning, AHHA’s new report ‘Enabling person-centred, team-based care’ outlines a plan for implementing person-centred, team-based care in Australia.

‘Teams form around identified patient groups. They take the time to understand the needs of these patients. They work with patients to co-design care models. They use their data to monitor outcomes and continuously improve the service they provide.

‘As a patient's condition changes over time, the composition of the team may change to reflect their shifting clinical and psychosocial needs.

‘However, to implement person-centred, team-based care effectively, action is needed in some key areas:

  • Population health planning and data driven models of care, with practices and services engaged in this process at the local level.
  • Clinical governance, with frameworks that span and link jurisdictional and professional boundaries, and provide local ownership and shared agreement of the care to be provided.
  • A cultural shift towards person-centred care, with purposeful and active inclusion of the patient, family and carers as essential components of the team.
  • Person-centred data and interoperable technology, with the use of indicators and measures embedded in clinical workflows, enabling real-time, shared goal-setting and decision-making with the patient and across sectors.
  • Investment in physical infrastructure, creating environments where teams can share and collaborate.
  • Workforce development, fostering capabilities such as in co-design, data analysis and quality improvement, and technology that supports team-based care, with student placements available to experience how high-functioning teams work.
  • Funding models, which incentivise the use of indicators and measures in routine clinical practice, support participation in population health planning, and provide greater flexibility in how teams achieve the desired outcomes.

‘Amidst the challenging circumstances created by the COVID-19 pandemic, now – more than ever – it is increasingly important for the system to enable teams to effectively come together to meet the unique needs of each patient.’ says Ms Verhoeven.

The report, Enabling person-centred, team-based care, is available here

The Australian Healthcare and Hospitals Association is the national peak body for public and not-for-profit hospitals, Primary Health Networks, and community and primary healthcare services.

Media contact: Alison Verhoeven, AHHA Chief Executive, 0403 282 501