A New Efficiency Challenge– 

Health care teams function best when all team members are at the top of their game


Much has been written about having to become more efficient as a health care industry.  Reform and transparency initiatives are catalyzing the delivery of health care resulting in better outcomes, better satisfaction and less cost.  Processes are being improved throughout the industry and are achieving excellent results.  We are beginning to truly show Value to consumers.

Today I would like to address a subtler component of this process–the need for each team member to function at the top of the game.  Specifically, this is a somewhat euphemistic way of dealing with a very touchy and controversial issue:  Maximizing the scope of medical practice for all of the care team members.

This topic is sure to bring a host of very strong opinions and I am bound to get a lot of push back.  Hospitals and professional societies deal with conflicts in this area on a regular basis. Caregivers can be very emotional about the issues of scope.  Also, as a health care team we must protect the patient against any possible incompetency or misuse of medical skills.

First of all, we need to acknowledge that health care in the 21st century has appropriately evolved into a health care team… No one individual, especially the physician, can possibly be responsible for the entire spectrum of care that a patient would receive.  Individualistic thinking by any member of the team could be counterproductive.  Medicine is simply a team effort.   Now, how do we maximize the functioning of this team?

It is obvious to me that the best functioning of any team occurs when each team member can contribute the most to the overall benefit of the patient based upon the training and abilities of each of the individuals.

The health care community and consumers need to encourage the most efficient use of each team member.  The roles of non-physician team members must be maximized.  The physician should be able to delegate as much responsibility to the individual team members as possible.   There are two critical stipulations:

1.  The health care professional needs to be appropriately trained and currently competent for the particular issue

2.  There must be adequate protocols and procedures in place that are state of the art for that provider to use.

As long as these two criteria are met, the physician, and most importantly the patient, can feel comfortable that the appropriate care is given at the appropriate time by the appropriate personnel.

Also, let’s acknowledge that many of the disputes involving scope of practice are based more on revenue potential than true inability to perform the particular procedure.  Are we focusing on preserving quality or preserving revenue? Let’s not be distracted and refocus back to the two criteria I listed above.


We also need to stop using the term “mid-level provider” when referring to nurse practitioners, physician assistants, etc.,.  First of all, I am not sure what that word actually means, and at best it sounds pejorative.  Why not simply use the expression “non-physician providers”, or simply call them by their rightful titles?

By the way, the issue of maximizing scope does not simply exist between physicians and non-physicians.  Anyone involved in hospital credentialing and privileging will readily recognize how often these issues come up between specialties.

Bottom line, we need to encourage all members of the team to practice at the top of their license and the top of their competency.  Rather than fight over individual turf we need to work together through protocols and processes that encourage efficiency and good quality of care.

Let’s work together on this…. Health care delivery is a team sport.  The best results are achieved when each team member is at the top of the game.  Let’s encourage this process.  In the end, the entire team will become more efficient and deliver better care.

Efficiency is not simply providing Value… quality, satisfaction and cost reduction… it requires each member of the team operating as efficiently as possible.

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