In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices
In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices
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DOI：
10.1370/afm.1531
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发表时间：
2013-05-01
影响因子：
4.4
通讯作者：
Bodenheimer, Thomas
中科院分区：
文献类型：
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作者：
Sinsky, Christine A.;Willard-Grace, Rachel;Bodenheimer, Thomas
我们强调从高功能的初级保健实践中收集的初级保健创新，我们相信这些创新可以促进喜悦的实践，并缓解医生的职业倦怠。为此，我们实地访问了23个高绩效的初级保健实践，重点关注这些实践如何在团队中分配职能，利用技术优势，通过数据改善结果，并使初级保健工作作为一生的职业可行和愉快。确定的创新包括(1)主动计划的护理，包括探访前规划和探访前实验室测试；(2)在团队之间共享临床护理，扩展了住宿协议、常备订单和小组管理；(3)通过协作文档(手写)、非医生订单输入和简化的处方管理共享文书任务；(4)通过口头消息和收件箱管理改善沟通；以及(5)通过托管、团队会议和工作流程图改善团队功能。我们的观察表明，从以医生为中心的工作分配和责任模式转变为共享护理模式，每个医生拥有更高水平的临床支持人员，以及频繁的沟通论坛，可以产生高功能的团队，提高专业满意度，并在实践中更多地使用喜悦。
We highlight primary care innovations gathered from high-functioning primary care practices, innovations we believe can facilitate joy in practice and mitigate physician burnout. To do so, we made site visits to 23 high-performing primary care practices and focused on how these practices distribute functions among the team, use technology to their advantage, improve outcomes with data, and make the job of primary care feasible and enjoyable as a life's vocation. Innovations identified include (1) proactive planned care, with previsit planning and previsit laboratory tests; (2) sharing clinical care among a team, with expanded rooming protocols, standing orders, and panel management; (3) sharing clerical tasks with collaborative documentation (scribing), nonphysician order entry, and streamlined prescription management; (4) improving communication by verbal messaging and in-box management; and (5) improving team functioning through co-location, team meetings, and work flow mapping. Our observations suggest that a shift from a physician-centric model of work distribution and responsibility to a shared-care model, with a higher level of clinical support staff per physician and frequent forums for communication, can result in high-functioning teams, improved professional satisfaction, and greater joy in practice.