Challenges at the Intersection of Team-Based and Patient-Centered Health Care

TEAM-BASED HEALTH CARE MAY HELP THE UNITED STATES achieve improved health and improved health care at asustainablecost. It iscentraltomanyreformsofhealth care delivery, both actual and proposed. Team-based carecanoccur inmanysettings (eg,home,office,hospital); focus on different problems (eg, specific diseases); and include teammemberswithavarietyofbackgrounds.Healthcareteams can be large or small, centralized or dispersed, virtual or faceto-face, and their tasks can be focused and brief or broad and lengthy.Thisextremeheterogeneity in tasks, foci, andsettings presentsachallengetodefiningoptimalteam-basedhealthcare. Recently,we ledaworkinggroup—ateamcomprisingapatientadvocate,physician, registerednurse,physicianassistant, social worker, and pharmacist—convened by the Institute of Medicine(IOM)toexplorethefoundationsofteam-basedhealth care. The background work included structured discussions with high-functioning teams from a variety of settings, which revealedthatsuchteamsareguidedbyasetofsharedprinciples and values that can be measured, compared, learned, and replicated (BOX). These principles and values are seemingly straightforward. But considering the realities of implementation and spread of team-basedcarealignedwiththeseprinciplesandvaluesraised difficult issues—3 of which deserve focused attention.