FROM THE EXPERT
SECRETS TO FOSTERING STRONG PROVIDER RELATIONSHIPS FOR OPTIMAL OUTCOMES
BY LAUREL MESSER, RN, MPH, CDE
Optimal patient outcomes hinge not only on high-quality care, but also on seamless continuity of care between the DE and the MD or midlevel provider such as a physician assistant (PA) or nurse practitioner (NP). Building bridges to achieve this goal requires teamwork and a strong infrastructure that includes:
- an office culture that values the unique role of DEs
- cohesive communication
- creative team-building strategies
BUILDING A CULTURE THAT VALUES DEsIt is important to establish an office culture in which patients understand that DEs aren’t just an extension of the physician or midlevel provider. Patients need to embrace the idea that educators have a unique scope of practice with a vital, distinct role in helping them manage their disease. Patients will be more likely to take full advantage of your expertise and guidance once they have a full understanding of this concept. They need to embrace the idea that you are there to partner with them during their lifelong journey of diabetes control. Creating this team-based culture starts from the inside out. When new providers join your team, they should receive formal and informal training about the team-based approach in your office. It must be explicitly communicated that coordinated care involves not just the physician/midlevel provider and the patient, but also the educator, the dietitian, the nurse, and other caregivers working together as a well-oiled healthcare machine. This is a powerful concept that changes the approach to patient care—for the better. While setting a collaborative tone in the practice requires a team approach, you can also directly advocate for diabetes education and your role as a professional. You play an essential role in patient education and care, and it’s important that you—and others—recognize this fact. Your skill set and education benefit patients on every level, and the more your colleagues and patients understand and embrace that, the better. Major care decisions should be made as a team. When members of the caregiving team have a mutual respect for the skill sets and knowledge that each brings, patients are the benefactors. For example, an interdisciplinary approach to evaluating whether a patient should move to integrated pump therapy with CGM should involve input from multiple disciplines when possible: the physician/midlevel provider plus the nurse, dietitian, and/or social worker (all unique diabetes educators!) to ensure that everyone is in agreement. Continuity of care means that important issues are discussed, such as the reasons a patient may be missing shots with multiple daily injections, whether the patient will adhere to more frequent BG checks, lifestyle and health literacy issues, etc. When those issues are identified and proactively addressed as a team, the patient will be much more likely to succeed.
COHESIVE COMMUNICATIONBy communicating a unified message to patients, the DE and MD/midlevel provider provide greater continuity and reinforce complementary aspects of the care plan. As an example, the MD or midlevel provider may have time to check a patient’s labwork, order new bloodwork, and adjust insulin doses. The DE may be able to spend more time using his/her specialized knowledge and skills to assess the patient’s most pressing issues, identify learning needs, and collaborate on care planning. Whenever possible, it is a helpful practice for the MD/midlevel and the educator to have a short “hand-off” in a private area before the other sees the patient. That way, you will know exactly what you are facing and what to focus on before you even walk into the room. Critical information can be shared in just a few short minutes—and you will be armed with knowledge to make the best use possible of your time with the patient. For instance, the MD/midlevel may instruct the patient to do her best to check blood glucose levels 4 times a day. After a brief hand-off to the educator, he leaves to see another patient. The DE can then enter the conversation with the patient and ask: Which 4 BG checks will those be? Where will you be during those times and will you have a meter with you? How will you remember? Which check will be the most difficult to complete? The DE’s education and assessment of patients often includes topics that the MD/midlevel does not have time to address. This time of year, sick day management comes to mind—assessing a patient’s knowledge base and ensuring that theyare educated with the tools they need for vomiting, fevers, ketones, when to go to the ED, and more. When working with pediatric patients, a lot of time may be spent talking about sports routines and how to handle diabetes care—proper storage of insulin, how to exercise properly wearing their device and using a meter, hydration, and other issues. Simply stated, educators can bring diabetes care from a plan on paper to real life. You play a pivotal role in helping patients realistically evaluate goals and how they will actually implement the new steps in the care plan. While MDs/midlevel providers are trained to inform patients of optimal diabetes care practices, educators know how to ask good questions and motivate patient behavior toward these practices. This is the definition of coordination of care—and when all of the moving parts and caregivers are working together to benefit the patient, it’s a thing of beauty.
CREATIVE TEAM-BUILDINGWhen we share our patients’ victories and struggles, it quickly puts us all on the same team. There is nothing like that feeling of someone announcing in the back room that a patient’s A1C came down a full percent, and having everyone clap and cheer and share in that patient’s success. Examples of a team approach that benefit both caregivers and patients include:
- A MORNING HUDDLE: This is where all members of the care team meet before patient appointments to map out the day’s trajectory: Who is taking the difficult cases and what should everyone be aware of? What nuances should be coordinated for specific patients who might be struggling? Who is seeing improvements that we can reinforce?
- WORKING TOGETHER TO BUILD BETTER PROCESSES: The administrative aspects of caring for patients are a reality in today’s healthcare world. Getting input and buy-in from MDs/midlevel providers, DEs, and other staff about office processes and efficiencies benefits the team and patients. For example, when customizing an electronic medical record (EMR) system, both DEs and MDs/midlevel providers should be consulted about how to best set up the templates for patient visits. You may want to consider a designated section for DEs to complete and one for MDs/midlevels to complete. This allows both to focus on their areas of expertise and highest priority aspects of care. It also allows educators to better demonstrate and track the work they are doing with patients.