Vegas Baby, Vegas
How Primary Care could learn a thing or two about team based care from Palliative Care and vice versa.
My family and I love Easter. It’s not often we get a four-day holiday and our family likes to take advantage of this time together to visit a new city in North America.
This year, we went to Las Vegas, Nevada. Our son is a huge fan of Battlebots on Discovery Channel. Robots Activate!
I have been to Vegas before but this will be the first time for my wife and son. I certainly look forward to introducing them to “the Strip” but also taking in a Golden Knights game and even a Maroon 5 concert (my wife’s favourite band).
My son still has no idea what a pay phone is.
Being in Vegas, I can’t help but think of Ocean’s Eleven.
Directed by Steven Soderbergh in 2001, it follows conman Danny Ocean and his team as they plot and execute a plan to rob not one, not two, but three Las Vegas casinos in a high stakes heist of epic proportions.
While most people know the stars of Ocean’s Eleven – George Clooney, Brad Pitt, Matt Damon – the supporting is also stellar in their own right. Don Cheadle is outstanding as Basher Tarr, while Julia Roberts and Andy García steal the scenes they’re in.
So, what does this have to do with palliative care in Canada, and Ontario for that matter?
Results from a recent OurCare national research survey of more than 9,000 people in Canada demonstrate strong support for team-based primary care.
I fully support the notion of team- based primary care and the many recommendations that came out of the OurCare survey.
So what can Primary Care learn from Palliative Care when it comes to team-based care, and vice versa?
Dame Cicely Saunders, credited with starting the modern hospice palliative care movement, was a physician, nurse and social worker. She was basically her own team! This clearly is not a realistic solution in today’s modern medical system but she recognized early on that patients with a life limiting illness required a team to care for them.
Dr. Eduardo Bruera perfectly shows this in his diagram:
Like primary care, team-based care should be the standard of care for patients facing a progressive, life-limiting illness.
I have written previously about issues surrounding training and health human resources in the field of palliative care. Currently palliative care training is not mandatory in many/most medical residency program and training positions for palliative care specialists are limited, not only in Ontario but across Canada. The same holds for schools of nursing, social work and so on.
Thee members of the interdisciplinary team includes but is not limited to: Pharmacy, PSW, PT/OT, RT, Spiritual Care, SLP, OT and even Psychiatry to help address severe mental health and addiction issues.
An excellent model for team-based care already exists in Ontario. Family Health Teams (FHTs) have been in existence since 2005. Modelled off the Patient Medical Home (PMH), FHTs provided team-based primary care to patients. I have previously written about our clinical model in Windsor, which is roughly based off the PMH and meets all the criteria for one.
Why not apply this model to all palliative care specialist teams?
While a great deal of emphasis, and rightly so, has been placed on building up primary level palliative care capacity (this includes primary care but also non-specialists such as oncology, nephrology, etc), perhaps more emphasis needs to be put on building up and organizing secondary level capacity simultaneously.
I have written previously about the opportunity to transform our health care system following the COVID-19 pandemic. But we must resist the urge to settle back into comfortable designs and constructs. Build Back Better?
A team is more than a group of individuals who work together. A team trains together. They learn together. They can anticipate each other actions.
A team is more than just the sum of its parts. Just ask the 2003/04 Arsenal Gunners. Also known as the “Invincibles” who ran the English Premiership table by not losing a single game.
Even robots are getting in on the action. A recent Wall Street Journal article highlights the synergy between teamwork and robotics, highlighted by something known as “RoboCup.”
“Robocup’s stated goal is to develop a team of fully autonomous robot soccer players capable of beating a human team by 2050.”
Look out Arsenal.
Healthcare providers who work together certainly collaborate. But a team has that special “Je ne sais quoi” or secret sauce that is the key.
For those interested in teamwork in medicine, I strongly recommend Dr Brian Goldman’s book “The Power of Teamwork.” The host of CBC’s “White Coat, Black Arts” writes both an entertaining and informative treatise on teamwork.
From CBC: “His latest bestselling book, The Power of Teamwork, explores how a team approach to medicine can improve more than our health-care systems. From more effective customer service to improving the performance of professional sports teams and even helping women break the glass ceiling, the teamwork mindset is shifting our culture.
Teamwork is the road to better job satisfaction in health care, safer culture, fewer mistakes, higher productivity and a greater sense of joy and ecstasy in your everyday work. And you don't have to work in health care to benefit from this," said Dr. Goldman, who wrote his latest book during the pandemic.”
A study by KPMG for Palliative Care Australia demonstrates that the provision of palliative actually saves money in the health care system. These savings are not due to the rationing or denial of care, rather, these savings accrue through more appropriate use of resources. Patients receiving team-based palliative care are much more likely to be care for in “the right place, at the right time.”
Shifting to team-based care is going to take hard work, coordination and collaboration. There will be setbacks and seemingly impossible obstacles to overcome. But that is what good teams do.
“Life won’t be the same post pandemic. End-of-life and palliative care shouldn’t be either.”
- Dr. Pamela Liao Ontario Medical Review
So if a team like Ocean’s Eleven can pull off the heist of a century, maybe Canada can become the model for team-based care in both Primary and Palliative Care.