Geographic or specialty teams: Which is best?
Use these tips to decide
Some hospital-based home care providers have organized their field staff into either geographic or specialty teams to reduce the cost of providing care and to increase nurses' and aides' efficiency.
Both types of teams have their defenders, but how can hospital-based home care company administrators know which type of team is best for their companies? To find out, administrators must examine their patient mixes and the geographic areas they serve, say agency managers who use geographic or specialty teams.
Here are some tips on which type of team to use and how to implement them:
* Look for excessive travel time used by field staff.
Daily mileage beyond 50 miles for a field worker may be excessive and could result in inefficient use of employees' time, home care administrators say. Tammy Killebrew, RN, BSN, agency manager at Seton Medical Center Home Care in Austin, TX, says her company considered it inappropriate for all employees to work throughout the 50-mile radius catchment area. She says four geographical teams were set up, and later improved locating field staff in zones near or en route to their homes.
"Nurses want to spend time attending to their patients and not driving around. The less travel they do, the more time they have for their patients," Killebrew says.
* Look at the area over which your operations are spread.
Small and compact areas often are more favorable for specialty care team formats, while operations in widespread areas are more suited to geographical team formats, administrators say. Small areas of operation need not be subdivided, and hence would be best suited for specialty teams if there is an adequate patient population to justify the investments.
* Examine your company's recent growth patterns.
After rapid growth in business over recent years, Sacred Heat General Hospital Home Health Services in Eugene, OR, decided to organize its field staff into multidisciplinary geographical teams to make the company's size more manageable. The area the company covered was too vast and patients too numerous to have all of the field staff covering the entire area.
"We quadrupled in size within a period of four years, and decided it would be more efficient to divide up the field staff into teams," says Juliana Schlessinger , RN, a field team supervisor at Sacred Heart.
The product of the restructuring was four multidisciplinary geographical teams working the division's 64-mile radius in Lane County, OR. Schlessinger says communication between and among the teams is much better, and care providers are drawing more satisfaction from the new format because traveling time was drastically reduced.
For Community Medical Center Home Health and Hospice in Toms River, NJ, specialty teams were set up early in the 1990s. But the teams proved to be too focused and inflexible after a period of high growth expanded the company's average patient census and geographical area, says Harriet Werkman, BSN, MSN, MHA, CNAA, the company's director. In response, the company transformed its specialty teams into geographical teams.
"After the restructuring, were able to increase productivity by being more general," Werkman says.
* Understand your patients' demands.
Where the layout of the area is not a crucial factor in deciding between the two care team formats, patient needs may be used to decide which is best. In areas where the demand for specialized care is high, specialty team formats are the best solution. For home health firms operating in small urban environments with high population densities, or in small areas with high referral levels, specialty formats would also be appropriate.
If both the area of operations and patient demands are crucial factors, Killebrew proposes the creation of geographical formats coupled with cross-training of field nurses. That approach, she says, has worked well for her company.
* Don't forget to focus on patient-nurse continuity.
Patients like to see the same nurse or home health aide providing them care. Schlessinger points out that Sacred Heart's home care agency was very large and the division into geographical zones gave both sides "a sense of a family within a family."
Once you have considered those factors, you need to plan how to make the change to specialty or geographic teams. The first steps taken towards the restructuring process determine how existing staff will view the entire initiative, and in some cases, the program's success or failure. Here are some tips on how to maximize the gains from changing to geographic or specialty teams:
* Involve the entire staff and do so as early as possible.
Your plan for restructuring field staff into geographic or specialty teams should have input from everyone who will be affected by it. Involve the entire staff in the process right from the beginning, says Toni McClay, BSN, the administrator at Memorial Hospital of Salem County Home Health and Hospice in Pennsville, NJ.
"Recruit as many of them as possible into work groups which hold brain-storming sessions on a regular basis," she says.
Killebrew adds that your staff members must be able to recognize the need for change.
* Maintain an effective communication system.
Good communication between management and staff is vital both during the change to teams and after. It is imperative that the field staff are kept abreast with what the management is doing, administrators say. As new decisions are taken, field teams should be able to discern the impact of such changes upon their operations and on the general objective of delivering quality care, administrators say.
* Use these steps to implement a geographical team format:
-- Look at the natural layout of your area, says Schlessinger. She and her colleagues at Sacred Heart serve a large area and used a map to come up with the geographical zoning. There was a river flowing across the area from east to west, and a major road running north to south, which served as sector dividers for teams.
-- Schlessinger also points out that when splitting a geographical region into team zones, such factors as the location of senior citizens residential areas or retirement homes, which generally produce higher number of visits, need to be considered.
Killebrew says her company used a different process to arrive at the same results. The area of operations was split into four zones using zip codes and the volume of referrals and admissions in each zip code.
"We tried to make sure that each area had the same or similar number of admissions," Killebrew says.
-- Staff your teams according to the needs of their zones' patients. Most of the home care companies interviewed had field teams of between three to ten nurses, and two to five home health aides. Depending on a geographical area's patient characteristics, the team would be composed of general home care nurses, hospice nurses, infusion nurses, and occupational and physical therapists. Social workers and home health aides are necessary, even though they operate on an as-needed basis. Where teams were more specialized, nurses specializing in pediatrics, cardiovascular therapy, speech therapy, and maternal child/high-risk pregnancy are also included.
Follow 3 steps
* Use these three steps to implement a specialty team format:
-- Start off with one specialty team, such as cardiovascular care, covering the entire area of operation, says Faye Royale-Larkins, RN, MPH, executive director of BJC Home Care Services in St. Louis.
-- Establish additional teams as patient volumes grow. At the same time, start investigating the most efficient way of utilizing the specialty teams, given their experience in various sections of your geographical area and the availability of feeder hospitals.
-- Reorganize the specialty teams into geographical zones based on such factors as patient census tracks or feeder hospitals. Larkins, however, warns that there is no clear-cut method of implementing each stage of the specialty team format.
"You cannot use a cookie cutter to achieve these critical milestones. You have to establish the most sensible options given your particular circumstances," she says. *
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