Such a team-based context would mean Dr. Jones has a behavioral health professional waiting in the wings of his practice who he can bring in to meet with his patient to dig more deeply into understanding what is happening and how he and his team can best help her. He can also call upon the social worker to help set-up the immediate phone reporting of the potential Domestic Violence and potential elder abuse to appropriate authorities in a timely fashion and gather his pre-scripted written summary dot-phrase so a letter can be sent and shared with the patient so she is aware of what is happening. Once the Behavioral Health professional has completed her assessment and recommendations, the social worker can help the patient understand the complex array of reporting requirements and make sure she understands next steps that will be taken.
Knowing how trauma can impact the entire family, Dr. Jones and the Behavioral Health professional talk through an urgent Virtual Family Meeting to be scheduled ASAP to maintain Dr. Jones and the Primary Care team’s relationship across the current patient, her husband and her son—maintaining their keen focus on the health of the entire family as well as the safety of today’s patient. She consents and says she will be staying at her sister’s home while the primary care health team engages in assuring her safety, health and the health of her family.
While much of this activity is occurring, Dr. Jones has completed seeing his final 2 patients and briefly drops in to check on this patient before heading to his meeting at Noon with his supervisor—armed once again with why he has become far more “productive” now that he finally has the team members that he has been asking for over the last 3 years in this health system. He wants to thank his supervisor for investing in the support and will bring up this case as one more example of how he is able to maintain his high professional standards of care AND meet the time-constraints of post-modern Advanced Primary Care.
Moving to this model of teamwork allowed him to shift away from his prior fear-based way of avoiding these painful conversations into being a more pro-active and effective primary care physician. His stress level has reduced and he feel rejuvenated in his work. Having a team to rely on has dramatically shifted him toward digging into what is truly troubling his patients and makes him proud to be a primary care physician. He can’t wait for the medical student to come this afternoon. It’s a short clinic, but he wants to share this care to help the student see why Advanced Primary Care is an inspiring and impactful profession. He hopes maybe his student will reconsider his inclination to sub-specialize and dive into the new Advanced Primary Care.
Team Design
We wish to take a somewhat different perspective regarding leadership as engaged in a team setting. Specifically, we turn our attention to the four spans within organizations that Robert Simons (2005) suggests play an important role in determining the effectiveness of teams. These four spans are: (1) control, (2) accountability, (3) responsibility and (4) support. Each of these spans can be narrowed or widened. Two of the spans measure the supply of resources the organization provides to project teams. The span of control relates to the level of direct control a team has over people, assets, and information. The span of support is its “softer” counterpart, reflecting the supply of resources in the form of help from people in the organization. The other two spans—the span of accountability (hard) and the span of influence (soft)—determine the team’s demand for organizational resources. The level of a project team’s accountability, as defined by the organization, directly affects the level of pressure on team members to make trade-offs; that pressure in turn drives the team’s need for organizational resources.
