From 'quarterback' to 'coach': the policy implications of family physicians' evolving role in team-based care.

Abstract

Project Colourful, an innovative model for delivering team-based care and improving access to family physicians at a specific Canadian clinic, provided a window on how physician-led primary care teams are evolving. Colourful allowed an action research team to draw out broadly applicable policy lessons as family physicians moved from exclusively 'quarterbacking' direct patient care to also taking on a more off-field role as 'coaches' of registered nurses. Participant observations (n = 12) of Colourful's design and implementation were supplemented with semi-structed interviews (n = 11) that focused on the project's origins; plans for scaling; and interprofessional teamwork issues. Transcribed interviews were analysed using an interpretive descriptive approach. The shift from quarterback to coach requires not only payment reform, but cultural change and training for physicians and other team members. Specific training here focuses on developing human resource skills and capacities that span: hiring, scope-of practice education, team dynamics, team member retention, and change management. Key support, resource, and governance considerations for policy makers looking to scale care models like Colourful include education to: flatten traditional interprofessional hierarchies; enable the communication required for successful teamwork; as well as, bolster the HR skills of physician coaches; ensure an optimized interprofessional mix; and empower team members to renegotiate scopes of practice at clinical and provincial levels.