We should consider a new position in our primary care teams — that of the scrum master. “Scrum” is a rugby term that comes from agile, a work methodology for software development that now is being applied to industry and health care.
In rugby, a scrum is a huddle where the teams come together with interlocked arms to regroup and start play again. In agile, scrum masters facilitate team huddles and cultivate the morale and energy of the group.
Symptoms of burnout are all too common in primary care — largely because our tools and organizational structures have not kept up with the changing nature of our work. Scrum masters and agile are another way to breath new life into our teams and improve everyday workflow.
Developing muscle memory for primary care teams
Teams in primary care are relatively new with muscle memory for team play still early in formation, especially for physicians, whose training and prevailing culture have lagged behind current needs. A specific role dedicated to the strength of teams could go a long way in increasing our effectiveness.
A scrum master serves as a mix of both coach and referee. The job entails facilitating communication and team interaction while removing barriers and creating external connections. The scrum master protects the team from extraneous distractions and curates the health of the team. It is a distinct role from the product leader in agile, whose job is focused on the specific team deliverables.
During team huddles, scrum masters ask these kinds of questions:
1. What did you do yesterday?
2. What will you do today?
3. Are there any impediments in your way?
What if a new patient with a complex and rare disease enters into a primary care team’s domain? How could a scrum master facilitate a connection with the specialist team involved and accelerate collaboration? What if a team has many part-time members — a reality in today’s world? Could a scrum master help that team operate as a more cohesive whole with improved patient continuity? What if internal dynamics on a team are problematic — what could a scrum master do to restore balance and harmony?
Agile and primary care redesign
In the legacy world of hospital systems, redesign efforts are challenged by the slow pace of monthly meetings and sign-offs by multiple committees. Even simple changes seem to require triathlete levels of endurance.
Agile brings us sprints — intense bursts of rapid iteration that stand up real solutions in a matter of days and weeks. Reimagining the workflows of primary care in this manner makes real change in real time possible — and gives us hope for a better primary care model that can reduce burnout and support the professional fulfillment of clinicians. In both this larger redesign process and in our daily teamwork, we could use scrum masters at our side — pacing the flow and keeping a finger on the pulse of the team.
A new primary care platform
To meet the needs of a population health model interwoven into the framework of one-on-one care, the work of primary care needs major retooling. Agile is one of the methodologies that can help us get there — and there are others, too. Lean has been a major focus over the last decade — and there are also design thinking, workflow science, organizational design, digital technologies, and intentional culture building. All of these will be needed as we create a new primary care platform that works for clinicians and for people.
In settings across the country, this crucial work to improve primary care is underway. Having a scrum master alongside us would make this journey of transformation a better team experience for everyone.
C. Todd Staub is senior vice-president, physician relations, OptumCare.
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