Team Up: How O&P Is Improving Outcomes Through Collaboration

As the O&P profession is faced with new challenges, some facilities are forgoing the once traditional hierarchical structure in favor of a team approach to patient care.

According to leaders in the field, it is more important than ever to generate new solutions and tap into the fresh thinking teamwork can provide.

Importance of teamwork

The collaborative approach can reach many different levels of an organization. Lesleigh Sisson, CFom, owner of O&P Insight and advisor with the OPIE, Futura Software Group, said teamwork brings together people of diverse backgrounds, education and experience, spanning from “the administrators to the clinical staff to the technicians. Each team member brings a unique and valuable perspective.”

With various skill sets and expertise coming together, team members can learn from one another, which allows them to see a situation from several different angles.

“When you have multiple sets of eyes on a specific challenge, you tend to come up with better solutions,” John M. Miguelez, CP, FAAOP, president and senior clinical director at Advanced Arm Dynamics, said.

Teamwork also allows a group to accomplish tasks more quickly and consistently, William Beiswenger, CPO, FAAOP, at Abilities Unlimited, told O&P News.

“When you work as a team, you do not have one individual saying, ‘Well, I think you should have this type of device,’ and then [the patient] goes somewhere else and hears, ‘No, I do not think that is the right thing. You should have something else.’ If we are all working together, then the patient gets the same advice rather than getting different ideas from each individual.”

Brian D. Steinberg, CO/LO
Brian D. Steinberg

Brian D. Steinberg, CO/LO, president of the Center for Orthotic and Prosthetic Excellence, agreed, saying, “Collaboration is a way to produce high-quality results consistently. The evidence for inter-professional coordination continues to grow, allowing us as a profession to provide a gold standard of care.”

Sisson said as the profession continues to face new challenges, teamwork has become an integral tool in achieving high-quality care. Of O&P businesses that do not promote collaboration, she said, “I do not see how they will survive.”

Image: Photo courtesy of Advanced Arm Dynamics, Bob Stovall.

Image: Photo courtesy of Advanced Arm Dynamics, Bob Stovall.

Barriers in synergy

There are barriers to working as a team, sources said. Poor communication is one of them. Assumptions, passive listening and unclear messages can prevent the exchange of thoughts and ideas.

In addition, with online communication tools replacing traditional face-to-face meetings, it is easier for a message to be misconstrued.

Communication also can be hindered by team members who are unwilling to adopt new methods of thinking, Sisson said.

“I see challenges as far as people wanting to hold on to the old ways of doing things. Many of us have been in O&P for a long time and want to hang on to what we have done in the past,” she said. “But sometimes, it is difficult to hold on and continue to move forward.”

“When I first got into the [profession], I worked for a company that had 20 different offices and spent 50% of their time competing against each other. That was a waste of energy,” Miguelez said. “Everybody has different personalities, but part of this is realizing just because someone has a different opinion or perspective on something, does not necessarily make it wrong.”

Teamwork also is threatened by strong competition for patients, according to Beiswenger.

John M. Miguelez, CP, FAAOP
John M. Miguelez

“There is plenty of opportunity for all of us to have equal market share, but there are also some communities where the practitioner ratio is high and maybe there are not enough patients to go around,” he said. “In those kinds of scenarios, [practitioners] are not going to want to interact with each other because there are folks who go out and try to capture any patients they can — any way they can — even by trying to pick up patients who have already been seen by other practitioners.”

Even when the patient is in one office, there could still be a struggle of ideas about what is best for them, Miguelez said, adding that teamwork “goes a long way to embrace different perspectives and make everyone feel like they are a part of the process and are not being dictated to.”

Steinberg agreed, and said adversarial relationships among staff members need to end.

“Teamwork is one of those buzzwords that is hard to define, but when it is missing from your practice, it is hard to ignore,” he said. “Offices with an ‘every person for themselves’ mentality tend to suffer from high levels of turnover, chronic moral problems and low productivity [and that is] a drag on profit that O&P practices can ill afford.”


Open communication

At Abilities Unlimited, Beiswenger keeps lines of communication open through frequent contact.

“We have groups that get together on a clinical basis to collaborate,” he said. “We are shuffling paper all day, communicating to and from physicians and therapists and other folks.

“We also meet with the administrative staff to make sure that we are doing things right as far as scheduling, billing and coding. We make sure everybody is aware of what we are doing so that the patient gets an opportunity to do the best they can with the device we provide.”

Thomas Gavin, CO, LO, national orthotics specialist at Hanger Clinic, has taken to Lync, an online video conferencing application, to keep team members connected.

Thomas Gavin, CO, LO
Thomas Gavin

“On a daily basis, I collaborate through Lync. With the current technology, I can virtually be in any patient room in the country,” he said.

Miguelez also employs this strategy, and on a monthly basis he presents a clinical challenge across Advanced Arm Dynamics’ seven centers.

“We do it in somewhat a unique way in that we have a presenter, a coach and a moderator on a particular call. The presenter will set up the issue, the coach will fill in some detail and then we share some insight that has meaning to the conflict.”

The team also gains experience through symposia, in which members from each center are paired with those from another center to tackle a clinical, leadership or business development challenge.

“We will bring people together a couple times a year and we call it the Advanced Arm Dynamics’ symposium,” Miguelez said. “There are clinical components about it, there is a practice management component, there are reimbursement strategies, manufacturer relations strategies. [There] is always an activity that everybody enjoys and it lets people let their hair down and enjoy each other.

“This creates a dynamic that builds relationships,” he added. “When we get together, it is a bunch of friends getting together. It allows people to pick up the phone in the future and share what is going on [and] that is crucial to our success.”

OPN175 Survey

Another crucial aspect is reaching across the table to professions closely related to O&P. Miguelez emphasized the importance of building rapport with manufacturers, insurers, therapists and patients.

“Our perspective is such that we are not creating a hierarchy. We want all parties involved to be at the same level and we do not want there to be any alpha dynamics involved,” he said.

He said when everyone is mutually accountable for the patient’s welfare, the effect is synergized and the outcomes are stronger.

Steinberg employs a clear set of goals for his team to accomplish. He said when there is a specific target, it aids in reaching quality outcomes.

“Our mission, goals and values are formally written and shared with the staff on a regular basis. Leaders communicate that teamwork and collaboration are expected,” he said. “No single member completely owns a work area or process.”

Lesleigh Sisson, CFom
Lesleigh Sisson

Sisson said team members each should know their role in attaining a goal and create a measurable process to reach it.

“Whether it is a financial goal, a clinical goal, [or a goal related to] administrative or compliance [needs], coming up with a plan to get there is important. It is not just [the responsibility of] the owners or the managers. The entire team has to come up with ideas as how they are going to achieve the result,” she said.


Add structure

According to Beiswenger, certain techniques can add structure to the process. Although a team should have defined goals, it should not be micromanaged.

William Beiswenger, CPO, FAAOP
William Beiswenger

“The best thing would be to start together as a group, branch of into individual specialties and come together again for the best outcome,” he said.

Training in specific areas also could enhance outcomes, Sisson added, “particularly with clinical, administrative and compliance procedures, as well as optimizing the use of their practice management software.

“One of the strategies that I have seen work well is teams sharing ideas about approaches that have been successful or maybe pitfalls to avoid with other teams, and having peer-mentoring type relationships.”

Beiswenger’s team meets biweekly to discuss patient outcomes. “The practitioners meet with the technicians and go over all the technical things like what we can do to have a better device, a newer-looking device and how to avoid possible problems that could occur,” he said.

“Then we track failures and rework things to make sure we are buying the right plastics and using the right components. We do in-service [workdays] where the practitioners teach the technicians and the technicians teach the practitioners. That way, everybody gets to know each other’s role and we do not overburden anyone.”

Feedback among team members is another important part of the collaboration process. Although most employees have a natural tendency to try to avoid offending a colleague, prosthetists should make it a priority to assess any miscommunications in care methods in order to keep the best interest of the patient. Feedback also can be given as acknowledgement to for a job well done, Miguelez said.

“We have a system that we use for evaluations and job descriptions called ‘key result areas.’ One of the important points is team support,” he said. “On a weekly basis, everybody reports on what they have done to support other team members, not only in their office, but throughout their organization.

“That fosters teamwork and keeps it front of mind because we cannot deal with the types of patients that we deal with without working as a strong, cohesive team.”

Although some disagreements are unavoidable, when communication is honest, it can instill an authentic level of trust. This creates a stronger bond and a comfortable environment in which ideas can flow freely.

“One major way that we can benefit from collaboration is by building strong teams,” Sisson said. “In an environment like this, people would have a more enjoyable experience and support one another.”

Improve outcomes

Patients who are pulled in different directions may not achieve the best outcome, Sisson said.

“It helps when the entire team understands the end goal, which is to provide great care while achieving successful reimbursement. Better functional outcomes, patient satisfaction and quality of life result are the areas that we have to focus on,” she said, and when a group of professionals work together at a common goal, it is feasible to achieve all three.

Steinberg suggested O&P professionals join the OPIE Choice Network, which strives to bring collective intelligence, combined strength and measurable quality care to the profession. With more than 980 locations utilizing the OPIE Software platform, O&P practices are positioned to gather, analyze and understand data about patient populations, he said.

“[That] information allows us the ability to make better decisions for our patients and practices [and] raise the level of care,” Steinberg said “Utilizing evidence-based practices provides better patient outcomes.”

Organizations like OPIE offer the opportunity for practices to leverage their data, purchasing power and expertise, and the ability to remain independent, while sharing the power of a larger pool of like-minded businesses.

Opportunities also are available at national meetings for O&P professionals to network with sources looking to collaborate, Gavin said.

“We cannot exist on an island. No matter what your experience or your background is, you are not the wheel; you are just a cog on the wheel. It is the team that rises to meet the challenge, not the individual,” he said.

“It takes a lot of patience, but it is up to all of us to move this profession forward. If we do not continue to collaborate and create new ideas, we will stagnate. If we work together, we will have a much larger impact.” – by Shawn M. Carter

Disclosures: Beiswenger, Gavin, Miguelez, Sisson and Steinberg report no relevant financial disclosures.

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