Patient Experiences with Teamwork During Telehealth Appointments

Abstract

Telehealth has transformed healthcare delivery by allowing patients to connect with their healthcare providers using audiovisual technology. There is a growing need to understand teamwork dynamics in virtual care encounters. The purpose of this study was to explore patient experiences of teamwork during telehealth appointments with their medical care team. This qualitative study involved semi-structured virtual interviews with 19 patients recruited from a midwest academic medical center who had a chronic condition and had participated in multiple telehealth appointments with their care team. Participants discussed their experiences with telehealth and interactions with their care team. Interview transcripts were analyzed by two independent reviewers using a thematic analysis to identify common teamwork themes. Participants commonly interacted with physicians or advanced practice providers during appointments, while also engaging with nurses, technicians, and administrative staff throughout all telehealth appointment phases. Key teamwork processes included both verbal and asynchronous communication as well as monitoring and adjusting of the patient care plan. Participants emphasized the importance of the online patient portal as playing a key role in facilitating these teamwork processes. Future research should explore provider perspectives of teamwork during telehealth, and tools to enhance pre-appointment information gathering and preparation in advance of a telehealth appointment.

INTRODUCTION

Telehealth, or telemedicine, is a vital tool for remotely connecting patients and healthcare providers using real-time audiovisual technology (Manocchia, 2020). Telehealth use—including videoconferencing and telephone-based interactions—expanded rapidly during the COVID-19 pandemic to extend access to healthcare while limiting traditional in-person encounters (Myrick et al., 2024). This healthcare delivery method has changed how patients interact with their medical providers to receive patient care while enhancing convenience and satisfaction for patients and providers (Hoff & Lee, 2022; Kruse et al., 2017).

While teamwork has long been recognized as an essential component of providing high-quality, patient-centered care in traditional healthcare settings, there is a growing need to understand teamwork dynamics in virtual care encounters (Rosen et al., 2018). As telehealth usage continues, it will be important to explore how teamwork factors – such as communication, leadership, team orientation, and team cohesion – impact the experience and effectiveness of telehealth encounters (McVey & Katigbak, 2024). Further, with patients at the center of the care team, there is a need to evaluate their experiences to provide insights into how teamwork might be optimized to ensure thorough and efficient virtual care. The purpose of this study was to explore patient experiences of teamwork during telehealth appointments with their medical care team.

METHODOLOGY

The study design was a qualitative research study conducted with individual semi-structured interviews. The Office of Regulatory Affairs approved this as an exempt research study (IRB# 164–21-EX). Study participants were adult patients (19 years of age or older) with a chronic condition(s) who had participated in two or more telehealth appointments with their medical care team within the last year at a large midwestern academic medical center. Participants were recruited using the institution’s opt-in to research recruitment system (where patients have opted-in to be contacted about research opportunities) and received up to three emails with study recruitment information.

Participants scheduled a time with a study researcher to complete an individual 30–45 minute semi-structured interview conducted via Zoom. Prior to the interview, participants received a copy of the study consent form and the interview questions. Informed consent was obtained from all participants prior to beginning the interview. Interview topics included describing the composition of their care team, their experience with the telehealth appointment process from scheduling through follow-up, and sharing good and bad experiences of teamwork during these telehealth appointments.

Interviews were recorded using Zoom cloud recording and an initial transcript was created using Zoom cloud transcription. Transcripts were then verified verbatim and de-identified to protect participant confidentiality. Transcripts served as study data. This study used a thematic analysis approach (Braun & Clark, 2006) where transcripts were independently reviewed by two research team members to identify initial teamwork processes and common themes among the participants about working with their care team. Research team members then met for discussion to come to consensus on any discrepancies.

RESULTS

Forty-four individuals expressed interest in participating in the study, and 19 participated in a study interview. We excluded one interview from the data set because the participant shared experiences about telehealth appointments that took place in a group setting, and all other participants’ telehealth appointments were conducted individually with their care team. All participants identified themselves as white and not Hispanic or Latino, 63% as female, 26% as male, 11% as transgender/nonbinary, with an average age of 45 years old. The average number of telehealth appointments per participant in the last year was eight.

Care Team Composition

Participants reported that a physician or advanced practice provider were the care team members they most commonly interacted with during a telehealth appointment. In addition to these primary clinicians, participants also noted involvement from other professionals during different phases of the telehealth encounter – such as scheduling, appointment preparation, and follow-up. These included nurses, patient care technicians, and administrative staff who contributed to the overall experience. Participants were also asked if they viewed themselves as members of the care team, and, 72% indicated that they did feel like they were active and engaged members of their own healthcare team.

Teamwork Processes

Overall, the most common teamwork processes experienced by participants were communication and monitoring/adjusting (See Tables 1 and 2 for example quotes illustrating the experience of these teamwork processes). Communication, which includes the exchange of information between team members, whether it be verbal or via electronic means, was most prevalent during the telehealth stages of scheduling, preparation, appointment, and follow-up while monitoring/adjusting was most prevalent during the stages of telehealth preparation and appointment. While participants highlighted verbal communication as an essential aspect of teamwork during telehealth appointments, they also reported asynchronous communication via the online patient portal as a key component of teamwork that was most utilized during the telehealth scheduling, patient preparation, and follow-up phases. This asynchronous communication by the participants occurred largely by sending information or pictures to their care team ahead of their scheduled appointment time. Participants also reported that the online patient portal was essential to help facilitate effective teamwork in general because it allowed the participants to review their health history, old appointment notes, laboratory results, complete electronic check-in, and receive reminders for upcoming appointments.

Table 1.

Patient experiences of communication during stages of a telehealth encounter.

Telehealth Stages	Communication
	Impact	Participant Quotes
Scheduling	Facilitates timely appointment access to care team given medical conditions, status.	“…it’s more like something’s happening now. So, usually they help facilitate by saying, “Hey, let me see if Dr. So and so, you know, can just pop in on his lunch hour. Are you available to do a quick telehealth then?”
Preparation	Expectation that all care team members (including patients) gather and have available all necessary information for exchange to increase appointment efficiency.	“…I’m supposed to meet with the physician, I end up having to meet with the nurse practitioner, and they do a good job of knowledge transferring, if you will, whatever information they need from me, or whatever questions they may have for me at a particular appointment. And so, the upside of that is that I don’t come in and feel like, oh, gosh, I have to catch this person up, because last time I met with somebody different. So, whether it’s that they’re leaving good notes in the chart, or having conversation, or whatever it might be.”
Appointment	Ability to clearly dialogue with care team members about patient condition, treatment ideas, and goals, with limited technological disruptions.	“Depending on which member of my care team I’m gonna meet with we’ll divide the questions up, but also share them more broadly across the team, too, just in case folks have other ideas or experiences about some of the things I’m questioning.” “…it’s very easy to talk over each other. They might ask a question and you answer, and then they start something, and you’ve got more say, or you’d wanted to start on it something else…allowing a little more pause between what each person says.”
Follow-Up	Online patient portal is an essential post-appointment care team communication mechanism.	“…I couldn’t imagine doing the telehealth without the back-and-forth communication [using the online patient portal], or without being able to see some of those things.” “If I have any questions that come up in between appointments, I would just submit them online to the particular member of the care team.”

Table 2.

Patient experiences of monitoring and adjusting during stages of a telehealth encounter.

Telehealth Stages	Monitoring and Adjusting
	Impact	Participant Quotes
Preparation	Patient engagement in documenting symptom changes, side effects, and completing necessary laboratory appointments to ensure current information is available for the care team to make modifications to the plan of care as needed	“I try to make sure that any labs I’ve had done here have made it there and are pre-entered. So that the physician, days ahead of time has time to review lab work. So, between my [specialist1] and my [specialist3], they tend to, we just order the labs here locally, but we try to make sure those get shared. And if there’s something one wants over to the other, we make sure that there’s a collaboration so that everybody’s got what they need.” “Any diagnostics on file and available for them to see ahead of time makes it work well, so that they’re all seeing the same picture and then can create the best decisions…if I didn’t provide all the lab work, they wouldn’t know that ‘well, we probably need to be looking at this’.” “I’ll make notes of, you know, like side effects of my medication or symptoms I’m experiencing so I don’t forget to bring it up.”
Appointment	Analysis and dialogue about changes in medical condition and status during follow-up appointments enables patients to address stability or changes in medical care needs	“We’ll try to tweak a few things here or there…if this isn’t working, if the we don’t see a change after so long, let’s get back, and we’ll try to adjust things as we go from there.” “…the doc’s like, “that’s a little odd.” And I’m like, I don’t necessarily say I’m feeling those kind of symptoms. But yeah, something’s, you know, kind of funky. And so, it’s like, “yeah, let’s check that again in a couple of weeks,”…Did a quick scan, the scan looked better than a previous one had years before, and they’re like it just doesn’t add up…something’s odd.”

Monitoring/adjusting, which involves the collection and analysis of information to inform changes to healthcare goals, was identified as another critical teamwork process for telehealth preparation and appointments. Participants reported that monitoring the status of their medical condition and reporting any changes to their care team was a task they took ownership of, while making adjustments (e.g., changes in medication regimen or treatment plan) was a responsibility of the healthcare team members.

A few participants reported that adaptability was an important teamwork process during telehealth scheduling, particularly when there was a need to be seen more urgently and there were no in-person appointment times available but there was availability to squeeze in a telehealth appointment with their care team. A few participants also reported that handoff/interteam communication, which included the asynchronous sharing of information between care team members (including relevant specialists) was an essential function of perceived provider preparation for telehealth appointments. However, overall patients did not feel like this was something that members of the care team did consistently in advance of their appointments.

DISCUSSION

The findings of this study reinforce the importance of good communication between care team members and patients across all stages of telehealth encounters to ensure everyone is on the same page regarding the broader goals of medical care. Ensuring clear and open communication can help build trust, clarify expectations, and address any concerns or questions that may arise during the telehealth appointment. The online patient portal was a critical mechanism to support asynchronous team communication between patients and their care team. This platform offers patients secure access to their health records, ability to message care team providers, schedule appointments, and receive important reminders regarding upcoming appointments, in addition to a better general understanding of their unique healthcare situation. As a result of these various functionalities, healthcare systems may want to ensure that patients receive adequate training and education on how to effectively navigate the online patient portal and when it is appropriate to use for asynchronous communication with their care team.

The exploratory nature of this study enabled us to capture details about patient experiences of teamwork when using telehealth while they were working with an established care team over time to manage a chronic condition. Thus, participant perspectives about teamwork in the virtual care setting were informed by familiarity with an intact care team. However, the limited scope of focus on patient experiences from this small sample limits generalizability and replicability of our findings.

An opportunity for improvement that emerged from this study was the need for resources to facilitate pre-appointment information gathering so that all team members are well-prepared to engage in a meaningful telehealth appointment. A pre-appointment checklist of all necessary components of a telehealth visit (e.g., for patients – recent set of vital signs, any changes to health conditions, new symptoms, updates from any other provider appointments; for providers—patients’ electronic chart has been reviewed including laboratory results and medications the patient is taking) could be developed and tested to evaluate its impact on improving effective patient and provider telehealth appointment preparation. Another area for improvement is ensuring that providers are consistently engaging in effective handoff/interterm communication with other members of the care team as participants highlighted this as an area of frustration and a hindrance to effective telehealth appointments. A post-telehealth appointment notification that prompts healthcare providers (or their team) to send post-appointment documents to other members of the patients care team, so everyone has the most current information about the patient, could be developed and tested as a mechanism to facilitate communication amongst the broader care team.

CONCLUSION

The findings from this research study explored patient perceptions of teamwork in a telehealth setting. The results highlight the importance of communication and monitoring/adjusting as key teamwork processes, as perceived by patients, during telehealth encounters. Effective verbal and asynchronous communication via the online patient portal emerged as a key component of patient care. Participants shared that they valued the ability to share information with all interdisciplinary team members conveniently in one location and felt that the patient portal enhanced their understanding of their health and health goals. Future research on provider perceptions of teamwork and telehealth and the implementation of tools to help facilitate the gathering of pre-appointment information may help support effective teamwork for high-quality patient-centered care.