Better Together: One Physician’s Case for Team-Based Care

For Victoria Boggiano, MD, MPH, an ABFM Diplomate and a 2017 Pisacano Scholar, the performance improvement requirement was never the obstacle. It was the opportunity.

Dr. Boggiano is a family physician at an academic family medicine department where she sees her own patients, precepts residents, and serves as team leader for one of four clinic halls. It is a training environment by design, which means new faces are constant. New residents, new medical students, new staff cycling in and out. In that kind of setting, building a cohesive, high-performing team is both more important and more difficult than in a traditional practice.

“To do good patient care, you have to have high-performing teams,” said Dr. Boggiano. “And if you don’t have one, it makes the work that much harder.”

Her answer to that challenge became her performance improvement project: a structured framework of pre-clinic huddles and post-clinic feedback sessions designed to build the kind of cohesive teamwork that does not happen by accident.

More Than a Huddle

Pre-clinic huddles are common in many practices. The team gathers before patients arrive, checks in on the schedule, flags any procedures or complex cases, and aligns on how they will communicate during a busy session. Dr. Boggiano was already doing some version of this, though inconsistent. What made her project distinct was what she added at the end of the day.

The post-clinic feedback session is exactly what it sounds like: a brief check-in at the end of clinic day where the team reflects on what went well, what each person did well, and how they can improve together. It sounds simple. In practice, it is rare.

Dr. Boggiano believes the post-clinic feedback session does something that goes beyond improving workflow. “Even asking for feedback is something that’s not always done,” she said. “If we show that we are open to and encouraging feedback, it enables people to come forward, admit mistakes, ask for clarification, talk about when they’re having challenges that otherwise they might not feel comfortable talking about.”

She was candid about what she learned from her own feedback sessions. She had always considered herself a strong communicator. Her team helped her see it differently. Clear instructions, she discovered, are only truly clear when they are written down, specifically, and confirmed. That realization came directly from the people she works alongside every day.

The Power of Every Voice

The data reflected real change. On the question of how often the huddle occurred before clinic sessions when working with her, the percentage of team members reporting it happened every session or most sessions jumped from 40% at the start of the project to 75% by the end. Given the small sample size inherent to a single clinic hall, the shift was meaningful.

But perhaps the most tangible outcome of the project was something the medical assistants on her team largely drove themselves: a laminated one-page checklist summarizing the full clinic day rhythm, from the opening huddle through patient flow to the end-of-session feedback. That the checklist came from the MAs themselves speaks to something Dr. Boggiano considers central to good leadership: when people feel heard and valued, they take ownership. The plan is to post it at every provider desk on every hall in the clinic.

“It really is MA-led,” Dr. Boggiano said. “I created the project because of the performance improvement requirement, but it is very much driven by the medical assistants on my team.”

Two of those medical assistants are joining her to present the checklist at an upcoming all-staff meeting, where it will be introduced to the wider clinic and partner sites. A performance improvement activity that fulfilled a requirement for one physician is now becoming standard practice for an entire department.

Good Habits Start Here

Working in a residency clinic means Dr. Boggiano is always teaching, whether she intends to or not. She sees her project not just as a practice improvement but as a model she hopes residents carry with them into their own careers.

“Family medicine has moved away from the idea that the physician is the all-knowing entity with all the answers,” she said. “In high-performing clinical teams, every single person has tremendous value and a very strong voice. If we embody and teach a culture of ‘we’re all learning and we can all do things better,’ that is better for patient care, better for professional well-being, and it reduces burnout.”

For Diplomates weighing whether a performance improvement activity is worth the effort, Dr. Boggiano offers a straightforward case. The project fit naturally within her existing clinic. It did not require additional resources or outside systems. It produced something tangible, useful, and ongoing. And it made her a better family physician in the process.

“It was really nice to say, I’m turning this into something we’re going to study,” she said. “Not a massive research endeavor, but something that felt very manageable and fit well within my clinic. And it’s leading to something very tangible that is literally going to be on the walls.”

That commitment to personal growth alongside her team reflects a higher standard of professionalism.

ABFM thanks Dr. Boggiano for sharing her story and for the thoughtful, patient-centered work she brings to her clinic every day.