1. No category

Teamwork Approach
and
Multidisciplinary Care
Kristin R Wise, MD, FHM
MUSC
June 4, 2013
Objectives
• Recognize benefits of teamwork in healthcare
• Recognize importance of multidisciplinary
involvement in healthcare teams
• List 4 trainable teamwork skills
• Describe ways to optimize teamwork in the
hospital setting
• Be familiar with AHRQ TeamSTEPPS program
Key Messages
• Majority of medical errors result from communication &
teamwork failures
• Teamwork in healthcare can improve outcomes, increase
patient & provider satisfaction and reduce medical errors
• AHRQ identifies leadership, situational monitoring,
mutual support & communication as 4 trainable
teamwork skills
• Interventions to improve teamwork in hospitals can
include the localization of physicians, daily goals-of-care
& checklists, teamwork training & interdisciplinary rounds
Background
National Institute of Library, NIH
In 1968 introduced term
“Patient Care Team”
Care of patients by a multidisciplinary team usually
organized under the leadership of a physician; each
member has specific responsibilities & the whole
team contributes to care of the patient.
Background
• Non-medical teams used to obtain
organizational outcome success
(aviation, military, manufacturing, business mgt)
Teamwork is the ability to work together
toward a common vision. The ability to
direct individual accomplishments toward
organizational objectives. It is the fuel
that allows common people to attain
uncommon results.
Andrew Carnegie
Background
Healthcare Team importance recognized now by:
WHO
AHRQ
Joint Commission
SHM
Institute of Medicine (IOM)
Institute of Healthcare (IHI)
American College of Physician Executives (ACPE)
Why teamwork in healthcare?
• Improve patient outcomes
• Improve process outcomes
• Increase patient satisfaction
• Increase staff satisfaction
• Reduce malpractice claims
• Reduce clinical errors
Why teamwork in healthcare?
Joint Commission
• 3528 sentinel events reported (1995-2004)
• Root cause analysis showed ~70% due to
communication & teamwork failures
The single biggest problem in communication
is the illusion that it has taken place.
George Bernard Shaw
Teamwork Training
Joint Commission
• Training improves pt safety, med errors
with improved communication & better
coordination of care
TeamSTEPPS
Team Strategies and Tools for Enhancing
Performance and Patient Safety
• training curriculum
• comprehensive set of ready-to-use materials
TeamSTEPPS
Who?
AHRQ & Dept of Defense
What?
Evidence-based teamwork system
When?
Implemented in 2005
Where?
6 regional training centers
Why?
Optimize patient outcomes
How?
Improve communication &
teamwork skills
TeamSTEPPS Logo
4 teamwork skills, 3 teamwork outcomes
4 Primary Trainable Teamwork Skills
Teamwork Outcomes
Performance
• Adaptability
• Accuracy
Knowledge
• Shared Mental Model
• Productivity
• Efficiency
• Safety
Attitudes
• Mutual Trust
• Team Orientation
Healthcare Team
Newer definition:
≥ 2 healthcare professionals from diverse
fields who perform interdependent tasks,
actively collaborate & share a common
goal to deliver optimal care for
hospitalized patients
Mayo Philosophy of
Team-Based Care
Healthcare Team Composition
• MD
• PT/OT
• RN
• Pharmacy
• Case Managers
• Dietician
• Social Workers
• Utilization Review
• Respiratory therapy
None of us is as smart
as all of us.
Ken Blanchard
From Individual to Team
Single focus
(clinical skills)
Dual focus
(clinical & team skills)
Individual
performance
Team
performance
Under-informed
decision-making
Informed
decision-making
Unbalanced
workload
Managed
workload
From Individual to Team
Having
information
Sharing
information
Self-advocacy
Mutual support
Self-improvement
Team improvement
Individual efficiency
Team efficiency
Healthcare Team
• Role clarity
• Who responsible for which aspects of care
• Who discusses which issues with patient
• Know own/others’ roles
• Embrace diversity
• Must value expertise & contributions that various
healthcare professionals bring to patient care
• Measure/recognize performance
• Solicit feedback
Healthcare Team
Interventions to improve teamwork in hospitals
• Localization of physicians
• Daily goals-of-care & checklists
• Teamwork training
• Interdisciplinary rounds
Healthcare Team:
Interdisciplinary Rounds
• Structured communication
system
• Daily team meetings
• Mandatory attendance
by all disciplines
Healthcare Team
Composition improves situational awareness
Common, accurate understanding of patient’s
condition, needs, clinical trajectory & feelings
based on multiple perspectives of the team
members
The way a team plays as a
whole determines its success.
You may have the greatest
bunch of individual stars in the
world, but if they don't play
together, the club won't be
worth a dime.
Babe Ruth
Key References
•
Bosch M, Faber MJ, Cruijsberg J, et al. Effectiveness of Patient Care Teams and the
Role of Clinical Expertise and Coordination: A Literature Review. Med Care Res Rev.
2009. 66:5S-34S.
•
O’Leary KJ, Wayne DB, Haviley C, Slade ME, Lee J, Williams MV. Improving
Teamwork: Impact of Structured Interdisciplinary Rounds on a Medical Teaching Unit.
J Gen Intern Med. 2010;25(8):826–32.
•
Mudge A, Laracy S, Richter K, Denaro C. Controlled Trial of Multidisciplinary Care
Teams for Acutely Ill Medical Inpatients: Enhanced Multidisciplinary Care. Intern Med
J. 2006. 36:558–63.
•
Smith ST, Enderby S, Bessler RA. Teamwork in Leadership and Practice-Based
Management. In: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS, eds.
Principles and Practice of Hospital Medicine. 1st ed. New York, NY: McGraw-Hill;
2012:860-65.
•
Internet Citation: Essentials Instructional Module: TeamSTEPPS® Long-Term Care
Version. July 2012. Agency for Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/professionals/education/curriculumtools/teamstepps/longtermcare/essentials/index.html