Post on 22-Dec-2015
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
Teamwork Outcomes
• Productivity• Efficiency
Attitudes• Mutual Trust• Team Orientation
Knowledge• Shared Mental Model
Performance• Adaptability• Accuracy
• Safety
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
Healthcare Team Composition
• MD
• RN
• Case Managers
• Social Workers
• Utilization Review
• Respiratory therapy
• PT/OT
• Pharmacy
• Dietician
None of us is as smart as all of us.
Ken Blanchard
From Individual to Team
Single focus
(clinical skills)
Individual
performance
Under-informed decision-making
Unbalanced
workload
Dual focus
(clinical & team skills)
Team
performance
Informed
decision-making
Managed
workload
From Individual to Team
Having
information
Self-advocacy
Self-improvement
Individual efficiency
Sharing
information
Mutual support
Team improvement
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/curriculum-tools/teamstepps/longtermcare/essentials/index.html