Teamwork Approach and

Multidisciplinary CareKristin R Wise, MD, FHM

MUSCJune 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

• 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

Mayo Philosophy of Team-Based Care

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