Teamwork Approach and Multidisciplinary Care

1. Teamwork Approach andMultidisciplinary Care Kristin R Wise, MD, FHM MUSC June 4, 2013

2. 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

3. 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

4. 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.

5. 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

6. 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)

7. Why teamwork in healthcare? • Improve patient outcomes • Improve process outcomes • Increase patient satisfaction • Increase staff satisfaction • Reduce malpractice claims • Reduce clinical errors

8. 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

9. Teamwork Training Joint Commission • Training improves pt safety, ↓med errors with improved communication & better coordination of care TeamSTEPPS TeamStrategies and Tools for Enhancing Performance and Patient Safety • training curriculum • comprehensive set of ready-to-use materials

10. 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

11. TeamSTEPPSLogo 4 teamwork skills, 3 teamwork outcomes

12. 4 Primary Trainable Teamwork Skills

13. Teamwork Outcomes Performance • Adaptability • Accuracy • Safety • Productivity • Efficiency Attitudes • Mutual Trust • Team Orientation Knowledge • Shared Mental Model

14. 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

15. Mayo Philosophy of Team-Based Care

16. 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

17. 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

18. From Individual to Team Having information Self-advocacy Self-improvement Individual efficiency Sharing information Mutual support Team improvement Team efficiency

19. 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

20. Healthcare Team Interventions to improve teamwork in hospitals • Localization of physicians • Daily goals-of-care & checklists • Teamwork training • Interdisciplinary rounds

21. Healthcare Team: Interdisciplinary Rounds • Structured communication system • Daily team meetings • Mandatory attendance by all disciplines

22. 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

23. 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

24. 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