The Fundamentals of Creating Cohesive Multidisciplinary Teams in the Medical Home

1. Session #B4B October 29, 201110:30AM The Fundamentals of Creating Cohesive Multidisciplinary Teams in the Medical Home Kenneth W. Phelps, Ph.D. Assistant Clinical Professor Department of Neuropsychiatry and Behavioral Science University of South Carolina School of Medicine Keeley J. Pratt, Ph.D. Post‐doctoral Fellow in Personalized Medicine Obesity Signature Program, RTI International Collaborative Family Healthcare Association 13th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

2. Faculty Disclosure We have not had any relevant financial relationships during the past 12 months.

3. Need/Practice Gap • More settings are adopting the use of integrated teams; however, most training programs have not adjusted to educate providers on how to work in settings where intense collaboration exists. • The resulting dilemma is that providers are often trained in silos, but have no real practice on how to effectively integrate their skill sets. • The presenters hope to address how providers can create effective, cohesive teams, as well as problem-solve common issues.

4. Objectives • Identify the necessity to use multidisciplinary teams in the patient centered medical home (PCMH). • Examine challenges when practicing on multidisciplinary care teams that arise from dissimilar education / training experiences. • List strategies to troubleshoot barriers to effective multidisciplinary care. • Describe methods for evaluation of collaborative team-based care. 

5. Experience with teams… • All of us can relate to being on a “team” • Sports teams (football, soccer, volleyball) • Education teams (school projects, IEP, PTO, board) • Extracurricular teams (glee club, band, fraternity) • Business or executive teams • Family, marriage, or relational teams • Healthcare teams • Others

6. “For a group of individuals to be transformed into a team, they must have a purpose that is distinctive, specific to the group and promotes member buy-in to a whole that becomes greater than simply collecting individual contribution toward the same objective.” Kohn and O’Connell, 2007, p. 45-46

7. “6 Habits of Highly Effective Teams” Entrusting team members with appropriate roles Establishing and regulating team norms Thinking laterally Strengthening emotional capacity to improve team relationships Expanding team self-awareness Practicing empathy and respectfulness Kohn and O’Connell, 2007

8. Why use multi-disciplinary teams? • Effectiveness of care • Efficiency of delivery • Targeting of BPS needs • Multiple expertise • Mutual learning • Limits oversight and mistakes • Increases professionalism

9. Effective Primary Care Teams An effective team may have the… • “capacity to function at a level that enhances the individual contributions of their members and team effectiveness.” Themes of primary care team effectiveness: • Understanding and respecting team members’ roles • Recognizing that teams require work • Understanding primary health care • Working together: practical know-how for sharing care • Communication*** Sargeant et al., 2008

10. Key Elements of Team Building • Defined Goals • Overall organizational mission statement • Specific, measurable, operational objectives • Systems (Clinical, Administrative, Financial) • Division of Labor • Training and Cross-training • Communication Structure and Processes Bodenheimer, 2007 for California Health Foundation

11. PCMH Team Soup: Most Important Ingredient? Communication Flexibility Collective Mentality Flat Hierarchy Shared Vision Dependability of Members Addressing Multiple Systems Etcetera

12. Common Team Challenges in PCMH • Languages of care • Unclear roles • Conflicting personalities • Minimal cohesiveness • No common goals • Alliances • Triangulation • Boundaries • Indistinct team leader • Absent patient and/or family

13. Narratives of Problematic Healthcare Teams

14. Troubleshooting Strategies • Give & Take Education • One Cohesive Treatment Plan • Reflective Listening • Role Statements • Outside Consultation • Evaluation

15. Give & Take Education • Appreciate each person’s unique skill set and overall contribution to the team • Prioritizing what information should be included in discussion • Round robin effect vs. lead/follow • Speaker-listener review *Consider use of personality inventories (True Colors, Myers Briggs, etc.) to highlight differences in approaches to the team and each person’s strengths.

16. One Cohesive Treatment Plan • Mission Statement = primary objectives • Vision Statement = values • Cohesive Treatment Plans • Biopsychosocial framework • System for designation and f/u • Location, location, location

17. Reflective Listening & Role Statements • Refresher on I-statements • Replacing the “I” with your professional role • Team-statements during meetings • VCR Approach • Validate • Clarify/challenge • Request Hardy and Laszloffy, 2005

18. Seeking Outside Consultation • When is it necessary? • How to find someone? • What is the anticipated end product? • Assess functional performance of team • Provide environment where feedback is the norm • Assist with problem solving, resolving conflict and enhancing cohesiveness

19. Evaluation • Process Groups • Observational Data • Live observation by 3rd party • Video or audio record • Formal Questionnaires • Providers • Patient or family • Frequency of re-evaluation/appraisal

20. References • Bodenheimer, T. (2007) Building Teams in Primary Care: Lessons Learned. California Healthcare Foundation. • Kohn, S. E., & O’Connell, V. D. (2007). 6 Habits of Highly Effective Teams. Pompton Plains, NJ: The Career Press. • Sargeant, J., Loney, E., & Murphy, G. (2008). Effective Interprofessional Teams: “Contact is Not Enough” to Build a Team. Journal of Continuing Education in the Health Professions, 28, 228-234. • Hardy, K. & Laszloffy, T. (2005). Teens who hurt: Clinical interventions to break the cycle. Guilford Publshing.

21. Questions

22. Contact Information • Kenny Phelps, Ph.D. Kenneth.phelps@uscmed.sc.edu (803) 434-4221 • Keeley Pratt, Ph.D. Keeley.pratt@gmail.com (317) 902-7233