Topic 4: Being an effective team player Why teamwork is an essential element Learning objectives: of patient safety 1 • understand the importance of teamwork in Effective teamwork in health-care delivery can health-care; have an immediate and positive impact on patient • know how to be an effective team player; safety [1]. The importance of effective teams in • recognize you will be a member of a number health care is increasing due to factors such as: (i) of health-care teams as a medical students. the increasing complexity and specialization of care; (ii) increasing co-morbidities; (iii) increasing Learning outcomes: knowledge and chronic disease; (iv) global workforce shortages; performance and (v) safe working hours initiatives. Paul M. Schyve, MD, senior vice president of the Joint What students need to know (knowledge Commission has observed, “Our challenge … is requirements) 3 4 not whether we will deliver care in teams but rather Knowledge requirements in this how well we will deliver care in teams.”[2] module include a general understanding of: • the different types of teams in health care; A typical example of complex care involving • the characteristics of effective teams; multiple teams would be a pregnant woman with • the role of the patient in the team. diabetes who develops a pulmonary embolus— her medical care team includes: an obstetrician, What students need to do (performance an endocrinologist and a respiratory physician. requirements) 5 The doctors and nurses looking after her will be Use the following teamwork principles to different during the day compared to at night and promote effective health care including: on the weekend. In a teaching hospital, there will • mindful of how one’s values and assumptions be teams of doctors for each specialty area, all of affect interactions with others; whom need to coordinate care with each other, • mindful of the of team members and how the nursing staff, allied health providers and the psychological factors affect team interactions; patient’s primary care team. • aware of the impact of change on teams; • include the patient in the team; This topic acknowledges that medical students • use communication techniques; are unlikely in their early years to have participated • resolve conflicts; as a member of health-care team themselves and • use mutual support techniques; often have little understanding of how teams are • change and observe behaviours. constructed and operate effectively. We aim in this topic to draw on students' past experiences of WHAT STUDENTS NEED TO KNOW teamwork as well as look forward to the teams (KNOWLEDGE REQUIREMENTS) they will increasingly participate in as later year students and practising clinicians. The different types of teams in health care Keywords: 2 Team, values, assumptions, roles and What is a team? 6 responsibilities, learning styles, listening skills, The nature of teams is varied and complex, conflict resolution, leadership, effective they include: (i) teams that draw from a single communication. professional group; (ii) multiprofessional teams; (iii) 119 Topic 4: Being an effective team player teams that work closely together in one place; (iv) distributed as in a multidisciplinary cancer team or teams that are geographically distributed; (v) primary health-care team. teams with constant membership; and (vi) teams with constantly changing membership. Teams can include a single discipline or involve the input from multiple practitioner types including Regardless of the type and nature of the team doctors, nurses, pharmacists, physiotherapists, they can be said to share certain characteristics. social workers, psychologists and potentially These include: administrative staff. The role these practitioners • team members have specific roles and interact play will vary between teams and within teams at together to achieve a common goal; [3] different times. Roles of individuals on the team • teams make decisions; [4] are often flexible and opportunistic such as the • teams possess specialized knowledge and leadership changing depending on the required skills and often function under conditions of expertise or the nurse taking on the patient high workloads; [5,6] education role as they are the ones that have the • teams differ from small groups in as much as most patient contact. they embody a collective action arising out of task interdependency [7]. In support of patient-centred care and patient safety, the patient and their carers are increasingly Salas defines teams as a “distinguishable set of being considered as active members of the two or more people who interact dynamically, health-care team. As well as being important in interdependently, and adaptively towards a terms of issues such as shared decision making common and valued goal/objective/mission, who and informed consent, engaging the patient as a have been each assigned specific roles or team member can improve the safety and quality functions to perform, and who have a limited of their care as they are a value information source lifespan of membership” [8]. being the only member of the team who is present at all times during their care. Examples of teams include choirs, sporting teams, military units, aircraft crew and emergency 8 9 response teams. The TeamSTEPPS™ [9] programme developed in What different types of teams are found the United States identifies a number of different in health care? 7 but interrelated team types that support and There are many types of teams in health deliver health care: care. They include labour and delivery units, ICUs, medical wards, primary care teams in the 1.Core teams community, teams assembled for a specific task Core teams consist of team leaders and members such as an emergency response team or who are involved in the direct care of the patient. multiprofessional teams such as multidisciplinary Core team members include direct care providers cancer care teams that come together to plan and (from the home base of operation for each unit) coordinate a patient’s care. and continuity providers (those who manage the patient from assessment to disposition, for Teams in health care can be geographically co- example, case managers). The core team, such located, as in an ICU or surgical unit, or as a unit-based team (physician, nurses, 120 Topic 4: Being an effective team player physiotherapist, and pharmacist) is generally • provide indirect, task-specific services in a based where the patient receives care. health-care facility, • are service-focused, integral members of the 2. Coordinating teams team, helping to facilitate the optimal health- The coordinating team is the group responsible care experience for patients and their families. for: • day-to-day operational management; Their roles are integrated in that they manage the • coordination functions; environment, assets and logistics within a facility. • resource management for core teams. Support services consist primarily of a service- focused team whose mission is to create efficient, 3. Contingency teams safe, comfortable and clean health-care Contingency teams are: environments, which impact the patient care • formed for emergent or specific events; team, market perception, operational efficiency • time-limited events (e.g. cardiac arrest team, and patient safety. disaster response teams, rapid response teams); 6. Administration • composed of team members drawn from a Administration includes the executive leadership variety of core teams. of a unit or facility, and has 24-hour accountability for the overall function and management of the 4. Ancillary services organization. Administration shapes the climate Ancillary services consist of individuals such as and culture for a teamwork system to flourish by: cleaners or domestic staff who: • establishing and communicating vision; • provide direct, task-specific, time-limited care • developing and enforcing policies; to patients; • setting expectations for staff; • support services that facilitate care of patients; • providing necessary resources for successful • are often not located where patients receive implementation; routine care. • holding teams accountable for team performance; Ancillary services are primarily a service delivery • defining the culture of the organization. team whose mission is to support the core team. This does not mean that they should not share the How do teams improve patient care? 10 same goals. The successful outcome of a patient Medical practice has traditionally focused on undergoing surgery requires accurate information the individual physician as solely responsible for a on catering and instructions in relation to “nil by patients care. However, patients today are rarely mouth” orders so that a patient does not looked after by just one health professional. inadvertently receive a meal that may place them Patient safety, in the context of a complex medical at risk of choking. In general, an ancillary services system, recognizes that effective teamwork is team functions independently, however, there may essential for minimizing adverse events caused by be times when they should be considered as part miscommunication with others caring for the of the core team. patient and misunderstandings of their roles and responsibilities. 5. Support services Support services consist of individuals who: The link between non-technical skills such as 121 Topic 4: Being an effective team player teamwork and adverse events is now well associated with reduced medical errors [15,16]. established [10,11], as