Instructor Resource Manual
Instructor Resource Manual
Module 7 – Team
Table of Contents
Lecture content outline 2
Post-lecture knowledge assessment items 6
Answer key and rationale for knowledge assessment items 8
Observation assessment form and scoring rubric 9
Sample Case 11
Sample case group debrief questions and instructor guide 12
Sample case role-play activity 13
Reflective writing assignment and instructor guide 15
Content Outline for Lecture
I. Introduction to COMFORT
a. COMFORT is an acronym that stands for 7 basic principles designed to be taught in early palliative care communication, care provided for individuals with a life-threatening or serious illness
b. The curriculum is based on empirical research in hospice and palliative care, including observations of interprofessional teams, team meetings, team member collaboration, and interviews with team members across a range of healthcare professions.
c. This lecture will provide an overview of module 7 – Team, and more specifically team meetings. This module is an introduction to entry-level communication skills.
II. Objectives overview
a. The objectives of this session are to provide a summary of interdisciplinary team collaboration and talk about communication in team meetings.
III. Interdisciplinary Collaboration
a. Interdisciplinary collaboration is so much more then just putting interprofessional health care workers team members in one room.
b. It requires you to share resources, engage in shared power by identifying common goals and establishing a unified message for the patient and family.
c. It also requires that you respect your colleagues by practicing active listening
IV. Interdependence & Flexibility
a. To begin our discussion about team communication, I’d like to review the elements of interdisciplinary collaboration. First, interdependence and flexibility among colleagues is necessary.
b. Flexibility means that your job or task changes for every new case. If you approach each case with the same task list, then you may not be engaging in the collaborative process.
c. For every member of the healthcare team, the goal is to provide holistic psycho-spiritual care (Grey, 1996). For example, sometimes you will need to answer questions about medication (even if you are a social worker) and sometimes you will be asked about religious beliefs (even if you aren’t a chaplain).
V. Newly created tasks & responsibilities
a. The second element of collaboration is that when you work with your colleagues, new tasks and responsibilities emerge. Again, do you have flexibility in what you provide for patients and families? Could working with team members change how you care for patients/families?
b. When team members collaborate, they share information with each other. This is much more then a shift change or a sharing a patient’s medical history. This is about sharing your expertise, your knowledge about best practices, successes, failures – and most of all, being available to colleagues.
VI. Collective ownership of goals
a. The third element of collaboration is collective ownership of goals. Collaboration establishes shared responsibility and a common purpose for this team.
b. Yes, a healthcare team’s goal is to provide patient-centered care. But how does each team member define that for the patient? If it varies, then there will be problems with team collaboration.
c. Team members must work together to clearly identify and define the plan of care and same goals for the patient/family.
VII. Reflection on process
a. Finally, the fourth element of collaboration is reflection on process. And honestly, this where teams have the most problems.
b. Most teams do not do this as a routine team function. Teams typically don't do this unless there is a problem with team communication!
c. Reflection on process involves reviewing the team process. Evaluating your own process – taking a checks and balances of team communication. Stopping to establish a team goal, a motto, or a mission statement – or using your company’s mission statement – as a way of checking to see if your working process lines up with the goals of patient care.
VIII. Team Meetings
a. The goal of the team meeting is to collaborate.
b. As a team member, your responsibility is to make sure that your expertise contributes to the patient/family care plan.
c. Team meetings are where conflict between team members happen, team members talk about their problems with patients/family, and coordinate care.
OPTIONAL: Ask the Audience to come and share their team meeting experiences or to describe the environment of team meetings that they have observed. If the audience has experience with teams, here are some questions to ask to promote further discussion:
- Are your team meetings boring?
- Do they have an environment where back-channel politics and personal attacks thrive?
- Are controversial topics ignored?
- Does the team fail to tap into all the opinions and perspectives of team members?
- Does the team waste time and energy with interpersonal risk management?
IX Communication Impaired Individuals (Rao, 2011; Mathisen, Yates & Crofts, 2011)
a. 22-42 million people with hearing impairment in care settings
b. 46 million people with disordered communication in care settings
c. To improve patient outcomes, diagnoses and treaments, patient/family understanding, and satisfaction, teams must attend to impaired individuals
d. Work collaboratively with interpreter service, nursing, medicine, allied health, dietary, EM, pharmacy, and pastoral care
e. Value team roles to achieve effective communication, appreciate diverse responses, understand different assessments, and reflect on practice and impact
IX. Groupthink
a. Definition of groupthink.
X. Groupthink
a. Unfortunately, many health care teams fall into groupthink patterns.
b. Groupthink can occur when “deeply involved” cohesive group members engage in a mode of thinking that centers on unanimity over the motivation to rationally assess various courses of action (Janis, 1982).
c. Group “work” becomes fixed on cohesion, rather than decision-making. Essentially, team members agree to agree.
d. One reason why groupthink occurs is because many healthcare teams are not evaluated for their team processes.
XI. When Groupthink Occurs
a. Groupthink occurs when there is pressure on group members to agree not to disagree (Napier & Gershenfeld, 1999).
b. Group members embrace a decision even though they recognize it may not be the best decision.
c. Sometimes difficult patients and/or family members can be perceived as a threat to the healthcare team.
d. Team members have to be careful not to stereotype patients/family members and focus on the unique dynamics of the patient/family case.
XII. Aspects that influence Groupthink
a. An awareness of relational factors can influence the way a team collaborates, or does not collaborate. For instance, power is a major element in groupthink and this is established via age, education, experience, and position on the team.
b. But also, individuals have their own inherent way of dealing with conflict---some are more comfortable with it, others see it as a threat.
c. A primary cause of Groupthink is self censorship. When multiple perspectives are suppressed, a lack of ideas and sharing occurs. If a dominant medicalese is used during team meetings and not all team members are familiar with terminology, self-censorship is likely to occur.
d. Structural and organizational constraints include high caseloads, administrative support, time and place of team meetings.
XIII. Ways to combat Groupthink (Whyman, 2005)
a. Here are some ways to help a team stay focused on collaborative decision-making.
b. Commonly, teams have a designated organizational leader. Leadership style can have an impact on team decision-making. Rotating leaders among the various interprofessional team members can enhance collaborative communication.
XIV. Assessing team experiences
a. Additionally, here are some things to think about the next time you are in a team meeting or observing a team meeting.
OPTIONAL: Ask the audience to share their team experiences or team observations. Offer the following options among those audiences who have current clinical team experiences:
i. My team is assessed, but I don’t know how.
ii. My team is assessed, but there is no clear protocol.
iii. My team is assessed regularly using clear protocols.
iv. My team is not assessed.
References
Grey, R. (1996). The psychospiritual care matrix: a new paradigm for hospice care giving. Am J Hosp Palliat Care, 13(4), 19-25.
Janis, I. L. (1982). Groupthink. Boston, MA: Houghton Mifflin.
Mathisen, B., Yates, P., & Crofts, P. (2011). Palliative care curriculum for speech-language pathology students. International Journal of Language and Communication Disorders,46, 273-285.
Napier, R. W., & Gershenfeld, M. K. (1999). Groups: Theory and Experience (6th ed). Boston, MA: Houghton Mifflin Company.
Rao, P. (2011, November). Our role in effective patient-provider communication. The ASHA Leader, 17.
Whyman, W. (2005). A question of leadership: What can leaders do to avoid groupthink. Leadership in Action, 25(2), 12.
Wittenberg-Lyles, E., Goldsmith, J., Ferrell, B., & Ragan, S. (2012) Communication and palliative nursing. New York: Oxford.
Post-Lecture Knowledge Assessment Items
1. What members of the team should practice psychospiritual care?
a) only medical professionals
b) only chaplains
c) only chaplains and social workers
d) all members of the care team
2. The Model of Interdisciplinary Collaboration includes the following principle(s):
a) New professional activities are created for each team member.
b) Team members work dependently.
c) Team members regularly reflect and evaluate their collaborative process.
d) Both A and C.
3. What is the purpose of meeting as a team?
a) To discuss organizational policy
b) To establish team hierarchy
c) To facilitate team collaboration
d) To vote
4. Which of the following is most likely a result of groupthink?
a) Team members rationally assess various courses of action.
b) Team members work collaboratively to develop a plan of care unique to the patient/family.
c) Team members effectively discuss and resolve conflicts as they arise.
d) Group members begin to think in terms of unanimity
5. Self-censorship, and structural characteristics are all potential contributing factors to a communication phenomenon called ______.
a) Collaboration
b) Groupthink
c) Shared power
d) Conflict
6. Which of the following is not involved in the principle of interdisciplinary collaboration—collective goal ownership?
a) Team members perceive the patient and family as an integral part of the interdisciplinary team.
b) Team members come to share a common purpose.
c) Team members working on the same plan of care do not need to meet.
d) Team members share the responsibility of producing holistic end-of-life care for patients and family members.
7. Identify one way to combat Groupthink during team meetings:
a) Your team should designate a team member to play devil’s advocate
b) Limit your meeting time to increase efficiency
c) Place your most senior staff member as the team leader
d) Avoid sharing team member feelings about patient care
ANSWER KEY - Post-Lecture Knowledge Assessment Items
1. Answer: D
Rationale: Interdisciplinary team members are united by psychospiritual care, the underlying care required to meet the needs of patients’/families’ personal labor with terminal illness that often brings psychological suffering and spiritual realities. Psychospiritual care is complex, ambiguous, and cannot be attended to best by any one core team member.
2. Answer: D
Rationale: Based on the model, interdisciplinary collaboration consists of: (1) interdependence and flexibility; (2) newly created professional activities; (3) collective ownership of goals; and (4) reflection on process.
3. Answer: C
Rationale: The team meeting facilitates communication that produces an interdisciplinary plan of care for each patient/family. During the meeting teams form a single care plan wherein team members share responsibilities and implement their part of the plan. Ideally, each member provides information about the patient’s plan of care and the patient’s family is addressed with a discussion.
4. Answer: D
Rationale: Groupthink can occur when “deeply involved” cohesive group members engage in a mode of thinking that centers on unanimity over the motivation to rationally assess various courses of action. In these groups, the focus of groupwork is on group cohesion and group relations rather than decision-making; groupthink results in poor decision-making and/or lack of collaboration.
5. Answer: B
Rationale: Structural constraints that influence group cohesion and the ability to collaborate include manageable caseloads, an organizational culture that supports and encourages interdisciplinary collaboration, administrative support, professional autonomy, and the time and space for collaboration to occur. Self-censorship occurs when group members elect not to share their opinion to counter a prevailing thought in the group. Structural characteristics and situational contexts also influence group cohesion, resulting in Groupthink. In these groups, the focus of groupwork is on group cohesion and group relations rather than decision-making; groupthink results in poor decision-making and/or lack of collaboration.
6. Answer: C
Rationale: Collaboration is produced through a collective ownership of goals as team members have a shared responsibility for producing quality holistic care. While each discipline has its own goal of care, team members have a shared common purpose.
7. Answer: A
Rationale: Appointing a team member to serve as devil’s advocate can help the team consider all options and enhance their ability to engage in creative problem solving.
1
The COMFORT Communication Assessment Scale
Module 7 - Team
Student:______
Element / Unacceptable(1) / Poor
(2) / Acceptable
(3) / Good
(4)
Assesses and evaluates the team environment / No assessment of team environment or infrastructure / Acknowledgement of team environment and infrastructure / Collection of information about team environment and infrastructure / Evaluation of professional roles, personal and structural characteristics, and history of collaboration to assess and plan for interdisciplinary collaboration and/or groupthink
Employs team-based hospice and palliative care / One health care professional determines the patient plan of care / Team members with biomedical expertise participate in the planning process / Most team members participate in the planning process / All members of interdisciplinary team participate in the planning process and employ distinctive attention to patient and family quality of life
Engages in constructive conflict / Avoids conflict / Enacts a recurring pattern of negative conflict between particular team members resulting in a pattern of withdrawal / Understands the growth and productivity of constructive goal disagreements and avoids Groupthink. / Welcomes and approaches conflict by engaging in active listening, defining the problem, asking open questions, clarifying responses, paraphrasing and reframing the discussion
Demonstrates collaborative communication skills / Fails to demonstrate collaborative communication skills / Inconsistently uses collaborative communication skills / Frequently uses collaborative communication but does not evaluate team goals or satisfaction / Consistently employs active contributions, fosters opposing viewpoints, and collectively evaluates team goals and communication processes
Practices interdependence and flexibility / Reluctance to engage in care tasks beyond expertise / Minimal engagement in care tasks beyond expertise / Substantive engagement of multiple roles and responsibilities / Regular sharing of information, tasks and role responsibilities, with aims to achieve care outcomes through versatility
Creates new tasks and responsibilities / No recognition of individual team member expertise / Members are available to one another at limited times / Members share information and tasks with the goal of providing optimal care for the patient/family / Members demonstrate interdependence through accessibility, information sharing, and task accomplishment, which maximizes member expertise
Performs reflection and evaluation / No reflection about team processes and communication / Awareness of poor team communication / Identifies shortfalls in team processes and communication practices / Recognizes shortfalls of team processes, establishes collaborative team goals, and evaluates team communication practices
Demonstrates interdisciplinary collaboration through task and relational communication / Emphasizes individual professional expertise rather than resources and information sharing / Attends to task communication predominantly / Incorporates task and relational communication across most team members. / Shares in success and failure, provides insights on communicating with patients/families (task), supports team members, shares in workplace stress (relational)
Comments to be filled out by students following recorded encounter: