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Topic 4: Being an effective team player - WHO

119 Topic 4: Being an effective team playerWhy teamwork is an essential elementof patient safety effective teamwork in health-care delivery canhave an immediate and positive impact on patientsafety [1]. The importance of effective teams inhealth care is increasing due to factors such as: (i)the increasing complexity and specialization ofcare; (ii) increasing co-morbidities; (iii) increasingchronic disease; (iv) global workforce shortages;and (v) safe working hours initiatives. Paul , MD, senior vice president of the JointCommission has observed, Our challenge .. isnot whether we will deliver care in teams but ratherhow well we will deliver care in teams. [2]A typical example of complex care involvingmultiple teams would be a pregnant woman withdiabetes who develops a pulmonary embolus her medical care team includes: an obstetrician,an endocrinologist and a respiratory doctors and nurses looking after her will bedifferent during the day compared to at night andon the weekend.

focused team whose mission is to create efficient, safe, comfortable and clean health-care environments, which impact the patient care team, market perception, operational efficiency and patient safety. 6. Administration Administration includes the executive leadership of a unit or facility, and has 24-hour accountability

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Transcription of Topic 4: Being an effective team player - WHO

1 119 Topic 4: Being an effective team playerWhy teamwork is an essential elementof patient safety effective teamwork in health-care delivery canhave an immediate and positive impact on patientsafety [1]. The importance of effective teams inhealth care is increasing due to factors such as: (i)the increasing complexity and specialization ofcare; (ii) increasing co-morbidities; (iii) increasingchronic disease; (iv) global workforce shortages;and (v) safe working hours initiatives. Paul , MD, senior vice president of the JointCommission has observed, Our challenge .. isnot whether we will deliver care in teams but ratherhow well we will deliver care in teams. [2]A typical example of complex care involvingmultiple teams would be a pregnant woman withdiabetes who develops a pulmonary embolus her medical care team includes: an obstetrician,an endocrinologist and a respiratory doctors and nurses looking after her will bedifferent during the day compared to at night andon the weekend.

2 In a teaching hospital, there willbe teams of doctors for each specialty area, all ofwhom need to coordinate care with each other,the nursing staff, allied health providers and thepatient s primary care Topic acknowledges that medical studentsare unlikely in their early years to have participatedas a member of health-care team themselves andoften have little understanding of how teams areconstructed and operate effectively. We aim in thistopic to draw on students' past experiences ofteamwork as well as look forward to the teamsthey will increasingly participate in as later yearstudents and practising clinicians. Keywords: team , values, assumptions, roles andresponsibilities, learning styles, listening skills,conflict resolution, leadership, objectives: understand the importance of teamwork inhealth-care; know how to be an effective team player ; recognize you will be a member of a numberof health-care teams as a medical outcomes: knowledge andperformanceWhat students need to know (knowledgerequirements) Knowledge requirements in this module include a general understanding of: the different types of teams in health care; the characteristics of effective teams; the role of the patient in the students need to do (performancerequirements) Use the following teamwork principles topromote effective health care including: mindful of how one s values and assumptionsaffect interactions with others.

3 Mindful of the of team members and howpsychological factors affect team interactions; aware of the impact of change on teams; include the patient in the team ; use communication techniques; resolve conflicts; use mutual support techniques; change and observe behaviours. WHAT STUDENTS NEED TO KNOW(KNOWLEDGE REQUIREMENTS)The different types of teams in healthcareWhat is a team ? The nature of teams is varied and complex,they include: (i) teams that draw from a singleprofessional group; (ii) multiprofessional teams; (iii)653421120 Topic 4: Being an effective team playerteams that work closely together in one place; (iv)teams that are geographically distributed; (v)teams with constant membership; and (vi) teamswith constantly changing of the type and nature of the teamthey can be said to share certain include: team members have specific roles and interacttogether to achieve a common goal; [3] teams make decisions; [4] teams possess specialized knowledge andskills and often function under conditions ofhigh workloads; [5,6] teams differ from small groups in as much asthey embody a collective action arising out oftask interdependency [7].

4 Salas defines teams as a distinguishable set oftwo or more people who interact dynamically,interdependently, and adaptively towards acommon and valued goal/objective/mission, whohave been each assigned specific roles orfunctions to perform, and who have a limitedlifespan of membership [8].Examples of teams include choirs, sportingteams, military units, aircraft crew and emergencyresponse teams. What different types of teams are foundin health care? There are many types of teams in healthcare. They include labour and delivery units, ICUs,medical wards, primary care teams in thecommunity, teams assembled for a specific tasksuch as an emergency response team ormultiprofessional teams such as multidisciplinarycancer care teams that come together to plan andcoordinate a patient s care. Teams in health care can be geographically co-located, as in an ICU or surgical unit, ordistributed as in a multidisciplinary cancer team orprimary health-care can include a single discipline or involvethe input from multiple practitioner types includingdoctors, nurses, pharmacists, physiotherapists,social workers, psychologists and potentiallyadministrative staff.

5 The role these practitionersplay will vary between teams and within teams atdifferent times. Roles of individuals on the teamare often flexible and opportunistic such as theleadership changing depending on the requiredexpertise or the nurse taking on the patienteducation role as they are the ones that have themost patient support of patient-centred care and patientsafety, the patient and their carers are increasinglybeing considered as active members of thehealth-care team . As well as Being important interms of issues such as shared decision makingand informed consent, engaging the patient as ateam member can improve the safety and qualityof their care as they are a value information sourcebeing the only member of the team who is presentat all times during their care. The TeamSTEPPS [9] programme developed inthe United States identifies a number of differentbut interrelated team types that support anddeliver health teams Core teams consist of team leaders and memberswho are involved in the direct care of the team members include direct care providers(from the home base of operation for each unit)and continuity providers (those who manage thepatient from assessment to disposition, forexample, case managers).

6 The core team , suchas a unit-based team (physician, nurses,897121 Topic 4: Being an effective team playerphysiotherapist, and pharmacist) is generallybased where the patient receives care. 2. Coordinating teamsThe coordinating team is the group responsiblefor: day-to-day operational management; coordination functions; resource management for core teams. 3. Contingency teams Contingency teams are: formed for emergent or specific events; time-limited events ( cardiac arrest team ,disaster response teams, rapid responseteams); composed of team members drawn from avariety of core teams. 4. Ancillary servicesAncillary services consist of individuals such ascleaners or domestic staff who: provide direct, task-specific, time-limited careto patients; support services that facilitate care of patients; are often not located where patients receiveroutine services are primarily a service deliveryteam whose mission is to support the core does not mean that they should not share thesame goals.

7 The successful outcome of a patientundergoing surgery requires accurate informationon catering and instructions in relation to nil bymouth orders so that a patient does notinadvertently receive a meal that may place themat risk of choking. In general, an ancillary servicesteam functions independently, however, there maybe times when they should be considered as partof the core team . 5. Support services Support services consist of individuals who: provide indirect, task-specific services in ahealth-care facility, are service-focused, integral members of theteam, helping to facilitate the optimal health-care experience for patients and their roles are integrated in that they manage theenvironment, assets and logistics within a services consist primarily of a service-focused team whose mission is to create efficient , safe , comfortable and clean health-careenvironments, which impact the patient careteam, market perception, operational efficiencyand patient safety.

8 6. Administration Administration includes the executive leadershipof a unit or facility, and has 24-hour accountabilityfor the overall function and management of theorganization. Administration shapes the climateand culture for a teamwork system to flourish by: establishing and communicating vision; developing and enforcing policies; setting expectations for staff; providing necessary resources for successfulimplementation; holding teams accountable for teamperformance; defining the culture of the do teams improve patient care?Medical practice has traditionally focused onthe individual physician as solely responsible for apatients care. However, patients today are rarelylooked after by just one health safety, in the context of a complex medicalsystem, recognizes that effective teamwork isessential for minimizing adverse events caused bymiscommunication with others caring for thepatient and misunderstandings of their roles andresponsibilities.

9 The link between non-technical skills such as10122teamwork and adverse events is now wellestablished [10,11], as is the increasing burden ofchronic disease, co-morbidities and ageingpopulations that require a coordinated andmultidisciplinary approach to care [12]. Baker et al. [1], in a major review of team training,contended that the training of health professionalsas teams constitutes a pragmatic, effectivestrategy for enhancing patient safety and reducingmedical errors . Teamwork has been associated with improvedoutcomes in areas such as primary care [13] andcancer care [14]. Teamwork has also beenassociated with reduced medical errors [15,16].As summarized in Table 12, improving teamworkcan have benefits beyond improving patientoutcomes and safety that include benefits for theindividual practitioners in the team , the team as awhole as well as the organization in which theteam resides (adapted from Mickan, 2005) [12].

10 How do teams form and develop? Considerable research into how teams formand develop has been conducted in other highstakes industries. As detailed in Table 13,Tuckmann [17] identified four stages of teamdevelopment: forming, storming, norming 4: Being an effective team playerOutcome measures of effective teamworkIndividual benefitsOrganizational benefitsTeam benefitsPatientsTeam membersReduced hospitalizationtime and costsImproved coordination ofcareEnhanced satisfactionEnhanced job satisfactionReduced unanticipatedadmissionsEfficient use of health-careservicesAcceptance of treatmentGreater role clarityBetter accessibility forpatientsEnhanced communicationand professional diversityImproved health outcomesand quality of careReduced medical errorsEnhanced well-beingTable 12: Measures of effective teamwork (adapted from Mickan, 2005)StageDefinitionFormingTypically characterized by ambiguity and confusion when the team first forms.


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