More Than a Buzzword: Teaching the Team Approach in Healthcare
By Jennifer Larson, contributor
Team-based care is spreading throughout our nation’s health system, incentivized by healthcare reform and pressures for improved cost containment, patient safety, quality of care and outcomes. But teamwork cannot just be a buzzword, nor is it simply grouping together physicians, nurses and allied professionals in a unit. The key to achieving true interprofessional teamwork is fully integrating it into an organization’s culture from the top down.
Teamwork is not solely a consequence of co-locating individuals together,” wrote Heidi B. King, MS, CHE, and James Battles, PhD, et. al. in a paper about TeamSTEPPS for the Agency for Healthcare Research and Quality. “Rather, it depends on a willingness to cooperate, coordinate, and communicate while remaining focused on a shared goal of achieving optimal outcomes for all patients.”
TeamSTEPPS, or Team Strategies and Tools to Enhance Performance and Patient Safety, was launched in 2006 as one response to the patient safety concerns voiced in the Institute of Medicine’s landmark 1999 report To Err is Human. The model was designed as a national evidence-based standard for team training in healthcare and is based on five key principles: team structure, communication, leadership, situation monitoring, and mutual support.
Since then, there have been additional developments that have continued to drive an emphasis on interprofessional education and collaboration, including a number of provisions in the Affordable Care Act and the IOM’s 2010 report titled The Future of Nursing, which called for interprofessional education for nurses.
In order for organizations to achieve the Triple Aim—improve the patient experience of care, improve population health and reduce healthcare per capita costs—they really must embrace the team approach, said Esther Emard, MSN, RN, consultant faculty to the American Association of Colleges of Nursing (AACN) and a retired chief operating officer of the National Committee for Quality Assurance (NCQA).
Two examples of programs recently undertaken in an effort to get people from a variety of disciplines to fully embrace the team mindset are the Room of Errors program at University of Virginia Medical Center and the “resident boot camp” at Rochester General Hospital in Rochester, New York.
Room of errors
It’s easy to get so busy on the job that you almost forget how valuable your fellow team members are. The team-building program recently launched at the UVA Medical Center, dubbed “Room of Errors,” reminded participants just how crucial collaboration and teamwork are to keeping their patients safe.
Julie Haizlip, MD, and her colleagues set up a simulation in an unused patient room and invited people who work in the pediatric intensive care unit to participate in an exercise designed to see how many errors they could spot. The participants were put into teams, then sent into a simulation room to write down all the errors they noticed without talking to anyone else.
“As you’d expect, the respiratory therapist would walk right in and walk up to the respirator,” Haizlip said. “The pharmacist would walk in and walk right to the medications.”
Afterward, the team members sat down and compared lists and marveled over the errors that other spotted that they had missed.
“It was heartening to hear people who already value each other recognize an even greater value in their function as a team,” said Haizlip.
A team of residents, nurse practitioner students, pharmacy residents and respiratory therapists joined two nurses (one new, one experienced) to participate in a new teamwork boot camp at Rochester General Hospital. They worked through simulated scenarios in three rotation areas—critical care, acute care and ambulatory care—and learned how to work well together in a high-stress situation.
For example, one scenario dealt with the death of a patient. A physician was needed to pronounce the patient, but the only person available was a new resident who’d never done it before, while the nurse had to wait awkwardly with the family. Through the exercise, they learned the challenges that each team member was going through. That really opened their eyes and made them appreciate each other in new ways, said clinical nurse specialist Ginny Riggall, DNP, RN, who helped launch the program.
Afterward, they talked about their efforts to cooperate, including using methods designed to improve communication Riggall said she hopes that this type of exercise has really helped the participants both understand other people’s roles and feel more secure in their own. That will help them more fully embrace the team approach.
“It’s going to become part of their culture,” Riggall said.
Understanding each other’s roles
Brenda Zierler, PhD, RN, a professor at the University of Washington School of Nursing, said she believes it’s particularly important for students to learn more about the roles and scopes of other health professions. Since many are members of the Millennial generation, they’re already accustomed to working in teams. But they may not fully grasp what other clinicians are trained to do.
That’s crucial, she explained, because team leaders may vary, depending on the situation and the various members’ skill-sets and knowledge of particular conditions and patient groups—what TeamSTEPPS refers to as “situational leadership.” For example, the person running the code needs to be the person with the best advanced cardiac life support training, not just a person with a specific set of letters after his or her name.
“You want an expert team, not a team of experts, as they say,” said Zierler.
John Owen, Ed.D, MSc, associate director for UVA’s Center for Academic Strategic Partnerships for Interprofessional Research and Education (ASPIRE), noted that it’s important to recognize that there will be different levels of knowledge and training on a team—and it’s possible for those with more to dominate the team and possibly hinder effective collaboration.
“One way to deal with this dynamic is to emphasize through training that effective collaboration is enhanced when healthcare professionals recognize the limitations of their professional expertise and the value of others’ professional expertise,” he said. “This recognition can occur when each professional knows and uses the expertise and capabilities of the other healthcare professionals, and when the focus is on the patient and not on each other’s roles and responsibilities.”
Experts stress that organizations must build a culture based on the interdisciplinary team approach, which includes a commitment to ongoing team-building and team-training efforts.
The specific strategies may vary by the type and size of the institution, but they all must be committed to establishing a framework and then making it sustainable over the long run, said Emard.
“If they’re one-time things, and you don’t have a way to continuously refresh the training, refresh the knowledge, refresh the skills,” she said. “You run the risk of it being a one-time flavor-of-the-month, so to speak.”