What Does Good Teamwork Look Like?
Executive Summary:
- Most healthcare sites work in silos
- Good teamwork improves efficiency and effectiveness at care sites
- Teamwork ingredients include knowledge of the work of others and respect for the work of others
- Understanding the work of those you work with daily leads to huge productivity gains
- Respect for the work of others greatly improves effective communication
Those of us who love sports know that for sports that involve teams that teamwork is essential. Those teams with the most developed teamwork skills are the most successful. The San Francisco Giants have won 2 of the last 3 World Series because they work so well together as a team.
Teamwork has been a weakness in healthcare for a long time. I do know of some sites where teamwork is well developed but for most sites there is much work that needs to be done to develop effective teamwork. I know that most of my readers know exactly what is meant when “silos in healthcare” is brought up. Such silos are evidence of poor teamwork development at a care site.
Teamwork in healthcare is becoming essential as payment models change. As reimbursement to providers is becoming based upon quality outcomes, effective and efficient care is becoming more important. Efficient—all the parts work well together. Effective—the right care delivered without any excess. It takes teamwork to be efficient and effective. Accountable care organizations and patient-centered medical homes are two examples of medical organizations focusing on efficient and effective care based upon teamwork.
Two recent articles from Modern Healthcare describe efforts in medical training to improve the teamwork skills of physicians. A February 4, 2013 article titled “Obamacare Transforms Med School” describes how first year medical students at Weill Corrnell Medical College work with nurses, nurse practitioners, social workers, health aides and physicians assistants in order to learn how to work effectively with clinical staff. Another article titled “AMA Wants Docs Trained for Teams, Safety” describes the efforts of AMA to increase teamwork in provider settings. The AMA is allocating $10 million in grants to medical schools to develop curriculum that focuses on team-based care and patient safety.
Since teamwork is becoming important in healthcare, we need to examine some of the characteristics of teamwork. Teamwork is very complex. Could anyone completely describe the excellent teamwork of the San Francisco Giants? I do not think so. However, you recognize it when you see it. I would like to illustrate what I believe are two important ingredients of teamwork: knowledge and understanding of the work of other staff and clinicians at a site and respect for the work of other staff and clinicians as reflected in communication.
To be efficient at a healthcare site each staff member should be as knowledgeable as possible of the work of other staff and of the key processes in which they are involved. At smaller ambulatory sites, such as primary care physician only sites or multispecialty sites, physicians, nurses, billers, front-office staff and management should be familiar with the work of each other. At larger sites such as hospitals, this is not possible but staff members should be knowledgeable of the work of those with whom they make contact every day.
Let me give you some examples of how this kind of knowledge improves efficiency. If a physician at a primary care site understands the billing and coding processes to some degree, then he or she will make certain that the patient visit forms and patient history contain the key elements so that coders can bill the payer to level of service provided. Revenue at a site improves as physicians better understand billing and efficiency increases as denials by payers decrease.
It is not easy for staff to learn about the work of others at their site. In an article in the 2010 edition of Health Affairs titled “How Teams Work—Or Don’t—In Primary Care: A Field Study of Internal Medicine Practices” the author states physicians and staff spend little time with each other daily. Thus, they do not see each other working. This can be overcome by actually watching each other work. The Japanese call this gemba—go and see how the work is being done. With my clients I take the time to go and see the front line staff at work. With this knowledge I am much more capable of providing data analysis that is relevant to their work and in helping create processes that are more efficient.
Another characteristic of good teamwork is the respect that each team member has for the other team members. Each team member values the work of the others. Respect for others leads to effective communication, which helps avoids errors in the delivery of care. There is no finger pointing if mistakes are made. Respect means that ideas from any team member that help overcome challenges in the care setting are valued.
At the University of Michigan Hospital there is a well-defined process for handing off a patient from post-op to a floor care unit. A team from post-op who were in charge of caring for the patient and a team from the floor unit meet at a designated exchange time at the floor unit. The two teams gather around the patient and discuss the current status of the patient and the care plan for the patient on the unit. Because of the respect that team members have for each other and for the process, communication is effective and efficient; all questions are taken seriously and answered. Few errors occur due to the handoff process.
It is time to take a few minutes to assess the quality of teamwork at your site. How well do you understand the work of others at your setting? Do you know their job descriptions? How effective is communication at your site? Is there a forum for sharing ideas about improving the work processes? Is there finger pointing when mistakes are made? If you are a leader at your site, then it is important that you work to improve teamwork. Patient outcomes will steadily improve and improved efficiency will improve the earnings margin.