Healthcare providers use teams to provide care for their patients: in emergency departments, in admission and discharge and on floors with inpatients where nurses comprise care teams. The effectiveness of these teams vary from one team to another, based upon the understanding of teamwork and quality of leadership. Although the use of teams for patient care and services are common, the use of teams to patiently and systematically solve problems or implement new programs is either inconsistent or not present at all. This is especially true in outpatient settings.
The silo mentality is common in healthcare settings. Physicians, especially in ambulatory settings, have little interaction with nurses. Administrators have limited day-to-day contact with clinicians or staff in large organizations. In the May 2010 edition of Health Affairs, which focused on the patient-centered medical home, the authors of “How Teams Work—Or Don’t—In Primary Care: A Field Study of Internal Medicine Practices” there is a description of three major groups found at these sites and the lack of communication between them. The first group,the physicians, spend their day going in an insular fashion from patient to patient, scheduled in neat little 15 minute blocks. The support staff—front office administrators, nurses, nurses aides, coders and practice manager—spend their time supporting the efforts of the physicians without making much significant contact with them. The third group—the patients—seem to go from waiting room to discharge as lambs being herded from one pasture to another, spending most of their time waiting and then spending a few precious moments with their physician. With this silo mentality, is it any wonder that healthcare organizations often fail to coordinate changes they are attempting in order to better meet the needs of their market and their patients?
The silo mentality is not sustainable. Payment models based upon quality of outcomes and patient satisfaction are replacing fee for service. Recently I read on Modern Healthcare that it is expected that by 2017 or 2018 about 80% of reimbursement will come from models other than fee for service. Thus, providers need to adopt new care models in order to stay in business. Can one or two leaders or officers at a care site bring about these changes without the assistance of staff and clinicians working in teams? Perhaps, but not without a lot stress and lack of effectiveness.
I believe that the most effective and efficient way to bring about necessary changes, to improve the quality of care and to adopt new processes is to use a team approach. Let me give a couple of examples. Recently on the Patient Safety and Quality Healthcare website (www.psqh.com) there was an article about how nurse educators could get floor staff to be consistent and conscientious about applying good safety standards in care (“How to Influence Accountability). The author gave strategies how to work with the floor nurses as team members so that they would adopt good care models, using approaches that fostered a culture of quality care.
The second example is taken from the Medical Group Managers Associations tool book for ICD-10 implementation. The book begins by stating the first step is to form a team made up of representatives from various departments at the care site—clinicians, managers, finance, billing, coding and administration. This would be a typical team at a large provider site; smaller sites need not have as many team members. This team is charged with overseeing the steps in the implementation: assessment of current state, plan of education for staff, updates in hardware and software, budgeting for the implementation and testing of the new system. The implementation is very complex and teamwork and team leadership is necessary.
One should not expect to put a team together and expect it to automatically accomplish the tasks or objectives set for it. There are several ingredients that are necessary for teamwork to be effective. To be effective they must be well organized and run. Based upon my experience in working with a variety of teams in a variety of settings and based upon discussions with colleagues along with research, I believe that there are several elements that are necessary for effective team meetings. These are:
- Strong leadership
- Preparation
- An agenda
- Staying focused
- Participation by all team members
- Decision rules
- A time limit
There are many skills required of a team leader. Besides controlling disruptions, he must also encourage all to participate. Someone who may be timid to speak should be encouraged; his or her idea may be one of the most innovative and important. When I am leading a meeting before I close discussion of a topic I make sure that I personally address any who have been quiet and ask if they have any comments. If not, I may ask them to summarize the previous discussion so that they will be involved.
As healthcare moves forward over new landscapes of care models and new reimbursement models, teamwork will be indispensable. If your site has little experience in teamwork, I think that forming teams using the discussed guidelines above with objectives that are not too challenging can help foster a culture of positive interaction that can lead to formation of teams with more challenging agendas and goals. Failing to use a team approach will prove in the end to be frustrating and not nearly as productive, as I have seen many times in my work.