Question

PHC214

Consider the tasks for team leaders in Table 8-1. Answer the following questions about a time when you served on a healthcare team (3 paragraphs). Compose your paper in MS Word.

In what ways did the leader create the conditions that enabled the team to function?

How did the leader build the team’s capacity to do its work?

To what extent did the leader coach the team to optimize its performance?

Review the methods for improving team decision making in Table 9-3 and answer the following questions (2 paragraphs).

Which method do you feel is most effective for the healthcare teams on which you serve? Provide your rationale.

Which method would you like to try, and under what circumstances? Provide your rationale.

the textbook (Understanding Teamwork in Health Care 1st Edition)

the link of the TextBook

https://www.dropbox.com/s/7py4azaz6lr7ksi/Understanding%20Teamwork%20in%20Health%20Care%20Book.pdf?dl=0

To what extent did the leader coach the team to optimize its performance?

Answer 1

effective teamwork is now globally recognized as an essential tool for constructing a more effective and patient-centred health care delivery system. Identifying best practices through rigorous research, which can provide data on optimal processes for team-based care, is subject to identification of the core elements of this system. Once the underlying principles and core values are agreed and shared, researchers will be able to more easily compare team-based care models and commissioners will be able to promote effective practices . Therefore, a number of designated health professional bodies worldwide have come out with recent statements to define teams and their roles and the characteristics of a successful team . They elaborated on essential values and principles of a team based health care, to share a common ground on this very hot topic. These have all been highlighted in this article. The potential challenges, and practical tips on how to successfully approach the task, have also been explored and included alongside proposed implementation strategies.

The Development and Characteristics of a Successful Health Care Team

Different types of teams can be identified in health care systems [2]:

Core teams

These are directly involved in caring for the patient.

They usually consist of team leaders and members who are direct-care providers such as nurses, dentists, pharmacists, doctors, assistants…etc. They also include case managers.

Coordinating teams

The group responsible for operational management, coordinating functions and resource management for core teams.

Contingency teams

Formed to deal with emergencies or specific events (e.g. cardiac-arrest teams, disaster-response teams,. etc).

Ancillary teams/services

The group supports services that facilitate patient care such as cleaners or domestic staff.

Support services and administration

Those who provide indirect, task-specific services in a health-care facility support services. It includes secretaries and the executive leadership of a unit or facility. This team has 24-hour accountability for the overall functioning of the organization. In order for any team to form and develop in a way that makes it coherent, effective and strong enough to face future challenges, research have shown that it usually passes through the following stages [2]:

Forming: Typically characterized by ambiguity and confusion. Team members may be unclear about tasks at this stage. They have not yet chosen to work together and may communicate in a superficial and impersonal manner.

Storming: A difficult stage when there may be conflict between team members and some rebellion against the assigned tasks. Team members may get frustrated here when do not progress well in the tasks.

Norming: Open communication between team members is established and the team starts to confront the task at hand. Generally accepted procedures and communication patterns are established.

Performing: The team focuses all of its attention on achieving the goals. The team is now close and supportive, open and trusting, resourceful and effective.

After being formed and continue to develop, Healthcare teams interact dynamically and have the common goal of delivering health services to patients. In order to succeed, the team members need to share

certain characteristics, which include [2]:

• Possess specialized knowledge and skills and often function under high-workload conditions.
• Know their role and the roles of others in the team(s) and interact with one another to achieve a common goal.
• Act as a collective unit, as a result of the interdependency of the tasks performed by team members.
• Possess specialized and complementary knowledge and skills.
• Take decisions.

Improving decision-making in groups through training

Making decisions about the care of patients is an essential task in health care. For each patient, many decisions have to be made. In the emergency room, for example, a doctor should decide which patient to see first, decide whether an image diagnostic should be made, and decide how the injury of this specific patient should be treated. This decision-making process can be further complicated by uncertainty about probabilities and outcomes. Nevertheless, a decision has to be made, regardless of the amount of evidence and the extent of uncertainty. Additional features of group decision-making in health care are particularly present in the front line, when resources are in short supply, time constraints apply and shortcuts are being sought. These situations are described by [Reason 1990] as when “the cognitive reality departs from the formalized ideal”

suggest that the quality of the decision-making process depends on factors such as the availability of data and information and the expertise of the decision-maker. However, the final outcome of the decision is also affected by situational factors (e.g. time pressure) and, in case of group decisions, by intragroup factors like active leading of the decision-making process and explicit or implicit communication of uncertainty. Some of the shortcomings observed in our previous studies regarding behavior could be suitably addressed by non-technical skill (NTS) training. The implementation of formal training in teamwork for health-care workers is also a specific recommendation of the Institute of Medicines report, To Err is Human: Building a Safer Healthcare System. Team Training is currently suggested as part of a comprehensive Patient Safety Plan published by the Joint Commission Accreditation of Health Care Organizations (JCAHO), the regulatory agency charged with hospital accreditation in the USA. Pat Croskerry, professor in emergency medicine at Dalhousie University (Canada), an important researcher in the field of patient safety summarized, that one thing they know from research is that experienced clinicians perform better than novices. He points to the fact that practice at clinical decision-making appears to improve performance and calls for “adequate training in critical thinking, problem solving, and a working understanding of the multiple cognitive and affective biases to which they might be vulnerable

Methods of Decision of Making

Risky-shift [Wallach et al. 1962]:

when people are in groups, they make decisions about risk differently from when they are alone; in the group, they are likely to make riskier decisions, as the shared nature of the risk makes the individual risk less.

Groupthink [Janis 1972]:

occurs when a homogeneous highly cohesive group is so concerned with maintaining unanimity that they fail to evaluate all their alternatives and options; groupthink members see themselves as part of an in-group which is working against an out-group, which is opposed to their goals.

Shared-information bias/common-knowledge-bias [Stasser and Titus 1985]:

the tendency for group members to spend more time and energy discussing information that all members are already familiar with, and less time and energy discussing information that only some members are aware of; consequences related to poor decision-making can arise when the group does not have access to unshared hidden information profiles in order to make a well-informed decision.

Curse-of-expertise [Camerer et al. 1989]:

the difficulty that results from knowing something; it is the “knowing” of something that makes it difficult to “readily re-create” the state of mind of not knowing and thus understand other group members’ reactions.

Social loafing [Latané et al. 1979]:

the tendency for people to exert less effort when being part of a group working on a common task (individuals can feel that their contributions don’t matter, and thus decrease their effort and contributions).

Practical strategic approach

“The context for health care and support is changing. Most significantly, with people living longer, we have a greater number of older patients and people to support, many with multiple and complex needs, and with higher expectations of what health, care and support can and should deliver. Delivering health and care support and services involves us working with people in a new partnership, offering and engaging with people in making choices about their health and care, and supporting ‘no decision about me without me” [3]. These are statements made by the senior NHS nurses, Midwifery staff and other health related professionals in the UK who have engaged a wide range of professionals and patients in assessing satisfactions and suggestions of these team members in quality of delivered care. Accordingly, they put a strategy to meet the rapidly progressing demands on the service. The purpose of the engagement was two-fold. Firstly, they wanted to get wider views on 6Cs: care, compassion, competence, communication, courage and commitment. They wanted to test whether these would resonate with staff and patients and form a common language of their vision. Secondly, they wanted to test responses to six areas of action that (underpinned by the 6Cs of value and behaviour) which will enable ongoing improvements in care and services for all patients and service users [3]. The strategy addressed equality issues under the Equality Act 2010, considering it from the point of view of both the people receiving care and those giving it. The six areas of action that were supposed to deliver their vision included [3]:

• Action area one: Helping people to stay independent, maximise well-being and improving health outcomes.
• Action area two: Working with people to provide a positive experience of care.
• Action area three: Delivering high quality care and measuring the impact.
• Action area four: Building and strengthening leadership.
• Action area five: Ensuring we have the right staff, with the right skills, in the right place.
• Action area six: Supporting positive staff experience.

Practical tips for health-care professionals [2]

• Always introduce yourself to the team
• Clarify your role
• Use objective (not subjective) language
• Learn and use people’s names
• Be assertive when required
• Read back/close the communication loop
• State the obvious to avoid assumptions
• Ask questions, check and clarify
• Delegate tasks to specific people, not to the air
• If something doesn’t make sense, find out the other person’s perspective
• Always do a team briefing before starting a team activity and a debrief afterwards
• When in conflict, concentrate on “what” is right for the patient, not “who” is right/wrong?
• And remember: “Teamwork doesn’t just happen”. It requires [2]:
  • – An understanding of the characteristics of successful teams
  • – Knowledge of how teams function and of ways to maintain effective teams.

Patient satisfaction

A sensitive indicator for a successful health delivered teamwork is Patient satisfaction, which requires:

C.P.R.

C: Compassionate Communication

P: Patient information/Pain management

R: Response

For a high patient satisfaction, the delivery of the following is critical [4]:

• Communicate to the patient who you are, what you do and who are the members of the team.
• Inform the patient daily what their plan is for the day and set expectations – write on the whiteboard so they can see it and revise as they need.
• Inform the patient and family if they have any questions, concerns to call – you are there to help.
• Encourage the patient to communicate how they are doing in managing their pain – their comfort is vital!
• Include the patient – tell them what you are doing in the room, even the simple things like adjusting IV’s or taking a vital sign. The more you communicate about what you are doing, the more comfortable they will be with asking questions.