Lecture for 3rd Year Medical
Students Faculty of Medicine King Fahad Medical City Riyadh on September 17,
2014 by Professor Omar Hasan Kasule Sr.
LEARNING
OBJECTIVES
- To understand the importance of teamwork in health-care;
- To know how to be an effective team player;
- To recognize you will be a member of a number of health-care teams as a medical students
- To identify the attributes of a successful team
- To facilitate the operation of small-group learning
- To maximize the power of teams to improve learning
Keywords: Team-player, Small-group learning, Team, values, assumptions, roles and responsibilities,
learning styles, listening skills, conflict resolution, leadership, effective
communication.
LEARNING OUTCOMES: knowledge and performance
LEARNING OUTCOMES: knowledge and performance
- The different types of teams in health care;
- The characteristics of effective teams;
- The role of the patient in the team.
DEFINITION OF A TEAM
Salas defines teams as a “distinguishable set of two or more
people who interact dynamically, interdependently, and adaptively towards a common
and valued goal/objective/mission, who have been each assigned specific roles
or functions to perform, and who have a limited lifespan of membership”
TYPES OF TEAMS
- Teams that draw from a single
- Professional group;
- Multi-professional teams
- Teams that work closely together in one place;
- Teams that are geographically distributed;
- Teams with constant membership;
- Teams with constantly changing membership.
- One task temporary teams
CHARACTERISTICS OF TEAMS
- Team members have specific roles and interact together to achieve a common goal
- teams make decisions;
- teams possess specialized knowledge and skills and often function under conditions of
- High workloads
- teams differ from small groups in as much as they embody a collective action arising out of task interdependency
TEAMS THAT SUPPORT
HEALTH CARE
- Core teams: direct care
- Coordinating teams: operational management
- Contingency teams: for emergent or specific events
- Ancillary services: eg cleaners
- Support services: indirect tasks
- Administration
HOW DO TEAMS FORM AND
DEVELOP? 1
- Forming: initiation
- Storming: conflict and adjustment
- Norming: getting to know one another
- Performing: perfection
BENEFITS OF TEAM WORK
- Reduced hospitalization time and costs
- Improved coordination of care
- Enhanced job satisfaction
- Reduced unanticipated admissions
- Efficient use of health-care services
- Acceptance of treatment Greater role clarity Better accessibility for patients
- Enhanced communication and professional diversity
- Improved health outcomes and quality of care
- Reduced medical errors
- Enhanced well-being
MEASURES OF EFFECTIVE TEAMWORK
- Open communication between team members is established
- Generally accepted procedures and communication patterns are established.
- The team focuses all of its attention on achieving the goals.
- The team is close and supportive, open and trusting, resourceful and effective
THE CHARACTERISTICS OF
SUCCESSFUL TEAMS
- Common purpose
- Measurable goals
- Effective leadership
- Effective communication
- Good cohesion
- Mutual respect
LEADERSHIP IN A TEAM
- Effective leadership is a key characteristic of an effective team.
- Effective team leaders facilitate and coordinate the activities of
- other team members
Communication techniques
for health-care teams
- Situation
- Background
- Assessment
- Recommendation
- Call-out: communicate important or
- critical information that:
- Check-back
- Handover or handoff
RESOLVING DISAGREEMENT
AND CONFLICT
- Key to successful teamwork is the ability to resolve conflict or disagreement in the team; this can be especially challenging for junior members of the team, such as medical students, or in teams that are highly hierarchical in nature.
- It is important for all members of the team to feel they can comment when they see something that they feel will impact on the safety of a patient.
TWO-CHALLENGE RULE
- The two-challenge rule is designed to empower all team members to “stop” an activity if they sense or discover an essential safety breach.
- There may be times when an approach is made to a team member but is ignored or dismissed without consideration.
- This will require a person to voice his or her concerns by restating their concerns at least twice, if the initial assertion is ignored (thus the name “two-challenge rule”). These two attempts may come from the same person or two different team members:
CUS: three-step process in assisting people in
stopping the activity.
- I am Concerned
- I am Uncomfortable
- This is a Safety issue
DESC Script: constructive process for resolving conflicts.
- Describe the specific situation or behavior and provide concrete evidence or data.
- Express how the situation makes you feel and what your concerns are.
- Suggest other alternatives and seek agreement.
- Consequences should be stated in terms of impact on established team goals or patient
- Safety. The goal is to reach consensus.
BARRIERS TO EFFECTIVE
TEAMWORK
- Changing roles
- Changing settings
- Medical hierarchies
- Individualistic nature of medicine
- Instability of teams
WHAT STUDENTS NEED TO DO:
(PERFORMANCE REQUIREMENTS)
- Be mindful of how one’s values and assumptions affect interactions with other team members
- Be mindful of the role of team members and how psychosocial factors affect team interactions, recognize the impact of change on team members
- Include the patient as a member of the team.
- Using mutual support techniques and resolving conflicts, using communication
- techniques and changing and observing behaviours
SUMMARY HOW MEDICAL
STUDENTS CAN LEARN TEAM WORK
- Team training for medical students can be effective using a variety of techniques, many of which can be delivered in the classroom or low-fidelity simulated environment.
- Ideally medical students should take part in real teams and learn through experience and guided reflection.
- As far as possible, team training should focus on as many principles of effective teamwork as possible.
TOOLS AND RESOURCES
- TeamSTEPPS™: Strategies and tools to enhance performance and patient safety Department of Defense in collaboration with the Agency for Healthcare Research and Quality (AHRQ) (http://teamstepps.ahrq.gov/abouttoolsmaterials.htm). TeamSTEPPS™ also includes free access to a number of trigger tapes and videos.
- SBAR Toolkit Institute for Healthcare Improvement (IHI), Oakland, CA Kaiser Permanente (http://www.ihi.org/IHI/Topics/PatientSafety/Safety General/Tools/SBARToolkit.htm).
- Teamwork in health care: promoting effective teamwork in health care in Canada Canadian Health Services Research Foundation (CHSRF), 2006 (http://www.chsrf.ca/research_themes/pdf/teamwork-synthesis-report_e.pdf).
