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Lecture for 3rd Year Medical
Students Faculty of Medicine King Fahad Medical City Riyadh on February 17,
2013 by Professor Omar Hasan Kasule Sr.
LEARNING
OBJECTIVES
•
understand the importance of
teamwork in health-care;
•
know how to be an effective team
player;
•
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
•
The different types of teams in
health care;
•
The characteristics of effective
teams;
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;
•
Multiprofessional 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
11
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 hand off
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.
16
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 maybe 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 atleast 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 behaviors
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.
•
Ideallymedical 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/SafetyGeneral/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).