Health workplaces are affected by a number of concerns. They range from those that can affect workers physical safety to those that can develop efficiency and productivity. Efficient teamwork is however a prerequisite for patients as it is an asset to workers and employers. Effective teamwork is a vital component of a healthy workplace; however, it’s not at its optimum point where health practitioners and employers anticipate it to be.
The perception of a team is broad, a team is something that comes into being when two or more persons are working collectively with a common purpose. A team’s blueprint greatly depends on the following: the task to be performed by the team, where and when to be performed. Despite the broad categories of teams, there are common features of a team. For example people working in a team have specific responsibilities particular to their knowledge and exact skills. One individual is then chosen to be the leader by the team members or those that created the team (Hutzschenreuter & Horstkotte 2013).A
Therefore in healthcare, teamwork is a continuing process of interaction among health practitioners (team members) in their continued care provision to patients. In many cases teamwork has been confused with collaboration but in practice they are not the same thing. Collaboration can exist even when health practitioners do not consider themselves as part of a team. An example of collaboration includes a dentist, physiotherapist and a family physician that provides the same patient with care but do not see themselves as a team. However, effective teamwork requires a very high degree of collaboration. Teamwork requires members to make clear decisions to work together in meeting the team’s common objective. Therefore, members have to let go their autonomy and allow the team to coordinate their activities either through their team leader’s decisions or common decision making. This means that professionals working in a team not only have the responsibility to deliver their specialized expertise but also commitment to examine activities undertaken by their team members. This also includes managing arising conflicts. Effective teamwork is associated with better patient satisfaction and high job satisfaction.
Effective teamwork is important and has a positive and immediate impact on safety of patients. Specialization and complexity of care has led to increased importance of team’s effectiveness in healthcare (Chisholm et al., 2010). Other factors such as increasing co-morbidities, global shortages in workforce, chronic diseases and safe practitioners working hour’s initiatives have also contributed to the need of effective teamwork in health care delivery. There are six broad types of teams in Medicare follows: multi- professional teams; teams working closely in a single place; teams with membership constantly changing; those whose membership is constant; geographically distributed teams and those whose members belong to a single professional group. Despite the different nature and type of groups, certain characteristics are common. They make decisions, members interact for the achievement of a common goal, they posses specialized skill and knowledge and high workloads characterize their functioning conditions (Chen & Huang, 2010). Geographically co-location of teams includes for instance a surgical unit or a primary care team or ICU. They may include single discipline or multi practitioner input e.g. Nurses, doctors, physiotherapists, psychologists, pharmacists, social workers and potentially administrative staff. All their roles will vary within teams and between teams at different times. The roles are often opportunistic and flexible. In support of patient safety and patient centered care delivery, patients and healthcare practitioners are considered as active members of the same team (health-care). Patients are considered in informed consent and shared decision making. This goes a long way in improving quality of care and ensures patient safety. Patients are considered valuable members of the team as valuable sources of information since they are the only member present during all times of care (Barron et al., 2011).
The following are interrelated teams that are found in healthcare that support and deliver care
Core teams; they consist of members and leaders that are involved in direct care delivery to patients. They include each unit’s home operation base, those that manage patients from the time they are brought in to discharge. They include physicians, physiotherapist, pharmacist and nurses.
Coordinated teams; they are responsible for day to day coordination of functions, operational management and resource management for the core teams.
Contingency teams; formed for emergent and specific events. Formed to cater for time limited events e.g. Cardiac arrest, disaster response and rapid response teams. The members are mostly drawn from several core teams (Chen, 2011).
Ancillary services team consists of people like domestic staff and cleaners. They support services that indirectly contribute to patients care. They also provide time limited direct care thus is task specific. Are located where patients receive routine care. This is basically a service delivery team that support core team.
Support services; consist of individuals that provide task specific services, indirect services in care facility. They are service focused and facilitate optimal health care experience to family and patients. They create comfortable, clean, safe and efficient healthcare.
Administration includes the managerial leadership of the facility or unit and organizations management. It shapes the culture of teamwork through defining the organizations culture, accounts for team performance, enforcing policies, setting staffs expectations, communicating and establishing vision (Ou et al., 2014).
How Teams Develop
There are four stages of team development as: Forming (characterized by confusion and ambiguity when the team forms. Team members are unclear about the task, impersonal in communication, guarded and superficial); storming (here members may be in conflict between members and sometimes rebellion against assigned tasks, members may not take seriously positions of power and maybe frustrated about the lack of task progress); norming (team members establish open communications and start working on task at hand. Generally accepted communication patterns and procedures are established); Performing (the team focus is directed to goal achievement, it becomes supportive and close, effective and resourceful, open and trusting.
The following are simple characteristics of making a healthcare team successful.
Common purpose: the leader should be able to generate a common purpose for the team members. The purpose should be defined clearly, demonstrate joint ownership and include collective interests (Chen, 2011).
Mutual respect; the team leader should get the members to respect each other’s beliefs and talents in addition to the members professional contributions. They should encourage, accept and respect diversity.
Good cohesion; this contributes to an identifiable and unique team spirit and increases team longevity as members always want to work together. In addition to that, a well cohesion between members increases commitment.
Effective communication: the leader should encourage sharing of information regularly and quickly, allow reflection time for the tea and keep written record for future references.
Measurable goals; they should be able to set goals that they can be able to measure on their progress and they should be focused on the teams progress.
Effective leadership; leadership should be effective in maintaining structures, support members, listen to them, manage conflicts and agree to share leadership functions.
The key characteristic of an effective team is an effective leadership. Effective leaders coordinate and facilitate other members activities by: making decisions and setting priorities; accepting leadership role; calling for assistance appropriately; monitoring situations constantly; resolving conflicts within the team; delegating tasks/ assignments; balancing the teams workload; empowering team members to ask questions and speak freely; organize team training and empowerment activities; maximizing performance and utilizing resources.
Including patients as a team member in health care teams is a new concept; traditionally patients had a passive role of being just receivers of care but it’s well known that each patient brings their own knowledge and skill about their illness/condition. Medical students can include patients and family as a way of showing leadership in this area (team, 2014). Establishing eye contact with patients confirming and seeking additional information during ward rounds and may also ensure safety by including the patient in checking for correct information.
The greatest communication problem is the illusion that whatever has been communicated has been accomplished. ISABAR is a tool that has ensured focus on communicated information. It’s concerned with communicating critical patient information that requires immediate action and attention. It ensures correct level of concern and information is exchanged amidst health professionals. It stands for situation, background, assessment and recommendation.
Is a strategy that is employed to communicate important information which; helps to redirect information to a particular person with responsibility of carrying out particular tasks; helps members of the team to look forward to the next step; inform all members of the team at once during emergencies.
It helps to ensure senders information is understood by the person receiving it as intended. Here the sender initiates the message, and then the receiver accepts the message and in return provides a feedback which the senders double checks to make sure that the message has been understood (Nielsen, 2010).
These are crucial times when if errors in communication occur, they may result to adverse outcomes. For an accurate and timely handoffs, I pass the baton technique is used. It comprises of introduction (where one introduces themselves, their job and role and the patients name); patient (name, age, location, sex and identifiers); assessment (chief complaint, symptoms, vital signs and diagnosis); situation (current status, code status, allergies, social economic factors and alerts). While baton comprises of: Background (previous episodes, family history, current medications and co-morbidities); actions (what are the actions required or that were taken and provision of a brief rationale); timing (actions prioritization, level of urgency and explicit timing); ownership people responsible including family/patient and practitioner/team); next ( anticipated changes, the plan, what’s to happen next and if there are any contingency plans).
It’s a key to having a successful teamwork. It’s mostly challenging to junior team members where team’s nature is highly hierarchical and for medical students. It is important for team members however to feel that they can contribute or comment on something that they feel can affect the safety of the patient. The following techniques can help solve this problem and help members to express concerns in an easy way.
It empowers all members of a team to stop any activity they are carrying out if they discover safety is breached. For instance if a team member ignore or dismisses an approach without considerations, it’s voiced again by restating the approach thus two challenge rule. They may come from two different people or even the same person (Team, 2014). The first challenge is inform of a question while the second one provides some support to members concern. In a bid to advocate for the patient, this rule ensures that the expressed concerns have been understood. If this doesn’t work, the next person in the chain of command is approached with the concern.
These are three shortened steps of a three step procedure applied to assist people stop an activity. It stands for concerned, uncomfortable and safety issue (Team, 2014).
Describes specific behavior or situations and provide concrete data or evidence. Expresses how this kind of situation makes one feel and their concerns. Suggestion of alternatives and seek agreement. State the consequences in terms of impact on patient safety and team goals. Then consensus is reached.
There are a number of barriers to establishing a successful teamwork as follows.
There is overlap and considerable changes in roles played by healthcare professionals. An example is a nurse performing colonoscopies, a nurse having prescribing rights and radiographers reading plain film x-rays. This changing role brings challenges to role acknowledgement and allocation.
Healthcare nature is changing over time leading to increased care delivery for chronic conditions hooked on community care (Segaro, 2014). These kind of changes calls for new team formation and modification of those existing.
Nursing is a highly hierarchical profession thus leading to difficulties in creating a team with all members running effectively while maintaining their hierarchies E.g. where members’ views are to be accepted while the leaders are always not doctors.
Medicine practice is based on a one on one relation between patient and doctors. This relationship is a core value in Medicare delivery though it is challenged in team care delivery. This can be at levels such as doctors not willing to share care of their patients.
Healthcare teams are transitory, practitioners come together for specific events, and once they task is over, the teams not to remain in place. This transitory nature also places great emphasis on member’s quality of training (Ou et al., 2014). This raises specific challenges where training and education are relegated at the expense of delivery of services.
This is a very important step in improving the team’s performance. In a simulated environment this can be done through observation of actual practice. Teamwork exercises can also be used. The assessment can also be done at individual performance level or the whole team. It’s mainly done by an expert through peer rating.
Traditionally patient safety was a sole responsibility of an individual physician, however today it’s a context of a complicated medical system (Li, 2013). Patients are looked after by many physicians therefore recognizing effective teamwork to be essential in reduction of adverse events that mainly result from miscommunication with other practitioners and misunderstanding of individual roles in care delivery. Increased patients requiring multidisciplinary care approach (aged population and chronic illness patients) require a well established teamwork.
In areas of primary care, improved outcomes have been associated with teamwork. This includes cancer care and reduced medical errors. Effective teamwork also benefits the organization (team residence) through: efficient use of healthcare services; professional diversity and enhanced communication; reduced hospitalization costs and time and individual practitioners through: better patient accessibility; enhanced well being and enhanced job satisfaction (Van et al., 2011).
References
Barron, J. M., Chulkov, D. V., & Waddell, G. R. (2011). Top management team turnover, CEO succession type, and strategic change. Journal of Business Research, 64(8), 904-910.
Chen, H. L. (2011). Does board independence influence the top management team? Evidence from strategic decisions toward internationalization. Corporate Governance: An International Review, 19(4), 334-350.
Chen, H. L., Hsu, W. T., & Huang, Y. S. (2010). Top management team characteristics, R&D investment and capital structure in the IT industry. Small Business Economics, 35(3), 319-333.
Chisholm-Burns, M. A., Lee, J. K., Spivey, C. A., Slack, M., Herrier, R. N., Hall-Lipsy, E., … & Kramer, S. S. (2010). US pharmacists’ effect as team members on patient care: systematic review and meta-analyses. Medical care, 48(10), 923-933.
Hutzschenreuter, T., & Horstkotte, J. (2013). Performance effects of top management team demographic faultlines in the process of product diversification. Strategic Management Journal, 34(6), 704-726.
Li, C. R. (2013). How top management team diversity fosters organizational ambidexterity: The role of social capital among top executives. Journal of Organizational Change Management, 26(5), 874-896.
Nielsen, S. (2010). Top management team internationalization and firm performance. Management International Review, 50(2), 185-206.
Ou, A. Y., Tsui, A. S., Kinicki, A. J., Waldman, D. A., Xiao, Z., & Song, L. J. (2014). Humble chief executive officers’ connections to top management team integration and middle managers’ responses. Administrative Science Quarterly, 59(1), 34-72.
Segaro, E. (2012). Internationalization of family SMEs: the impact of ownership, governance, and top management team. Journal of Management & Governance, 16(1), 147-169.
Team, R. C. (2014). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2013.
Team, W. E. R. (2014). Ebola virus disease in West Africa—the first 9 months of the epidemic and forward projections. N Engl J Med, 2014(371), 1481-1495.
Van Knippenberg, D., Dawson, J. F., West, M. A., & Homan, A. C. (2011). Diversity faultlines, shared objectives, and top management team performance. human relations, 64(3), 307-336.
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