Teamwork

PATIENT-DOCTOR RELATIONSHIP
Dr. Gilbert C. Yang || November 15, 2016

Content Outline:
Teams in Improving Patient Care
I. BEING AN EFFECTIVE TEAM PLAYER  Teams represent a pragmatic way to improve patient
a. What is a Team? care
b. Types of Teams in Health Care  Teams can improve care at the level of
c. Team in Improving Patient Care o The organization
d. Forming and Developing Teams
i. Tuckmann’s 4 stages of Team o The patient – outcomes and safety
Formation o The team as a whole
e. Components of a successful team o The individual team member
f. Leadership
g. Barriers to Teamwork Forming and Developing Teams
h. Incidents in other Industries  Tuckmann’s 4 Stages of Team Formation and
i. Assessing Team Performance
j. Performance Requirements Development
i. Practical Tips for Medical
Students
ii. Gaining Informed Consent
iii. SEGUE
II. ENGAGING WITH PATIENTS AND CAREERS
a. Cultural Competence
b. Open Disclosure
i. Key Principles
ii. Harvard Framework
c. Patent Role in minimizing Adverse Events
d. SPIKES

LEGEND:
‼
Presentation Mentioned in Remember Book
the lecture

Table 1. Tuckmann’s 4 Stages of Team Formation and

BEING AN EFFECTIVE TEAM PLAYER Development
What is a Team? Stages Behaviours Tasks
FORMING Characterized by unclear about the
 A team is a distinguishable set of two or more people
confusion and task
who interact dynamically, interdependently and
adaptively towards a common and valued ambiguity
goal/objective/mission, who have been each assigned
specific roles or functions to perform, and who have a Team members
limited lifespan of membership. may not have
 A team is a group of two or more individuals who: chosen to work
o Interact dynamically together
o Have a common goal/mission
o Have been assigned specific tasks
may have
o Possess specialized and complementary
guarded,
skills
superficial, and
o
impersonal
Types of Teams in Health Care
communication
 Teams found in Health Care
STORMING Difficult Stage Some rebellion
o Multi-professional/drawn from a single
against task
profession There may be assigned
o Co-located/distributed conflict between
o Transitory or long standing team members Frustrations at a
lack of progress in
 Core Teams Team members ay task
o Coordinating teams jockey for positions
o Contingency team of power
NORMING Open Team starts to
o Ancillary services
communication confront tasks at
o Support services between team hand
o Administration

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 Teamwork
members o Lack of explicit coordination
o Miscommunication/communication
Generally
accepted Assessing Team Performance
procedures and  Assessing team performance can be carried out:
communication o In the workplace
patterns are
established o In simulated environments
PERFORMING Team is now close Team focuses all o Through observing teamwork exercises
and supportive its attention on  Team work can be assessed by external experts or by
achieving the peer observation
Open and trusting goals
Performance Requirements
Resourceful and  Medical students can apply teamwork principles in
effective their interactions with other students and through
observing and being part of health-care teams
Components of a Successful Team  Practical tips medical students can start practicing
 Effective teams possess the following features: now to improve teamwork include
o A common purpose
Medical students can start practicing now to improve
o Measurable goals
teamwork
o Effective leadership and conflict resolution 1. Always introducing yourself to the team
o Good communication 2. Reading back/closing the communication loop
o Good cohesion an mutual respect 3. Stating the obvious to avoid assumptions
o Situation monitoring 4. Asking questions, checking and clarifying
o Self-monitoring 5. Delegating tasks to people
o Flexibility 6. Clarifying our role
7. Using objective (not subjective) language
8. Learning and using people’s names
Leadership
9. Being assertive when required
 Effective team leaders coordinate an facilitate 10. If something doesn’t make sense, finding out the other
teamwork by: person’s perspective
o Delegating tasks or assignments 11. Doing a team briefing before undertaking a team
o Conducting briefs, hurdles, debriefs activity and a debriefing afterwards
o Empowering team members to speak freely 12. When conflict occurs, concentrating on “what” is right
and ask question for the patient, not “who” is right
o Organizing improvement activities and
Gaining informed Consent
training for the 1. The diagnosis
o Inspiring “followers” and maintain a positive 2. The degree of uncertainty in the diagnosis
group culture 3. Risks involved in the treatment
o Accepting the leadership role 4. The benefits of the treatment and the risks of not
o Calling for help appropriately having the treatment
o Constantly monitoring the situation 5. Information on the recovery time
6. Name, position, qualifications and experience of
o Setting priorities and making decisions
health workers who re providing the care and
o Utilizing resources to maximize performance treatment
o Resolving team conflicts 7. Availability and costs of any service required after
o Balancing the workload within a team discharge from hospital

Barriers to Teamwork SEGUE (Northwestern University)

 Changing role  Set the stage
 Medical hierarchies  Elicit information
 Individualistic nature of medicine  Give information
 Unstable nature of teams  Understand the patient’s perspective
 End the encounter
Incidents in other industries
 Failures in the following team behaviors have been ENGAGING WITH PATIENTS AND CAREERS
identified as being responsible for accidents in other Cultural Competence
industries:  Understand cultural differences
o Roles not being clearly defined  Know one’s own cultural values

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 Teamwork
 Understand that people have different ways of
interpreting the world
REFERENCES:
 Know that cultural beliefs impact on health
 Be willing to fit in with the patient’s cultural or ethnic 1. Dr. Gilbert Yang’s discussion and Powerpoint
background presentation
2. 2019 C ad 2019 A Transcriptions
Open Disclosure
 Informing patients and their families of bad outcomes
of medical treatment, as distinguished from the
disease or injury being treated

Key Principles
 Openness and timeliness of communication
 Acknowledgment of the incident
 Expression of regret/apology
 Recognition of the reasonable expectations of the
patient and their support person
 Support for staff
 Confidentiality

Harvard Framework
 Preparing
 Initiating conversation
 Presenting the facts
 Actively listening
 Acknowledging what have heard
 Responding to any questions
 Concluding the conversation
 Documentation

Patient Role in inimizing Adverse Events

 Patients want to be involved in their health care – but
it depends on the tasks
o Patients were comfortable (85%) asking
about a medication purpose
o Nearly half (46%) were very uncomfortable
about asking healthcare workers whether
they had washed their hands (After every
patient encounter)

SPIKES

S
•Sharpen Listening Skills

P
•Pay attention to patient perception

I
•Invite the patient to discuss detail

K
•Know the facts

E
•Explore emotions and deliver empathy

S
•Strategize next steps with patient or family

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