Amid our efforts to improve health care quality, a primary factor that can significantly influence the patient outcome is neglected. That factor is teamwork.
Everyone knows that health care is a team sport. However, does everyone play their part to result in a well-functioning team? And how can health care pathways help to build a stronger team?
It’s are these questions that Dr. Svin Deneckere (University of Leuven) answered during our masterclass in February 2022. The article talks about the need for teamwork in healthcare, how care pathways can help, and the implications for developing care pathways.
Growing Need For Teamwork In Healthcare
“Patient care is team a sport. However, healthcare is unique in that no other team sport has greater potential for catastrophic outcomes.”
Over the last decade, many experts have pointed out the need for health care providers to coordinate better across departments, specialties, and shifts. This is crucial for safe, high-quality, and affordable care.
Cross-boundary teamwork is even more crucial while caring for patients with chronic conditions. Teamwork is also essential while making time-sensitive decisions in emergency departments staffed around the clock by over-worked doctors and other professionals.
For years, clinicians have relied on role-based coordination. Every professional has designated roles. For instance, the physician is responsible for diagnosis and treatment. According to the role-based model, responsibilities are clear, but so are boundaries. The transition where the role of one professional is over and others begin is unclear.
Besides, this type of role-based teamwork has limitations in practice. While roles have been established, their role in larger goals is often neglected. Professionals in different roles think and communicate differently. This further complicates coordination. It is rarely seen that people actively exchange ideas, communicate about progress, or help each other.
So, we need to have teamwork for better results.
Why Healthcare Teams Are Pseudoteams?
West and Lyubovnikova refer to health care teams as “pseudo teams,” where a group of people has interdependence of tasks, but are managed by different leaders and may have different professional goals.
The notion of core and non-core teams can help clarify team boundaries. The core team is the group of staff led directly by the manager, while the non-core or wider multidisciplinary team includes other groups or professions responsible for the same patients.
People are merely working in close proximity to others, and many have the same supervisor. However, they are not real teams as they are not working together collectively. And not all members are accountable for every task’s completion.
On the other hand, real teams are more than a collection of people working in proximity to each other. They work closely and interdependently towards clear, shared objectives. Members of the real team also have effective and regular communications, usually in the form of meetings.
Due to dysfunctional processes and inputs, pseudo-teams pose threats to the psychological well-being of team members and the safety of patients.
Impact of pseudo-teams on team members:
- Higher work pressure
- Increased frustration
- Higher work pressure or burnout
These factors may cause healthcare professionals to be prone to work errors, stressors, aggression at work, and accidents. This, in turn, have damaging consequences in the health field.
Reasons why we have pseudo teams in healthcare::
- Fragmented disconnected organizational structures
- No incentives in the financing system to collaborate or promote collaboration
- Low level of agreement and low level of predictability (on what is high-quality care)
- High specialization, high task interdependence, high functional diversity
- Higher interprofessional boundaries, different educational backgrounds of the team working on the same patient
- Power and status differences, high competitive power
- Unclear leadership structure
- Temporary ad hoc teams with low group identity, lack of role clarity, and poorly trained
- Increasing job demands, high workload, different work schedules
What is a team?
Katzenbach and Smith 1993: A small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable.
Effect Of Pseudoteams On Patient Outcomes
There is a consistent association between teamwork and patient outcomes. Various studies have shown that team training interventions resulted in a tremendous improvement in patient outcomes, including mortality and morbidity. Studies have also shown that teamwork influences clinical performance.
When people are supported by their team, there is a reduction in the impact of daily job stressors, including patient care. And this, in turn, results in favorable patient-reported experiences.
On the other hand, a lack of empowerment and a culture of disrespect affects patient safety. Besides, the absence of teamwork may cause harm. Research suggests that poor communication and teamwork were a cause for 2/3 of adverse events.
Studies have shown three major areas of how to improve teamwork in health care:
1. Teamwork training programs: These involve a systematic process through which a team is trained to master and improve team competencies (e.g., crew resource management, cross-training )
2. Structured communication protocols: Tools that seek to improve the reliability of transferring critical information (e.g., briefing and debriefing checklist)
3. Organizational interventions: These are interventions that seek to change work processes and structures so that they support more effective communication
One of the best interventions to improve teamwork in healthcare is implementing care pathways. Compared to other interventions, care pathways are most effective in standardizing low uncertainty and low complexity care processes. Uncertainty implies the course of disease or treatment of a particular patient.
Care pathways allow professionals to implement evidence-based key interventions and reduce clinical variations in everyday practice. Moreover, they also boost organizational performance by improving coordination and strengthening relationships among team members.
According to AHRQ, considering different types of team training, care pathway development is considered a behavior change intervention that is a mix of cross-training, team-building, and self-correction exercises.
The care pathway allows the trading of tasks and roles of team members. This allows providing feedback on performance, setting goals, and increasing evidence-based practice. It also allows for forming an overall team vision based on which high-performing teams can be built.
What are Care Pathways?
A care pathway is a complex intervention for the mutual decision-making and organization of care processes for a well-defined group of patients during a well-defined period.
Characteristics that define care pathways:
- Goals and key elements of care are based on best practice, evidence, and patients’ expectations
- Allows communication among team members and with patients and their family
- Facilitates coordination of care process by harmonizing the roles and sequencing of activities of the multidisciplinary care team, patients, and their relatives
- Provides the documentation, monitoring, and evaluation of variances and outcomes
- Supports the identification of the appropriate resources
Example of care pathway as team intervention focuses on the care process:
Relationship Between Care Pathways And Team Outcome
In his Ph.D., Svin Deneckere investigated the impact of care pathways on interprofessional teamwork. The results showcase that care pathways are an effective and workable intervention that leads to:
- Higher level of organization of care
- Lower emotional exhaustion
- Higher level of competence
- Reduced risk of burnout among caregivers
In addition, the study also indicates that the care pathway leads to:
- Better conflict management
- Higher team climate for innovation
- Higher perception as being a real team
- Higher shared vision and objectives and task orientation
Implications For Care Pathway Development
Care pathways should not only be used to improve care processes but also to design teams and organizations.
Some implications that would help include:
- Training staff in both technical and non-technical skills
- Analyzing teamwork needs before care pathway development. This will allow in defining an effective training approach customized to the teams’ needs
- Including an additional team training component within CP protocols focused on creating essential team-related skills to improve interprofessional relations
- Engaging key personnel from all the levels of the organization, from frontline managers to the executive office
- Creating the ability to innovate, adapt, and react efficiently and effectively when the situation calls for it
- Coming up with a service-line driven, team-based, and patient-focused organizational model that puts both care processes and teams in the frontline of concern needs to be pursued
Healthcare organizations face multiple challenges to improve or develop, but creating a high-performance team is the most important challenge to tackle.
Patient care can be improved by identifying and addressing the barriers to leadership and physician participation. In the end, the success of a health care organization lies in its ability to build a powerful team.
Creating a care pathway helps a team function more effectively. It also offers a framework to encourage professional engagement, a safe environment, and a supportive organizational structure with clear goals. Care pathways will prevent burnout of professionals, reduce adverse events, and improve the quality of care.