Teaching teamwork: An academic imperative

As healthcare organizations shift their focus away from episodic care and toward population health management, they are realizing the need to change the way they approach healthcare delivery.

Population medicine requires deliberate coordination across interdisciplinary care teams where the groups recognize each team member’s distinct and equally-contributing role and engage in interactive and collaborative communication. High-functioning teams have flat hierarchies, employ structured communication techniques and have defined methods for resolving conflict. Such teams do not evolve by accident—all members acknowledge that partnership and cooperation are necessary and grasp what’s involved in consistently embodying these characteristics. More specifically, group members understand what team behaviors entail, commit to demonstrating those behaviors and practice them until they become second nature.

Rethinking provider education
Although healthcare organizations can offer team training to their staff and physicians to establish expectations and provide clear-cut communication strategies, this will only go so far in modifying the long-established behaviors of self-reliance and siloed decision making. To ensure reliable team-based performance over the long-term, the healthcare industry must reimagine how it lays the groundwork for cross-provider collaboration, looking at ways to train individuals before they even begin their careers. In particular, academic institutions responsible for training the next generation of providers should revisit their respective curricula in response to the shifting healthcare environment. This idea is not limited to physicians, but applies to all providers, including physician assistants, nurse practitioners, nurses and allied health professionals.

Unfortunately, while providers are expected to coordinate care across clinical disciplines once they have formally entered the workforce, clinical education–regardless of discipline— has historically limited opportunities for in vivo interactions across academic programs. The good news is there is a growing consensus among academic institutions regarding the need to incorporate “soft skills”—such as effective communication and dispute resolution—into curricula. There has even been some progress made. For example, the American Medical Association’s Accelerating Change in Medical Education Consortium partners with academic institutions throughout the United States with a of goal of aligning medical education with the professional expectations of a clinical environment increasingly focused on “systemness” (delivering patient-focused, seamless and high-quality care across the many parts of the system to maximize value for customers). Entities like the American Medical Association, the Robert Wood Johnson Foundation and others are in the process of partnering with academic institutions and community-based programs to pilot, and eventually, scale innovative clinical education models, which include competency development around working in a team environment that prioritizes collaboration.

Ensuring patients are part of the team
A key element in delivering team-based care is engaging the patient and the patient’s support system as active members of the care team. Involving patients in their care not only positively correlates with patient satisfaction, but it can be part of an effective strategy to improve patient outcomes, especially for those individuals with chronic conditions that are best handled through self-management. It stands to reason that the more committed the patient and family, the more likely the individual will stay on top of proactive care strategies—regular testing, diet and exercise and medication compliance. This commitment to healthy behaviors can result in less acute visits and more sustainable outcomes.
As with teamwork concepts, providers historically have not been consistent about involving patients in their care. For many providers, there is a question of how best to do this, and their educational upbringing has not provided a lot of direction.

The first step involves recognizing the individual as an active care team member rather than a passive consumer of a service. This starts by developing a more patient-centered “bedside manner.” Once viewed as a tertiary component of clinical education, this concept is gaining traction from academic institutions as a competency of equal importance to technical acumen. Helping providers develop and hone skills like reflective listening, motivational interviewing and clinical empathy can increase their comfort in utilizing these skills to establish the necessary trust and rapport to promote patient care activation. Similarly, providing academic instruction on “difficult conversations,” such as those involved in end-of-life care—and giving providers an opportunity to practice those conversations in a safe space—can encourage providers to proactively facilitate dialogue at a point in time where active patient participation is still possible, and patient choice can be accommodated.

It requires a commitment
The need for reliable and consistent teamwork across the continuum is a foundational element in realizing robust and responsive population health management. The more academic institutions can provide opportunities to learn, practice and cement teamwork and patient engagement behaviors, the better providers will become at compassionately managing the health of diverse populations.

Justine Olsen is a Healthcare Strategy Analyst for Ensocare.

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