Team-based care.

Team-based care.
Weinstock M. Hosp Health Netw. March 2010.

This piece highlights TeamSTEPPS as a training and awareness strategy to infuse teamwork into health care delivery.
http://psnet.ahrq.gov/resource.aspx?resourceID=17797




Team - Based Care

Health care is a team sport, but too often practitioners act as individual players. This foldout considers the barriers to collaboration and how to overcome them.
Research by Matthew Weinstock

There's No 'I' in Team
Health care is a team sport, but all too often practitioners act as individual players. They're siloed from the time they walk into medical, nursing or pharmacy schools to the time they touch their first patient. And while they may interact with each other in the care of a patient or a group of patients, those collaborations typically occur in short bursts and can result in communication lapses. Studies from the Joint Commission, Veterans Health Administration and others point to poor communication between caregivers as one of the top causes of medical errors and near misses. Add to that staffing shortages in almost every discipline, the growing interest from payers—including Medicare—to bundle payments, and the push toward accountable care organizations and it quickly becomes evident that fostering an environment that embraces teamwork is of critical importance.

"We have rapid in-and-out of the hospital and sicker patients," says Robert Wise, M.D., vice president, division of standards and survey methods at the Joint Commission. "The environment makes it harder to be heard and make sure that everyone knows what everyone else is doing."

The concept of team-based care isn't new. The Institute of Medicine highlighted the importance of the concept in its 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century. Others have been promoting team-based care for even longer. The challenge is implementation. There are a host of innovations being used now to encourage better communication—huddles; briefings before a patient handoff; timeouts before a surgery; the SBAR technique, situation background assessment recommendation—but there's still a need to build a foundation of teamwork to ensure that those types of activities are meaningful and successful, says James Battles, social science analyst for patient safety at the Agency for Healthcare Research and Quality.

AHRQ, along with the Department of Defense, has been giving hospitals and practitioners a boot camp in team-based care since 2006. The TeamSTEPPS program focuses on building up core competencies in teamwork. The aim is to improve the quality and safety of care. There are other initiatives under way, including one driven by hospitalists at the University of California San Diego Medical Center. The Joint Commission also has a keen interest in team-based care.

"The expectation of our standards is that you have some type of team-based care going on," Wise says. "And that is based on having a leadership that supports it and is trying to move it forward." Wise points to such policies as eliminating disruptive behavior and the universal protocol for preventing wrong-site surgery as examples.

This foldout focuses primarily on quality and safety aspects, but team-based care certainly extends beyond those issues, especially as health care becomes more integrated. A multidisciplinary approach will likely become the norm. Groups such as the American College of Physicians are developing models that incorporate team-based care into a doctor's daily practice.


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TeamSTEPPS: Taking the Right Steps in a Three-Phase Approach

In the early 2000s, the Agency for Healthcare Research and Quality and the Department of Defense began working together on a patient safety initiative aimed at improving teamwork in health care settings. The result was TeamSTEPPS, or Team Strategies and Tools to Enhance Performance and Patient Safety. The joint program officially launched in November 2006 and has thus far involved more than 1,500 organizations and 12,000 individual professionals. The premise behind TeamSTEPPS is simple—physicians, nurses, pharmacists, technicians and anyone else who touches a patient must work together to ensure safe and high-quality care. "Frequently what happens is we work as a group, but not a well-defined team," explains Andrew Kosseff, M.D., medical director of system clinical improvement at SSM Health Care. The 13-hospital system has been deploying TeamSTEPPS for the past couple of years. Put another way, caregivers are rarely trained together and end up focusing on their independent tasks. TeamSTEPPS teaches staff to understand one another's roles and come together in collaborative ways to improve quality and safety. The first step, says James Battles, social science analyst for patient safety at AHRQ and head of TeamSTEPPS, is to make sure that the organization is ready for change. "If you are not ready, don't even bother going forward," he says. "You'll do more damage by introducing something that people haven't bought into."

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