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Building effective teams - Dr Charles Pain
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Building effective teams - Dr Charles Pain

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This is the presentation given by Dr Charles Pain, Director Health Systems Improvement, Clinical Excellence Commission, at the recent Team Health Consultatin Forum.

This is the presentation given by Dr Charles Pain, Director Health Systems Improvement, Clinical Excellence Commission, at the recent Team Health Consultatin Forum.

Published in: Health & Medicine, Business

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  • 1. Building Effective Healthcare Unit Teams: Why, Who and How?
    Dr Charles Pain, Director Health Systems Improvement
    Clinical Excellence Commission
  • 2. What Teams Do
    Work together
    Respect each other
    Don’t throw hospital passes
    Celebrate together
  • 3. Why?
  • 4. Aim
    To improve the quality and safety performance of the NSW public health system
  • 5. The problem
    • Healthcare systems have low perceived reliability
    • 6. Efforts to improve reliability have had limited success and sustainability
    • 7. Healthcare providers are under increasing pressure to improve reliability (and so are the politicians)
  • Determinants or Root Causes
    • Poor governance and organisation
    • 8. Insufficient resources
    • 9. Insufficient skills
    • 10. Inadequate tools
  • Root causes manifest as:
    • Failure to set objectives of care
    • 11. Poor teamwork and coordination, including poor communication
    • 12. Fragmentation of care
    • 13. Missed diagnosis
    • 14. Inadequate and inappropriate treatment
    • 15. Failure to recognise deterioration
  • Garling’s view
    Garling emphasises the need for, “A new model of teamwork… to replace the old individual and independent ‘silos’ of professional care.” [Overview, para 1.25]. He also talked of “…strengthening the training of new clinicians in better, safer treatments based on a patient-centred team approach; [Overview, para 1.34].
     
  • 16. Garling’s view continued
    “The evidence shows that a team-approach to treatment is likely to produce the best results. One proven technique is the multi-disciplinary ward round which includes the consultant and registrar, junior doctors, nursing staff, pharmacists and, where relevant, allied health professionals such as speech therapist or physiotherapist.” [Overview, para 1.110]
  • 17. Evidence on benefits
    • 91% of staff surveyed say they belong to a team but when the definition is applied as a filter, then only 50% of staff actually work in a team. The others work in pseudo teams.
    • 18. Error rates are lowest in real teams
    • 19. Longitudinal data from the NHS shows that for each 10% increase in the proportion of real teams in an organisation there is a corresponding 3.1% reduction in patient mortality (HSMR)
    Professor Michael West , Head of Department, Aston Business School.
    Organizational Behaviour in Health Care Conference, Birmingham April 2010
  • 20. Staff teamwork matters most to patients
    “Among patients who offered excellent ratings, how well the doctors and nurses worked together was the main factor that influenced their rating.”
    Bureau of Health Information
    Insights into Care: Patients’ Perspectives on
    NSW Public Hospitals, May 2010
  • 21.
  • 22. Who?
  • 23. The Healthcare Unit Team
    Family
    Patient
    Clinicians
    Non-clinicians
  • 24. Teams intersect at the healthcare unit level
    Professional
    Specialist
    Teams
    Medical
    Nursing
    Allied health
    Generalist
    Teams
    Horizontal Teams
    WARD
    Vertical Teams
    JMO
    SRMO
    Nursing
    Allied Health
    Clerical
    Patient Support
    Source: Professor Steven Boyages
  • 25. how?
  • 26. CEC Health Systems Improvement Model
    Knowledge and
    Skills
    Macrosystem
    Governance
    Microsystem
    Resources
    Tools
    CHP May 2011
  • 27. Nature of solutions
  • Principles for a solution
    Health services are frogs not bicycles (A. Mant)
    Multidisciplinary teams (healthcare unit teams) are our basic production units (cells). They deliver care to patients.
    Patients are part of the team.
    We should start re-designing the system at the microsystem level but also recognise the importance of the macrosystem (organism)
    A multivalent approach is needed to be sustainable
  • 31. Team Functions (Unit Facility)
    Leadership and Governance
    Team Structure and Dynamics
    Care Planning, Coordination and Delivery
    Standard Protocols and Procedures
    Patient Safety and Quality Systems
    Patient Experience Management
    Education, Training and Supervision
    Workforce Management and Development
    Information Access
    Support Services and Equipment
  • 32. Team Functions
    Leadership & Governance
    Care Planning
    Co-ordination & Delivery
    Team Structure & Dynamics
    Standard Protocols
    & Procedures
    Patient Experience
    Excellent
    Care
    Information Access
    Patient Safety &
    Quality Systems
    Education, Training
    & Supervision
    Support Services
    & Equipment
    Workforce Management
  • 33. Examples of Practical Tools
    NUM role redefined
    Interdisciplinary
    Leadership
    (nursing, medical
    & allied health)
    Care Planning with
    Objectives
    Care Navigation
    Ward Rounds
    Uniforms
    Name Badges
    Ward Meetings
    Leadership & Governance
    Care Planning
    & Co-ordination
    Team Structure & Dynamics
    Care Planning
    Co-ordination & Delivery
    Handover checklist
    Standard Observation
    Chart
    Asking, listening and
    Responding
    Complaints
    management
    Excellent
    Care
    Standard Protocols
    & Procedures
    Patient Experience
    Information Access
    Patient Safety &
    Quality Systems
    Incident Reporting
    and Review
    Risk register
    Prioritisation
    EMR
    Decision support
    Education, Training
    & Supervision
    Support Services
    & Equipment
    Workforce Management
    Supplies
    management
    Prioritisation of
    equipment
    Core skills training
    (eg. DETECT)
    Rostering for seniority
    Skill balance
  • 34. Way Forward
    Develop partnerships with CETI, NaMO, ACI, Academics, etc.
    Adopt TeamFirst Framework as a basis for understanding and implementing a microsystems approach
    Develop implementation method involving team building through coaching and communities of practice, and provision of teamwork tools.
  • 35. Way Forward (cont.)
    Implement by laying or reinforcing foundations for healthcare unit teams, by focussing on unit leadership, role clarity of members, and establishment of key team structures and processes.
    Obtain or develop necessary tools for teams to perform key functions, and support them in designing unique tools, where required.
  • 36. Way Forward (cont.)
    Ensure organisational support at all levels.
    Evaluate
  • 37. QUESTIONS?
  • 38. Prioritisation Framework
    HIGH
    Priority 1
    Priority 2
    Cost effectiveness of solutions
    Priority 4
    Priority 3
    HIGH
    LOW
    Population importance of problems
    (prevalence & consequence)
    CHP 2010

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