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.

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Building effective teams - Dr Charles Pain

  1. 1. Building Effective Healthcare Unit Teams: Why, Who and How?<br />Dr Charles Pain, Director Health Systems Improvement<br />Clinical Excellence Commission<br />
  2. 2. What Teams Do<br />Work together<br />Respect each other<br />Don’t throw hospital passes<br />Celebrate together<br />
  3. 3. Why?<br />
  4. 4. Aim<br /> To improve the quality and safety performance of the NSW public health system<br />
  5. 5. The problem<br /><ul><li>Healthcare systems have low perceived reliability
  6. 6. Efforts to improve reliability have had limited success and sustainability
  7. 7. Healthcare providers are under increasing pressure to improve reliability (and so are the politicians)</li></li></ul><li>Determinants or Root Causes <br /><ul><li>Poor governance and organisation
  8. 8. Insufficient resources
  9. 9. Insufficient skills
  10. 10. Inadequate tools</li></li></ul><li>Root causes manifest as:<br /><ul><li>Failure to set objectives of care
  11. 11. Poor teamwork and coordination, including poor communication
  12. 12. Fragmentation of care
  13. 13. Missed diagnosis
  14. 14. Inadequate and inappropriate treatment
  15. 15. Failure to recognise deterioration</li></li></ul><li>Garling’s view<br />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]. <br /> <br />
  16. 16. Garling’s view continued<br /> “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]<br />
  17. 17. Evidence on benefits<br /><ul><li>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. 18. Error rates are lowest in real teams
  19. 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)</li></ul>Professor Michael West , Head of Department, Aston Business School.<br />Organizational Behaviour in Health Care Conference, Birmingham April 2010<br />
  20. 20. Staff teamwork matters most to patients<br /> “Among patients who offered excellent ratings, how well the doctors and nurses worked together was the main factor that influenced their rating.”<br />Bureau of Health Information <br />Insights into Care: Patients’ Perspectives on<br />NSW Public Hospitals, May 2010<br />
  21. 21.
  22. 22. Who?<br />
  23. 23. The Healthcare Unit Team<br />Family<br />Patient<br />Clinicians<br />Non-clinicians<br />
  24. 24. Teams intersect at the healthcare unit level<br />Professional<br />Specialist<br />Teams<br />Medical<br />Nursing<br />Allied health<br />Generalist<br />Teams<br />Horizontal Teams<br />WARD<br />Vertical Teams<br />JMO<br />SRMO<br />Nursing<br />Allied Health<br />Clerical<br />Patient Support<br />Source: Professor Steven Boyages<br />
  25. 25. how?<br />
  26. 26. CEC Health Systems Improvement Model<br />Knowledge and<br />Skills<br />Macrosystem<br />Governance<br />Microsystem<br />Resources<br />Tools<br />CHP May 2011<br />
  27. 27. Nature of solutions<br /><ul><li>Effective
  28. 28. Sustainable
  29. 29. Scalable
  30. 30. Affordable</li></li></ul><li>Principles for a solution<br />Health services are frogs not bicycles (A. Mant)<br />Multidisciplinary teams (healthcare unit teams) are our basic production units (cells). They deliver care to patients.<br />Patients are part of the team.<br />We should start re-designing the system at the microsystem level but also recognise the importance of the macrosystem (organism)<br />A multivalent approach is needed to be sustainable<br />
  31. 31. Team Functions (Unit Facility)<br />Leadership and Governance<br />Team Structure and Dynamics<br />Care Planning, Coordination and Delivery<br />Standard Protocols and Procedures<br />Patient Safety and Quality Systems<br />Patient Experience Management<br />Education, Training and Supervision<br />Workforce Management and Development<br />Information Access<br />Support Services and Equipment<br />
  32. 32. Team Functions<br />Leadership & Governance<br />Care Planning<br />Co-ordination & Delivery<br />Team Structure & Dynamics<br />Standard Protocols <br />& Procedures<br />Patient Experience<br />Excellent<br />Care<br />Information Access<br />Patient Safety & <br />Quality Systems<br />Education, Training <br />& Supervision<br />Support Services <br />& Equipment<br />Workforce Management<br />
  33. 33. Examples of Practical Tools<br />NUM role redefined<br />Interdisciplinary <br />Leadership <br />(nursing, medical <br />& allied health)<br />Care Planning with <br />Objectives<br />Care Navigation<br />Ward Rounds<br />Uniforms<br />Name Badges<br />Ward Meetings<br />Leadership & Governance<br />Care Planning<br />& Co-ordination<br />Team Structure & Dynamics<br />Care Planning<br />Co-ordination & Delivery<br />Handover checklist<br />Standard Observation<br />Chart<br />Asking, listening and <br />Responding<br />Complaints <br />management<br />Excellent<br />Care<br />Standard Protocols <br />& Procedures<br />Patient Experience<br />Information Access<br />Patient Safety & <br />Quality Systems<br />Incident Reporting <br />and Review<br />Risk register<br />Prioritisation<br />EMR<br />Decision support<br />Education, Training <br />& Supervision<br />Support Services <br />& Equipment<br />Workforce Management<br />Supplies<br /> management<br />Prioritisation of <br />equipment<br />Core skills training <br />(eg. DETECT)<br />Rostering for seniority<br />Skill balance<br />
  34. 34. Way Forward<br />Develop partnerships with CETI, NaMO, ACI, Academics, etc.<br />Adopt TeamFirst Framework as a basis for understanding and implementing a microsystems approach<br />Develop implementation method involving team building through coaching and communities of practice, and provision of teamwork tools.<br />
  35. 35. Way Forward (cont.)<br />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.<br />Obtain or develop necessary tools for teams to perform key functions, and support them in designing unique tools, where required.<br />
  36. 36. Way Forward (cont.)<br />Ensure organisational support at all levels.<br />Evaluate<br />
  37. 37. QUESTIONS?<br />
  38. 38. Prioritisation Framework<br />HIGH<br />Priority 1<br /><ul><li>Sepsis program
  39. 39. BTF
  40. 40. Hand hygiene</li></ul>Priority 2<br />Cost effectiveness of solutions<br />Priority 4<br />Priority 3<br />HIGH<br />LOW<br />Population importance of problems <br />(prevalence & consequence)<br />CHP 2010<br />