Patient care

1. Lesson 2: Health Care
Team Collaboration
Module 7: Enhancing Practice
Oncology Patient Navigator Training:
The Fundamentals

2. Acknowledgments
This work was supported by Cooperative Agreement #1U38DP004972-02 from
the Centers for Disease Control and Prevention. Its contents are solely the
responsibility of the authors and do not necessarily represent the official views
of the Centers for Disease Control and Prevention.
Portions of this lesson have been adapted with permission from the Patient
Navigator Training Collaborative of the Colorado School of Public Health.
We would like to thank:
• The GW Clinical Learning and Simulation Skills (CLASS) Center for
providing space to film video simulations for this lesson.
• Actors in the simulation videos: Thelma D. Jones (patient navigator) and
Brittney Stretsbery (dietitian).

3. Competencies
4.5 Communicate effectively with navigator colleagues, health professionals and health
related agencies to promote patient navigation services and leverage community
resources to assist patients.
6.1 Support a smooth transition of patients across screening, diagnosis, active treatment,
survivorship and/or end-of-life, working with the patient’s clinical team.
7.1 Work with other health professionals to establish and maintain a climate of mutual
respect, dignity, ethical integrity and trust
7.3 Participate in interpersonal teams to provide patient-and population-centered care
that is safe, timely, efficient and equitable.

4. Learning Objectives
• Work in cooperation with those who receive care, those who provide
care, and others who contribute to or support the delivery of
prevention and health services to forge interdependent relationships
to improve care and advance learning
• Contribute to a positive working atmosphere
• Identify potential barriers to a smooth transition of patients across
screening, diagnosis, active treatment, survivorship and/or end-of-life
care, working with the patient’s clinical team
• Describe how culture, background, religious beliefs and attitudes
impact patient care and the working environment
• Solve conflicts and enable a constructive negotiation in a healthcare
team

5. Health Care Professionals
Patient
Doctors
Mid-level
providers
Nurses
Patient
navigators
Pharmacists
Technologists
& Technicians
Therapists &
Rehabilitation
specialists

6. Teamwork
Teams are two or more people working
together (collaborating) to accomplish a
common goal.
Source: Clements, n.d.

7. Types of Teams
Interprofessional
Teams
Multidisciplinary
Teams
Source: Mitchell et al., 2010.

8. Characteristics of Effective Teams
Trust
Respect
Collaboration
Source: O’Daniel et al., 2008.

9. What Prevents Interprofessional
Teamwork in Health Care?
Work in silos
Struggle with
communicating with
others of different
disciplines
“In-group” and “Out-
group”
Source: Mitchell et al., 2010.

10. Impact of Dysfunctional Teams
Low job
satisfaction among
staff
Increased conflicts between
health care professionals
Waste of resources
Fragmented or
duplicated care
Poor outcomes for patients
Poor work environment
Source: Mitchell et al., 2010; Lee et al., 2010.

11. Collaborative Work Environment
• Diverse teams that share knowledge
• High quality health care
• Increase in job satisfaction
• Decrease in staff turnover
• Reduction of health care costs
Source: Mitchell et al., 2010; Lee et al., 2010.
• Patient-focused
• Offers effective
clinical care
• Improved patient-
outcomes

12. Video
Click here to watch the video

13. Collaborative Work Environment
• Helps establish relationship
• Encourages patients to use other
members of the health care team
• Helps health care colleagues by providing
resources and informing them about the
patient’s specific needs and preferences
for care

14. Barriers to Team Collaboration
It takes time
Perceived loss of autonomy
Lack of trust
Clashing perceptions/approaches
Territorialism
Lack of awareness
Source: O’Daniel et al., 2008.

15. Barriers to Team Transition
• Transition between patient navigators
• Medical insurance issues
• Patient’s lack of understanding of
next steps:
• Diagnosis
• Survivorship
• End-of-Life

16. Supporting a Smooth Care
Transition
Barriers Solutions
Confusion about who continues
with care
 Identify who gets the handoff
Team members may be
misinformed about next steps
 Ensure that everyone knows
about the transition
Patient may feel that the
support system is shrinking
 Continue to advocate
for the patient

17. Components of Successful
Teamwork
• Non-punitive environment
• Clear direction
• Clear and know roles and tasks
• Respectful atmosphere
• Shared responsibility
• Acknowledgement and processing of conflict
• Clear specifications regarding authority and
accountability
• Clear and known decision-making procedures
Source: O’Daniel et al., 2008.

18. Case Study
• You are asked to be on a committee to help
your institution meet the Commission on
Cancer Survivorship standard.
• Your role is to advocate for a process that is
patient-centered. You are asked to help
identify patients who have completed
treatment and should get a survivorship care
plan.

19. Scenarios: Diversity in the
Workplace
Immediate
surgery
Eye
contact
Medicaid
Source: Galanti, n.d.; Jeffreys, 2008.

20. Diversity on Health Care Teams
• Better working environments
• Better problem solving
• Bridge the gap between clinical and
cultural knowledge
• Informed about patient environment
Learning about differences can mitigate
conflicts from cultural differences
Source: Dreachslin et al, 2000; Roth et al., 2012; Shaw-Taylor et al., 1998.

21. Barriers to Effective Communication
O’Daniel et al., 2008.
Personal values and expectations Differences in schedules and professional routines
Personality differences Varying levels of preparation, qualifications and status
Hierarchy Differences in requirements, regulations and norms of
professional education
Disruptive behavior Fears of diluted professional identity
Culture and ethnicity Differences in accountability, payment and rewards
Generational differences Concerns regarding clinical responsibility
Gender Complexity of care
Historical interprofessional and intraprofessional
rivalries
Emphasis on rapid decision-making
Differences in language and jargon

22. Solutions for Effective
Communication
Foster a culture of
common purpose,
intent, trust, respect
and collaboration
Start with common goal
= high quality patient
care
Be self-aware of
personal biases and
beliefs
Source: O’Daniel et al., 2008.

23. Understanding Conflict
To understand conflict you must have:
• At least 2 parties
• Parties must be interdependent (need
each other)
• Perceived incompatible goals
• Perceived scare resources
• Perceived interference

24. Examples of Conflict in the Workplace
Patient needs not factored by doctor
Lack of clarity around who is responsible
Needing help from another team member
Who will work with the patient
Supervisor
Dealing with different departments
Outside organizations

25. Resolving Conflict
• Work at talking about the issues
• Recognize the value of the
conflict
• Recognize conflict is a spiral and
you can change the direction of
the spiral
• Emphasize common goals
• Check perceptions
• Use competent communication
techniques
• Agree to disagree and
• Attack the problem, not the
person

26. Methods for Solving Conflict
SBAR
Walk in
the Woods

27. SBAR Method
• “What is going on with
the patient?”
Situation
• “What is the context?”
Background
• “What do you think the
problem is?”
Assessment
• “What would you do to
correct the problem?”
Recommendation
Source: O’Daniel et al., 2008.

28. Walk in the Woods
Step 1
• Self-Interests
Step 2
• Enlarged Interests
Step 3
• Enlightened Interests
Step 4
• Aligned Interests
Source: Marcus, 2002; Marcus et al., 2012.

29. Step One: Self Interest
Define the problem
Who has a stake in the
problem or who has a say
and who will be impacted
by the outcome?
Source: Marcus, 2002; Marcus et al., 2012.

30. Step Two: Enlarged Interests
Identify
• What everyone agrees on to
reframe the problem
• What everyone agrees on
Source: Marcus, 2002; Marcus et al., 2012.

31. Step Three: Enlightened Interests
All parties freely brainstorm new and creative
ideas to solve the problem. Rank solutions as
follows:
• Unanimous agreement
• Ambiguity
• Clear disagreement
Marcus, 2002; Marcus et
al., 2012.

32. Step Four: Aligned Interests
• Parties share what they “must, want and would
like to receive,” and what they are “eager, willing
and unwilling to give” in the deal
• Discuss what they will and will not commit to, how
they will meet their objectives and what are the
implications for the proposed deal
• Agreement should be written down
• Each party should gain something out of the deal
Source: Marcus, 2002; Marcus et al., 2012.

33. Success
“If I succeed, you succeed;
and if you succeed, I
succeed. Therefore, let’s
work toward achieving
mutual success.”
Source: Marcus, 2002; Marcus et al., 2012.

34. Conclusion
In this lesson you learned to:
• Work in cooperation with those who receive care, those who provide care,
and others who contribute to or support the delivery of prevention and
health services to forge interdependent relationships to improve care and
advance learning
• Contribute to a positive working atmosphere
• Identify potential barriers to a smooth transition of patients across
screening, diagnosis, active treatment, survivorship and/or end-of-life care,
working with the patient’s clinical team
• Describe how culture, background, religious beliefs and attitudes impact
patient care and the working environment
• Solve conflicts and enable a constructive negotiation in a healthcare team

35. References
• Clements, D., Dault, M., & Priest, A. (2007). Effective teamwork in healthcare: Research and reality.
Healthcare Papers, 7 Spec No:26‐34. doi: 10.12927/hcpap.2013.18669.
• Dreachslin, J. L., Hunt, P. L., & Sprainer, E. (2000). Workforce diversity: Implications for the effectiveness
of health care delivery teams. Social Science & Medicine, 50(10):1403‐1414. doi: 10.1016/s0277-
9536(99)00396-2.
• Galanti, G‐A. (2001). The challenge of serving and working with diverse populations in American
hospitals. Diversity Factor, 9(3):21‐26. Retrieved April 15, 2021,
from https://hsc.unm.edu/community/toolkit/docs8/culturaldiversity.pdf.
• Jeffreys, M. (2008). Dynamics of diversity: Becoming better nurses through diversity awareness. Imprint,
55(5):36‐41. Retrieved Aprril 15, 2021, from https://pubmed.ncbi.nlm.nih.gov/19177982/.
• Lee, J. I., Cutugno, C., Pickering, S. P., Press, M. J., Richardson, J. E., Unterbrink, M., Kelser, M. E., &
Evans, A. T. (2013). The patient care circle: A descriptive framework for understanding care transitions.
Journal of Hospital Medicine, 8(11):619‐626. doi: 10.1002/jhm.2084.
• Marcus, L. J. (2002). A culture of conflict: Lessons from renegotiationg health care. Journal of Health
Care Law & Policy, 5(20): 447‐478. Retrieved April 15, 2021,
from https://digitalcommons.law.umaryland.edu/jhclp/vol5/iss2/6/.

36. References (Cont.)
• Marcus, L. J., Barry, C. D., & McNulty, E. J. (2012). The walk in the woods: A step‐by‐step method for
facilitating interest‐based negotiation and conflict resolution. Negotiation
Journal, 28(3):337‐349. https://doi.org/10.1111/j.1571-9979.2012.00343.x.
• Mitchell, R., Parker, V., Giles, M., White, N. (2010). Review: Toward realizing the potential of diversity in
composition of interprofessional health care teams: An examination of the cognitive and psychosocial
dynamics of interprofessional collaboration. Medical Care Research & Review, 67(1):3‐26. doi:
10.1177/1077558709338478.
• O’Daniel, M., & Rosenstein, A. (2008). Chapter 33. Professional Communication and Team
Collaboration. In Hughes RG (Ed.) Patient Safety and Quality: An Evidence‐Based Handbook for Nurses.
Rockville (MD): Agency for Healthcare Research and Quality (US). Retrieved from:
http://www.ncbi.nlm.nih.gov/books/NBK2637/.
• Patient Navigator Training Collaborative. (n.d.). http://patientnavigatortraining.org/.
• Roth, L. M., Markova, T. (2012). Essentials for great teams: Trust, diversity, communication ... and joy.
Journal of the American Board of Family Medicine, 25(2):146‐148. doi: 10.3122/jabfm.2012.02.110330.
• Shaw‐Taylor, Y., & Benesch, B. (1998). Workforce diversity and cultural competence in healthcare.
Journal of Cultural Diversity, 5(4):138‐146. Retrieved April 15, 2021,
from https://pubmed.ncbi.nlm.nih.gov/10196937/.

37. Thank you!
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