Healthcare delivered in a collaborative environment consisting of interprofessional teams has gained widespread acceptance in recent years. In addition, there exists evidence that healthcare delivery is optimized in this type of environment. Yet, truly integrated team-based care remains far from the norm in today’s healthcare environment. Why is this?
An article in this week’s issue of JAMA addresses the challenges in implementing team-based care. The authors of the paper are members of an Institute of Medicine Working Group on this topic. They have identified three difficult issues with which they have struggled.
The first is the role of the patient on the healthcare team. Rather than being simply passive recipients of care, patients can play a valuable role as active team members. In the patient safety literature, some authors have identified that patients can make significant contributions to identifying the source of errors and can help prevent future errors from occurring. Still, many struggle with how to best incorporate patients in a proactive way on teams. The authors propose the analogy of an orchestra, “with individual patients as soloists, entering, leaving and making unique contributions, always supported by the larger ensemble.”
The second issue is accountability and flexibility on teams. That is, how can the need for flexibility on healthcare teams be met, while at the same time ensuring there is accountability for actions and outcomes? One proposed idea is to develop clear lines of accountability and leadership tasks, but not to equate leadership with clinical decision-making. And, in some circumstances, it may well be the patient who takes the lead.
The third issue is training for teamwork. Many academic institutions in this country have revised their classroom educational techniques to foster teamwork but when health professional students complete their experiential training, they do not see collaborative care teams modeled and this can create a disconnect for the students. Here at the University of Arizona, a concerted effort has been made in recent years to promote interprofessional education and practice.
Finally, the authors of this commentary propose five shared values among team members: honesty, discipline, creativity, humility and curiosity – and five principles to guide team-based care: clear roles, mutual trust, effective communication, shared goals and measureable processes and outcomes. If you are a member of a healthcare team reading this now, you may want to ask yourself if your team has these values and these principles.
Wynia MK, Von Kohorn I, Mitchell PH. Challenges at the intersection of team-based and patient-centered healthcare. JAMA 2012; 308(13): 1327-8.