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Perspectives
Team Work in Action: Lessons LearnedThe Perspectives for this issue comes from four different kinds of teams—two engaged in medical education innovation, one providing consultation to an institutional research planning team, and one working to improve patient safety in the operating room. Each of the teams had members who participated in either the 2007 AAMC Enhancing Team Effectiveness program or the 2008 TeamWorks! program, which both were supported in part by a grant from the Robert Wood Johnson Foundation. Team members' responses address both team work concepts they have put to use and the lessons they have learned in their work with teams. University of Virginia School of Medicine
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Respondents:
Juliet Trail, M.A., trail@virginia.edu
Steven S. Wasserman, Ph.D., ssw3an@virginia.edu
What team concepts, processes, and skills have worked particularly well to move the work of your teams forward?
We have used the knowledge gained during our participation in the AAMC TeamWorks! program to help transform existing work groups and committees into what we call "principled" teams. Initiating change in group culture requires patience and courage. This may not be easy for existing, goal-oriented groups. The transformation to a principled team requires significant time and investment as manifested by initial discussions clarifying team ground rules, mission, and goals. Transformation also includes on-going "housekeeping" activities such as check-in/debriefing at each meeting and periodic review of team principles, tools, and skills. We have observed that time spent for team building is recouped later via greater efficiency and enhanced effectiveness in reaching goals. Work groups and committees are at greater risk of ineffectiveness or dysfunction if unclear mission, vague goals, or internal or external conflict are left unaddressed. Furthermore, institutional leaders must be active partners during the change process and remain actively engaged with team progress and struggles, providing ongoing assistance as needed.
What has been the most important lesson that you have learned in your work with teams of health professionals and staff?
Unlike teams created de novo, pre-existing work groups have a history and culture prior to their transformation to a principled team. We have found the following to ease initial reluctance to making a transition: translating the vocabulary of team dynamics to terms that are understood by team members; illustrating the process using our own experience with high-performing teams; and allowing the team to decide how best to adopt or adapt the TeamWorks! model. Timelines with interim goals are needed to facilitate group transformation while maintaining forward momentum.
As members of our academic teams become more proficient at and comfortable with the benefits of principled teams, they will transfer knowledge to subsequent institutional groups. Similarly, we, as team consultants, hope to use each experience to hone our skills at transforming working groups into principled teams across the University of Virginia School of Medicine.
The Doctoring 1 Instructors of Record Team educates first-year medical students, continuously enhances the first-year Doctoring curriculum and leads faculty development sessions aimed at empowering medical faculty to assist medical students in achieving their goals.
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Team members John Onate, Karnjit Johl, Suzanne Edison-Ton, and Joanna Garcia |
Respondents:
W. Suzanne Edison-Ton, M.D., M.S., wetona.edison-ton@ucdmc.ucdavis.edu
Karnjit Johl, M.D., karnjit.johl@ucdmc.ucdavis.edu
What team concepts, processes, and skills have worked particularly well to move the work of your teams forward?
We have been working with health professional teams since medical school when we began our careers in medicine. Many positive team concepts have occurred naturally, but there have also been quite a few team dysfunctions that were difficult to address without an understanding of team processes and a language with which to discuss them. We have found the learning styles concept particularly useful, especially in teams centered around medical student and resident education. Learning styles affect the way one learns but also the way one teaches. Understanding that others have different learning and teaching styles has helped us to appreciate different approaches to teaching medical concepts. We have also found ground rules and the check-in process invaluable for facilitating smooth and productive meetings.
What has been the most important lesson that you have learned in your work with teams of health professionals and staff?
The most important lesson we have learned in our work with teams is to allot time for discussion of the process. It is easy to make assumptions that the others on your team will want to work in the same way or on the same task or even that they have the same goal. In the long run, it is better to start with check-in with everyone on the team to make sure expectations are much more explicit. We think just the simple team concept of looking at your process has worked particularly well in moving the work along. It has also probably been the most difficult to implement as people are not used to or always comfortable with having these discussions. Our ability to value and honor the interests and skill of each team member has vastly improved through the focus on teams and team functioning. This has, in turn, made our team much more productive and creative in addressing our task of first-year medical student "Doctoring" education.
The Medical Education Leadership Team is responsible for all aspects of medical education at Mount Sinai from student life to administration and management of programs.
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Respondents:
Erica Friedman, M.D., erica.friedman@mssm.edu
David Muller, M.D., david.muller@mssm.edu
The 2006-2007 AAMC Enhancing Team Effectiveness program clarified the importance of educating health care professionals about team dynamics in order to effectively partner to achieve shared goals. This is true for medical educators, administrators and physicians. Using the tools, resources, skills, and ongoing mentorship acquired from this program, we were able to analyze our medical education leadership team's functioning, create a safe space for sharing insights about our own individual strengths and weaknesses and "ideal" team dynamics, specifically addressing communications skills, learning styles and conflict resolution.
What has been the most important lesson that you have learned in your work with teams of health professionals and staff?
The process allowed us to gain an appreciation of the value that each member brought to the team and to acknowledge that we functioned well because of these synergies. Possibly the most valuable part of the exercise was coming to the realization that we shared the same goals, yet approached them in very different ways.
As a result of these achievements in our leadership team, we created a curriculum to teach and assess medical student teamwork skills. This curriculum was implemented in the first year of medical school in the Anatomy, Histology and Art and Science of Medicine courses and required students to create ground rules, shared goals and successfully team together to learn course content. We also required they do self and peer assessments to provide 360 degree formative feedback about their team skills and group dynamics. Preliminary results in this first year of the teamwork curriculum have been very encouraging; the vast majority of students reported that the teamwork skills they acquired greatly enhanced learning and peer relationships.
The Perioperative Change Team are members of the Creighton University Department of Anesthesiology and provide clinical care in the Operating Rooms and other clinical sites at a tertiary care academic medical center in Omaha, Nebraska.
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Respondents:
Robert J. McQuillan, M.D., robertmcquillan@creighton.edu
Chad Bauerly, M.D., chadbauerly@creighton.edu
Rasheed Amao, M.D., rasheedamao@creighton.edu
In February 2007, Creighton University Medical Center began a systematic training program in the perioperative area using TeamSTEPPS™, an evidence-based teamwork system aimed at optimizing patient outcomes by improving communication and other teamwork skills among healthcare professionals. This program, along with the AAMC TeamWorks! program, provided us with the tools to begin the process of changing our culture. We have seen successes with improvement in staff and patient satisfaction, improvement in on-time prophylactic antibiotic administration, improvment in time-outs, and we are tracking our overall surgical outcomes looking for impact in that area. We have found several concepts and skills to be particularly helpful, namely situational awareness (the state of knowing the current conditions affecting the team's work), mutual support (the willingness and preparedness to assist other team members during operations), communication (effective sharing of information as a coordinating mechanism or supportive structure for teamwork), situational leadership (leadership that arises when there is a need and the designated leader is unable to provide what is necessary), conflict/dispute resolution, SBAR (a tool for structured communication: situation, background, assessment and recommendation), and hand-offs.
What has been the most important lesson that you have learned in your work with teams of health professionals and staff?
The most important lesson we have learned is that teamwork is not optional. You cannot decide "whether to do teamwork or not." In the clinical arena where critically ill patients are in the care of a group of healthcare providers and where the performance of the group and therefore the quality of the patient outcome is interdependent and no one member can do it all, then by this definition you have a team and teamwork is not optional. It is the quality of the teamwork that demands our attention for success.
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