Discussion Board and replies
#1
Naimah Z. Page
Apr 6, 2021 2:07 PM
The goals of healthcare performance improvement are not about just improving the practices and procedures of individuals. The goals include making positive improvements systemically through an organization, which means that teams of people working together need to be targeted. If there is anything I have taken away from the cases we’ve discussed so far, it is that many times preventable errors are due to lack of communication across a team. Healthcare workers operated in silos that prevent communication, collaboration, and efficient decision making based on current evidence. Lighter (2011) argues that using teams is important because they provide the opportunity for collaboration across specialties and skill sets, which in turn makes decisions more effective and informed. Team charters make these various specialties and skill sets work effectively together by defining responsibilities and expectations. Rather than a top-down hierarchical decision making structure that is considered “traditional,” the team approach eliminates the gaps in communication and accountability that can occur with a top-down, siloed approach to decision making (Lighter, 2011). In addition, teams can achieve more than an individual can. Mayo and Woolley (2016) argue that it is key not only to build a team with smart people on it, but to ensure that processes exist so team members with relevant knowledge can speak up when it’s time, and can impact the team’s work with that knowledge. They call this process one of maximizing collective intelligence, meaning that one person’s expertise can can improve the work of everyone around them, creating a positive ripple effect in an organization where everyone ends up more informed, more aware, and more effective. The key in making this work is collaboration and communication, as well as the empowerment of individual team members to make a difference within and through their team (Mayo & Woolley, 2016). Resources: Lighter, D. E. (2011). Advanced performance improvement in health care: Principles and methods. Sudbury, MA: Jones and Bartlett. Mayo, A.T. & Woolley, A.W. (2016). Teamwork in health care: maximizing collective intelligence via inclusive collaboration and open communication. AMA J Ethics 18(9); doi: 10.1001/journalofethics.2016.18.9.stas2-1609
#2
Lydia Wang
Apr 5, 2021 4:20 PM
Teams are absolutely critical in healthcare performance improvement. As discussed in Lighter's chapter 2, physicians were traditionally the apex of the healthcare landscape with other staff, like nurses, pharmacists, medical assistants, etc. as the supporting staff. However, health care has grown to be increasingly interdisciplinary with each member of the team playing a critical role for the delivery of efficient and effective patient care. Similarly, when embarking on healthcare performance improvement. each member of the team also must be allowed a voice.
The role of teams is to bring together a variety knowledge, experiences, skillsets, and ideas to the table to identify and address healthcare performance improvement projects. Having people from a variety of backgrounds with different perspectives can only strengthen the outcomes of healthcare performance improvement projects and ensure all angles have been addressed. One team member alone usually does not have the sufficient resources at hand to make the best decision, especially if the healthcare performance improvement project crosses many functional areas. With these complex projects, it can be helpful to have teams bring creativity, critical-thinking skills, and a variety of possible solutions to the table to figure out the best possible outcome.
As an example, my large healthcare system employer recently realized that diabetes management within our employee population has been especially challenging and in need of performance improvement. As such, members of our human resources team called together a focus group composed of primary care physicians, pharmacists, nurses, health coaches, and employees with diabetes to discuss the current experience of diabetes management for an employee to identify areas of improvement. These discussions were enlightening for all as many new pieces of information were learned from each other. Next, the primary care physicians, pharmacists, nurses, and health coaches met to discuss best practices and potential solutions to remedy the areas for improvement. Our discussions were led by the human resources team who are not clinical but much more business-minded to keep us grounded to what was realistic. After many team meetings, we finally have put together a pilot program to best manage our most at-risk employees with diabetes and provide the resources that the providers and patients involved need. We would not have been able to come up with such a comprehensive plan without the entire team, as the perspectives from each discipline offered new insights. Ultimately, I do think that we will see a much more pronounced improvement in the performance of diabetes management in our employee population from this program than we would have seen if any one member of the team decided to embark on the quality improvement project on his or her own.
References:
Lighter, D. E. (2011). Advanced performance improvement in health care: Principles and methods. Sudbury, MA: Jones and Bartlett.
U.S. Department of Health and Human Services. Improvement Teams. Retrieved from https://www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/improvementteams.pdf.
#3
Michael Leroy Kehr
Apr 6, 2021 11:22 PM
What role do Teams have in Healthcare Performance Improvement?
The use of teams within healthcare has gained traction over the past few decades. Previously, patient care was established through a hierarchy lead by a physician who, essentially, made all decisions for the patient during the encounter. The central decision making forced the provider to utilize their copious amounts of knowledge gained during their formal training, but also forced them to make health decisions in areas that they did not have a large amount of knowledge or the knowledge is antiquated. This led to increased errors, and decreased effective communication, especially when the physician was questioned about a treatment decision. As healthcare has matured, the industry has "discovered" the value of teamwork in improving performance and patient outcomes.1 As disease management has become more complex with increased knowledge of conditions as well as how to treat them, the need for interdisciplinary teammates becomes a need in modern healthcare. Members of a care team may include doctors, nurses, physician assistants, specialists, and other non-clinical professionals who are integral to caring for a patient. The fundamental concept is that a team is a group of individuals who coordinate their actions for a common purpose, which in healthcare is the prevention or treatment of disease and promotion of health.2 Having been part of interdisciplinary rounds within a hospital, each teammate provides their expertise on a particular portion of the patient's care plan and provides guidance and collaboration when patient care plan discussion uncover interdependencies between specialties.
The same teams that actively participate in a patient's clinical management also participate in process improvement, including root cause analysis when there is a sentinel event or medical error, patient grievance investigations, or workflow opportunities increasing waste in the patient throughput process. The expertise of the specialties is critical to understand where the care or process fell short and how their specialty can impact the process to prevent future errors or to optimize workflow within a health care facility. The team will create a problem statement, participate in brainstorming to uncover ideas of potential causes of the defect, create containments that will prevent the defect from reaching future patients during investigation, and finally implementing countermeasures to prevent the defect from reaching all patients, once the root cause(s) is/are identified.1 Having teammates with clinical and real world experience collaborate on patient care and quality will provide a larger impact than if one person was working alone, in a vacuum. These teammates will have a shared goal to collaborate to improve the quality and safety of the care their patients receive during their encounter.
References:
1. Lighter, D. E. (2011). Advanced performance improvement in health care: Principles and methods. Sudbury, MA: Jones and Bartlett
2. Heath, S. (2019). How to Use Team-Based Care to Improve the Patient Experience. Retrieved from: https://patientengagementhit.com/news/how-to-use-team-based-care-to-improve-the-patient-experience