Case study and health care provider

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Teams and Teamwork Case Studies

LEARNING OUTCOMES

After successfully working through the case studies in this chapter, you will be able to:

1. Demonstrate the ability to apply the Teams and Teamwork Sub-competencies to problem-based case studies in this chapter.

2. Operationalize the behaviors of Teams and Teamwork through case study application. 3. Evaluate how the Sub-competencies of Teams and Teamwork in Interprofessional Collaboration are demonstrated

in the case study discussions.

4. Identify the importance of Interprofessional Collaboration as it applies to each case.

This chapter presents patient- and population-based case studies designed to highlight the application of teamwork concepts to practice. Case studies are intended for use in group discussions or debates, as role- playing exercises, or as individual learning exercises. The authors acknowledge that all four Core Competencies may apply in each case; however, learning in this chapter is purposefully focused on Teams and Teamwork (TT) Sub-competencies. Carefully crafted guiding questions provide direction for learners and faculty facilitators.

Case Study Guidelines For each practice case study, you are asked to consider and apply specific Sub-competencies of Teams and Teamwork. These will be clearly indicated to you before you begin to read the case study. The Sub- competencies of Teams and Teamwork are provided for your reference in Box 15.1.

Box 15.1

Teams and Teamwork Core Competency and Related Sub– competencies ( IPEC, 2016, p .14)

Statement: General Core Competency of Teams and Teamwork Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient/population-centered care and population

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health programs and policies that are safe, timely, efficient, effective, and equitable.

TT1. Describe the process of team development and the roles and practices of effective teams. TT2. Develop consensus on the ethical principles to guide all aspects of teamwork. TT3. Engage health and other professionals in shared patient-centered and population-focused

problem-solving. TT4. Integrate the knowledge and experience of health and other professions to inform health

and care decisions, while respecting patient and community values and priorities/ preferences for care.

TT5. Apply leadership practices that support collaborative practice and team effectiveness. TT6. Engage self and others to constructively manage disagreements about values, roles, goals,

and actions that arise among health and other professionals and with patients, families and community members.

TT7. Share accountability with other professions, patients, and communities for outcomes relevant to prevention and health care.

TT8. Reflect on individual and team performance for individual, as well as team, performance improvement.

TT9. Use process improvement strategies to increase the effectiveness of interprofessional teamwork and team-based services, programs, and policies.

TT10. Use available evidence to inform effective teamwork and team-based practices. TT11. Perform effectively on teams and in different team roles in a variety of settings.

Case studies can be used as individual problem-based learning activities or incorporated as part of a variety of group learning activities. You can independently determine how each case study will be used after considering your specific learning needs and educational setting. Discussion questions and/or suggested learning activities are provided after each case study. You are encouraged to modify these questions and activities or pose your own to meet specific learning needs. Chapter 13 of this text provides foundational theory related to Teams and Teamwork; Chapter 14 provides examples to help readers operationalize specific Sub-competencies. Both chapters will be useful in considering the case studies that follow.

Case Study: Team or “Pseudoteam” Specific Sub-competencies to consider and apply: TT1, TT3; also consider resources from Chapter 13 describing the characteristics of “true teams” versus “pseudoteams.”

Individuals with intellectual and developmental disabilities (IDD) often encounter challenges in maintaining a healthy lifestyle. Get FIT is a community-based program that was developed to promote access to physical activity, as well as education about healthy lifestyle choices, for individuals with IDD living in the community. You have the opportunity to volunteer at the Get FIT program at your local university and observe the following.

Clients with IDD arrive at the campus community center with their group home care providers. The clients gather around a table and socialize with one another and the individuals providing the program. The group home care providers sit in chairs toward the back of the room. The session begins with nursing students discussing the importance of healthy food choices. The discussion centers on sugary beverages, diet beverages, and water. Several clients actively interact with the nursing students and each other for half an hour. At that point, the physical activity portion of the session begins. Students from occupational therapy and physical therapy disciplines lead a gentle stretching and strengthening program for the group. Each client is assisted by a student volunteer who records the specific activities the client completes. This is followed by a group activity that is set to music to encourage everyone to “get moving.” Students interact

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with their assigned clients throughout the session. Everyone seems to enjoy the physical activity and the social interactions. At the end of the session, student volunteers guide clients to their respective care providers to return to their home.

Discussion Questions

1. Based on your understanding of the case study presentation, were the individuals providing the Get FIT program functioning as a true team or pseudoteam? Provide specific examples as a rationale for your perspective.

2. Identify at least two potential benefits of interprofessional collaboration for the clients participating in this program.

3. Suggest additional team members who can engage in this client- and population-centered program. How would you rework the scenario to illustrate engaging other professionals in shared patient- and population-focused problem solving?

4. Offer at least three suggestions for team development and effective teamwork practices in this setting. Refer to Chapters 13 and 14.

Case Study: Providing Team-Based Care in a School Setting Specific Sub-competencies to consider and apply: TT1, TT4, TT5, TT11.

Sarah Edwards is an 8-year-old girl who was born prematurely in a complicated birth to a mother who was addicted to drugs. She lives with her grandmother, who is her legal guardian. Sarah has multiple physical, emotional, and cognitive challenges. She has limited verbal ability to express her needs and is prone to behavioral outbursts. She attends special education classes in her community school. The interprofessional team includes her special education teacher, instructional paraprofessionals, the school nurse, the case manager/social worker, a behaviorist, a speech therapist, an occupational therapist, and a school psychologist.

Sarah's physical, emotional, and psychological well-being is the focus for all team members. The team works together effectively to address behaviors and implement strategies to improve the fluctuating challenges in the classroom and at home. There are no turf battles; rather the team cohesively discusses and makes recommendations, easily shifting the leadership role depending on the situation. Working in teams involves sharing expertise and relinquishing some professional autonomy to work closely with others to share the care and improve the client's outcomes. The entire team is valuable and provides essential resources in their area of knowledge. For example, adjustments in Sarah's medication may require the nurse or case manager to intervene. The behaviorist may change the behavioral management program, whereas the remaining team members implement the plan and provide feedback on its effectiveness. If the team determines that Sarah's increasing outbursts stem from frustration with a limited ability to express her needs, the speech therapist takes the lead and works closely with the teacher, paraprofessionals, and family to identify the most appropriate communication strategies. The team integrates individual expertise of all members in shared planning to develop, implement, and reinforce team-based care.

By working closely together, the team members are aware of one another's plans and can transition activities more smoothly. For example, one day the speech therapist was running late because of a team meeting for another student. The occupational therapist realized this, and rather than ending the therapy session on time and leaving Sarah to wait for the speech therapist, the occupational therapist continued to work on team goals by incorporating goals both the occupational therapist and speech-language pathologist were addressing. The occupational therapist made use of the extra time to address communication and recognition of objects along with the motor skills practice of reaching and grasping objects. This creative use of time helped Sarah smoothly transition to her speech therapy session.

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At a team meeting, the team discusses a concern raised by Sarah's grandmother about recent behavioral problems at home that seem to stem from her school day. Sarah's grandmother reports that for the past few weeks, Sarah has been agitated and prone to outbursts when she arrives home from school. Team members share their experiences related to circumstances throughout the day that seem to trigger outbursts in Sarah and what strategies help in calming her. The special education teacher notes that unexpected schedule changes and disrupted routines are especially challenging for Sarah. The behaviorist and the paraprofessionals reports that fatigue, hunger, and toileting needs commonly lead to emotional outbursts. The occupational therapist shares observations from her sessions working on sensory integration that loud noises trigger strong emotional responses from Sarah and disrupt her ability to participate in activities. The speech-language pathologist notes that Sarah seems relaxed and calm when reading in a quiet environment. The team works together, troubleshooting to determine how to reduce potential triggers. The team recommends changing Sarah's schedule during the last period of the school day from a group physical activity held in the combined classroom with multiple students to quiet reading time to help Sarah adjust to the end of the school day transition to home.

Discussion Questions This case study illustrates how each member of the healthcare team, from the teacher to the paraprofessionals to the speech therapist, was able to integrate the knowledge and experience of others to make decisions about Sarah's plan of care.

1. Why is interprofessional collaboration important in this case study? 2. Identify at least two of the practices that support effective teams that are illustrated in this case

study. 3. Refer to Chapters 13 and 14. Who do you believe is the team leader in developing Sarah's plan of

care? Explain your reasoning. 4. Give an example of a situation described in the case study in which leadership appropriately

shifts from one team member to another member. 5. Who should be included in problem solving and planning related to Sarah's care? Can you

suggest other healthcare professionals and other professionals who should be part of the team? 6. Describe how team members' roles in the school setting differ from other settings.

Case Study: Community Health Concerns Background Provision of healthcare services typically focuses on individual patients, but broader consideration of population health needs is also warranted. The TT3 Sub-competency addresses population-centered problem solving, whereas TT7 addresses healthcare outcomes related to prevention. Public health initiatives such as Healthy People 2020 focus on population health beyond individual patients. For example, the obesity epidemic continues to rise in the United States. Although this has