Health care professional development: Working as a team to improve patient care

* Both of Amir Babiker and Maha El Husseini have equal contributions and act as first authors in this paper.

Correspondence to: Dr. Amir Babiker, Assistant Professor and Consultant Paediatric Endocrinologist, European Diploma in Leading and Managing in Health Care Settings (MSc module), Anglia Ruskin University, Cambridge, UK King Saud University and King Khalid University hospital, Riyadh, Saudi Arabia, as.ude.usk@rekibabima ; +966 537806560, Fax: +966 114691512

In delivering health care, an effective teamwork can immediately and positively affect patient safety and outcome. The need for effective teams is increasing due to increasing co-morbidities and increasing complexity of specialization of care. Time has gone when a doctor or a dentist or any other health practitioner in whatsoever health organization would be able to solely deliver a quality care that satisfies his or her patients. The evolution in health care and a global demand for quality patient care necessitate a parallel health care professional development with a great focus on patient centred teamwork approach. This can only be achieved by placing the patient in the centre of care and through sharing a wide based culture of values and principles. This will help forming and developing an effective team able to deliver exceptional care to the patients. Aiming towards this goal, motivation of team members should be backed by strategies and practical skills in order to achieve goals and overcome challenges. This article highlights values and principles of working as a team and principles and provides team players with a practical approach to deliver quality patient care.

Act as a collective unit, as a result of the interdependency of the tasks performed by team members.

Know their role and the roles of others in the team(s) and interact with one another to achieve a common goal.

After being formed and continue to develop, Healthcare teams interact dynamically and have the common goal of delivering health services to patients. In order to succeed, the team members need to share certain characteristics, which include [ 2 ]:

Performing: The team focuses all of its attention on achieving the goals. The team is now close and supportive, open and trusting, resourceful and effective.

Norming: Open communication between team members is established and the team starts to confront the task at hand. Generally accepted procedures and communication patterns are established.

Storming: A difficult stage when there may be conflict between team members and some rebellion against the assigned tasks. Team members may get frustrated here when do not progress well in the tasks.

Forming: Typically characterized by ambiguity and confusion. Team members may be unclear about tasks at this stage. They have not yet chosen to work together and may communicate in a superficial and impersonal manner.

Those who provide indirect, task-specific services in a health-care facility support services. It includes secretaries and the executive leadership of a unit or facility. This team has 24-hour accountability for the overall functioning of the organization. In order for any team to form and develop in a way that makes it coherent, effective and strong enough to face future challenges, research have shown that it usually passes through the following stages [ 2 ]:

They usually consist of team leaders and members who are direct-care providers such as nurses, dentists, pharmacists, doctors, assistants…etc. They also include case managers.

Today, as both clinicians and patients integrate new technologies into their management process, the overall rapidity of change in health care systems will continue to accelerate. The U.S. National Guideline Clearinghouse has listed over 2,700 clinical practice guidelines now, and, each year, the results of more than 25,000 new clinical trials are published [ 16 ]. No single practitioner can handle, absorb and use all this information, and the need for specific knowledge in specialized areas of care by different team members has become a necessity. Now, more than ever, there is an obligation to strive for perfection in the science and practice of inter-professional team-based health care [ 1 ]. Each clinician relies upon information and action from other team members. Yet, without explicit acknowledgment and purposeful cultivation of the team, systematic inefficiencies and errors cannot be addressed and prevented [ 1 ].

One all-knowing physician, or a private nurse living in the community in the “good old days” cared for people, and either was very easy to approach when needed at any time of the day [ 1 ]. Health care has changed enormously since then with more rapid pace in the last 20 years. It is now seen as undesirable in health care to practice in isolation and may even put the patient at risk [ 14 , 15 ]. The complexity of modern health care, which is evolving rapidly acts as a driving force behind the transition of health care practitioners’ from being soloists to members of teams who share a common aim [ 1 ].

Nowadays, patients are rarely looked after by just one health professional. In the context of a complex healthcare system, an effective teamwork is essential for patient safety as it minimizes adverse events caused by miscommunication with others caring for the patient, and misunderstandings of roles and responsibilities [ 2 ]. Patients are undoubtedly interested in their own care and must be part of the communication process too; their early and throughout involvement has been also shown to minimise errors and potential adverse events [ 2 ].

An effective team is a one where the team members, including the patients, communicate with each other, as well as merging their observations, expertise and decision-making responsibilities to optimize patients’ care [ 2 ]. Understanding the culture of the workplace and its impact on team dynamics and functioning will make a team member a good team player.

Team-based health care is the provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient – to accomplish shared goals within and across settings to achieve coordinated, high-quality care [ 5 ]. The incorporation of sharing responsibilities with accountability between team members in health care systems offers great benefit. However, in practice, shared responsibility without high-quality teamwork can result in immediate risks for patients. For example, poor communication between health-care professionals, patients and their caregivers, has emerged as a common reason for patients taking legal action against health-care providers [ 2 ]. Medical errors, “near misses” and other adverse events may also occur due to inadequacy of communication among team members even in a well coherent team [ 6–10 ]. Moreover, lack of purposeful team care can also lead to unnecessary waste [ 11 ]. Therefore, identification of best practices may help avoiding some of these dangers, and may help to control costs [ 12 , 13 ].

A team can be defined as a distinguishable set of two or more people who interact dynamically, interdependently and adaptively towards a common and valued goal/objective/mission, who have been assigned specific roles or functions to perform and who have a limited lifespan of membership [ 2 ].

The nature of a team is varied and complex. Though many patients may think that the most effective team is the multidisciplinary team, however, teams may be drawn from a single professional group.

An effective teamwork is now globally recognized as an essential tool for constructing a more effective and patient-centred health care delivery system. Identifying best practices through rigorous research, which can provide data on optimal processes for team-based care, is subject to identification of the core elements of this system. Once the underlying principles and core values are agreed and shared, researchers will be able to more easily compare team-based care models and commissioners will be able to promote effective practices [ 1 ]. Therefore, a number of designated health professional bodies worldwide have come out with recent statements to define teams and their roles and the characteristics of a successful team [ 1–4 ]. They elaborated on essential values and principles of a team based health care, to share a common ground on this very hot topic. These have all been highlighted in this article. The potential challenges, and practical tips on how to successfully approach the task, have also been explored and included alongside proposed implementation strategies.

Values, Principles and Benefits

The values needed in an effective team member harmonize with the core competency domain of “Values/Ethics” put forward in the meeting sponsored by Inter-professional Education Collaborative (IPEC)entitled “Team-Based Competencies”.The following are five personal values that characterize the most effective members of high-functioning teams in health care [1]:

Honesty: A high value is put on effective communication within the team, including transparency about aims, decisions, uncertainty, and mistakes. Honesty is critical to continuous development and for maintaining the mutual trust, which is prerequisite for a high-functioning team.

Discipline: Team members carry out their roles and responsibilities with discipline, even when it seems inconvenient. Such discipline allows teams to develop and stick to their standards and protocols even as they seek ways to improve.

Creativity: Team members are excited and motivated to tackle emerging problems creatively. They see even errors and some unanticipated bad outcomes as potential opportunities for improvement.

Humility: Team members do not believe that one type of training or perspective is uniformly superior to the training of others, though they recognize differences in training. They also recognize that they are human and will make mistakes. Hence, a key value of working in a team is that fellow team members can rely on each other to help recognize and avert failures, regardless of where they are in the hierarchy.

Curiosity: Team members are dedicated to reflecting upon the lessons they learned in their daily activities and using this reflective experience in continuous professional development and the functioning of the team.

Principles of Team-Based Health Care

There are many models to describe effective teamwork. Historically, these have come from other industries, such as the aviation’s crew resource management (CRM) [2]. The principles that characterize a successful team based health care include [1]:

Shared goals: The team, including the patient and, where appropriate, family members or other support persons, generate a common and clearly defined purpose that includes collective interests and demonstrates shared ownership.

Clear roles: There are clear expectations for each team member’s functions, responsibilities, and accountabilities, which optimize the team’s efficiency and often make it possible for the team to take advantage of division of labour, thereby accomplishing more than the sum of its parts. Mutual trust and respect: Team members earn each other’s trust, creating strong norms of reciprocity and greater opportunities for shared achievement. They respect and appreciate the role of each other. They also respect each other’s talents and beliefs, in addition to their professional contributions. Effective teams also accept and encourage a diversity of opinions among members.

Effective communication: This is crucial for the teamwork success. The team prioritizes and continuously refines its communication skills. It has consistent and accessible channels for complete communication, and used by all team members across all settings.

Measurable processes and outcomes: Reliable and timely feedback on successes and failures should be agreed and implemented by the team. These are used to track and improve performance immediately and put strategies for the future.

Leadership: Effective team leaders facilitate, coach and coordinate the activities of other team members. Effective leadership is a key characteristic of an effective team.

Benefits of effective teamwork

Effective teams can improve care at the level of the organization, the team itself as a whole, the individual team member and the patient ( ) [2]:

Table 1

Organizational benefitsTeam benefitsPatient benefitsBenefits to team membersReduced time and costs of hospitalizationImproved coordination of careEnhanced satisfaction with careEnhanced job satisfactionReduction in unexpected admissionsEfficient use of health-care servicesAcceptance of treatmentGreater role clarityServices are better accessible to patientsEnhanced communication and professional diversityImproved health outcomes and quality of care Reduced medical errorsEnhanced well-beingOpen in a separate window