Building Effective Healthcare Unit Teams:

Why, Who and How?

Dr Charles Pain, Director Health Systems Improvement

Clinical Excellence Commission

What Teams DoWork together

Celebrate together

Respect each other

Don’t throw hospital passes

WHY?

Aim

To improve the quality and safety

performance of the NSW public health

system

The problem

• Healthcare systems have low perceived

reliability

• Efforts to improve reliability have had

limited success and sustainability

• Healthcare providers are under increasing

pressure to improve reliability (and so are

the politicians)

Determinants or Root Causes

• Poor governance and organisation

• Insufficient resources

• Insufficient skills

• Inadequate tools

Root causes manifest as:

• Failure to set objectives of care

• Poor teamwork and coordination, including

poor communication

• Fragmentation of care

• Missed diagnosis

• Inadequate and inappropriate treatment

• Failure to recognise deterioration

Garling’s view

Garling emphasises the need for, “A new model of

teamwork… to replace the old individual and

independent ‘silos’ of professional care.”

[Overview, para 1.25]. He also talked of “…

strengthening the training of new clinicians in

better, safer treatments based on a patient-centred

team approach; [Overview, para 1.34].

 

Garling’s view continued

“The evidence shows that a team-approach to

treatment is likely to produce the best results. One

proven technique is the multi-disciplinary ward

round which includes the consultant and registrar,

junior doctors, nursing staff, pharmacists and,

where relevant, allied health professionals such as

speech therapist or physiotherapist.” [Overview,

para 1.110]

Evidence on benefits

• 91% of staff surveyed say they belong to a team but

when the definition is applied as a filter, then only 50%

of staff actually work in a team. The others work in

pseudo teams.

• Error rates are lowest in real teams

• Longitudinal data from the NHS shows that for each

10% increase in the proportion of real teams in an

organisation there is a corresponding 3.1% reduction

in patient mortality (HSMR)Professor Michael West , Head of Department, Aston Business School.

Organizational Behaviour in Health Care Conference, Birmingham April 2010

Staff teamwork matters most to patients

“Among patients who offered excellent ratings, how well the doctors and nurses worked together was the main factor that influenced their rating.”

Bureau of Health Information Insights into Care: Patients’ Perspectives onNSW Public Hospitals, May 2010

306185

148 639

281239

142 662

45 34 19 982 2 41 1

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Metro Rural / Regional S/W State

Compared to other factors that affect the delivery of safe, quality healthcare how important is effective teamwork to the delivery of quality healthcare in your dept/unit?

Most Important One of the top three most important issues One of the top ten most important issues

Only a mildly important issue Not important

Key: Metro = metropolitan, S/W = statewide services (Ambulance and Justice Health)

WHO?

The Healthcare Unit Team

Patient

Non-clinicians

Clinicians

Family

WARD

ProfessionalSpecialist

Teams

GeneralistTeams

JMOSRMONursingAllied HealthClericalPatient Support

MedicalNursingAllied health

Teams intersect at the healthcare unit level

Source: Professor Steven Boyages

Horizontal Teams

Ve

rtic

al T

eam

s

HOW?

CEC Health Systems Improvement Model

Macrosystem

Tool

s

Knowledge and

Skills

Resources

Gov

erna

nce

Microsystem

CHP May 2011

Nature of solutions

• Effective

• Sustainable

• Scalable

• Affordable

Principles for a solution

1.Health services are frogs not bicycles (A. Mant)2.Multidisciplinary teams (healthcare unit teams)

are our basic production units (cells). They deliver care to patients.

3.Patients are part of the team.4.We should start re-designing the system at the

microsystem level but also recognise the importance of the macrosystem (organism)

5.A multivalent approach is needed to be sustainable

Team Functions (Unit Facility)

1. Leadership and Governance2. Team Structure and Dynamics3. Care Planning, Coordination and Delivery4. Standard Protocols and Procedures5. Patient Safety and Quality Systems6. Patient Experience Management7. Education, Training and Supervision8. Workforce Management and Development9. Information Access10.Support Services and Equipment

ExcellentCare

Leadership & Governance

Education, Training & Supervision

Support Services & Equipment

Information Access

Care PlanningCo-ordination & Delivery

Standard Protocols & Procedures

Team Structure & Dynamics

Patient Experience

Workforce Management

Patient Safety & Quality Systems

Team Functions

ExcellentCare

Leadership & Governance

Education, Training & Supervision

Support Services & Equipment

Information Access

Care Planning& Co-ordination

Standard Protocols & Procedures

Team Structure & Dynamics

Patient Experience

Workforce Management

Patient Safety & Quality Systems

Handover checklistStandard Observation

Chart

Supplies management

Prioritisation of equipmentRostering for seniority

Skill balance

Core skills training (eg. DETECT)

Incident Reporting and ReviewRisk registerPrioritisation

Ward RoundsUniforms

Name BadgesWard Meetings

NUM role redefinedInterdisciplinary

Leadership (nursing, medical

& allied health)

EMRDecision support

Asking, listening and RespondingComplaints management

Care Planning with Objectives

Care Navigation

Examples of Practical Tools

Care PlanningCo-ordination & Delivery

Way Forward

1.Develop partnerships with CETI, NaMO,

ACI, Academics, etc.

2.Adopt TeamFirst Framework as a basis for

understanding and implementing a

microsystems approach

3.Develop implementation method involving

team building through coaching and

communities of practice, and provision of

teamwork tools.

Way Forward (cont.)

3. Implement by laying or reinforcing

foundations for healthcare unit teams, by

focussing on unit leadership, role clarity of

members, and establishment of key team

structures and processes.

4.Obtain or develop necessary tools for

teams to perform key functions, and

support them in designing unique tools,

where required.

Way Forward (cont.)

5.Ensure organisational support at all levels.

6.Evaluate

QUESTIONS?

Prioritisation FrameworkC

ost

effe

ctiv

ene

ss o

f sol

utio

ns

Population importance of problems (prevalence & consequence)

HIGHLOW

HIGH

Priority 1•Sepsis program•BTF•Hand hygiene

Priority 4 Priority 3

Priority 2

CHP 2010