High-functioning Teams Research Articles

Rutgers Robert Wood Johnson Medical School.

Rutgers Robert Wood Johnson Medical School.

An Interprofessional Simulation-Based Orientation Program for Transitioning Novice Nurses to Critical Care Roles in the Emergency Department: Pilot Implementation and Evaluation

The emergency department (ED) relies on high-functioning teams to deliver consistent and safe patient care. Experts recommend that both emergency physicians and ED nurses participate in team training. However, there are currently no nationally accepted curricula for either profession to embed this training in their professional development, particularly for health workers who are novice or transitioning into critical care roles. An interprofessional educator team designed and embedded a series of simulation scenarios within a novel orientation program for novice nurses transitioning to critical care roles in the ED to teach clinical and teamwork skills for conjoint groups of resident physician and novice nurse learners. The team created four interprofessional simulations to represent the acuity and breadth of patient populations in the ED critical care bays. To date, the team has conducted 24 two-week orientation sessions for 48 nurses and 51 resident physicians. Overall mean scores for the Debriefing Assessment for Simulation in Healthcare (DASH) instrument from nursing participants in the first 18 sessions were high. Qualitative evaluation data from both nurses and physicians demonstrated a positive impact of the simulations and provided insight into respective roles, identities, and priorities across professions. Participant feedback led to iterative steps in refinement of the simulations, including adjustments in debriefings and logistics of the orientation program. A team-based interprofessional simulation program was found to be feasible and acceptable for practicing novice physicians and nurses as part of a nursing critical care orientation program in the ED. Future work will assess the program's long-term impact on teamwork and safety in the actual clinical environment.

The How Matters: How Primary Care Provider Communication With Team Relates to Patients' Disease Management.

Investigating primary care provider (PCP)-team communication can provide insight into how colleagues work together to become high-functioning teams more able to address an increasingly complex set of tasks associated with chronic disease management. To assess how PCP communication with their care team relates to patients' health. Longitudinal study of how 3 aspects of PCP-care team communication-participation, time spent listening, and uninterrupted speaking length-relate to disease management of patients with hypertension or diabetes, and the effect of these team communication behaviors on PCP-patient communication as a pathway by which this relationship might exist. We used multilevel regression models. Twenty-seven PCPs and 98 team members, and 18,067 patients with hypertension and 8354 patients with diabetes affiliated with a federally qualified health center with 12 practice sites. Primary data on communication collected using sociometric sensors worn by PCPs and team members, patient-PCP communication data collected with surveys, and patient health, PCP and patient characteristics extracted from electronic records. PCPs participated in 75% of care team conversations, spent 56% of conversation time listening, and had an average uninterrupted speaking length of 2.42 seconds. PCP participation, listening, and length of uninterrupted speaking time were associated with significantly higher odds that their patients had controlled hypertension and diabetes and improvements in disease control over time. PCP-patient communication mediates this relationship. PCP-team communication is associated with patient health management. How team members speak with one another may be as important as the content of their communication.

Strategies and Tools to Enhance Team Performance.

The ability for teams to work together in a coordinated manner may be where the greatest improvements in health care occur in the next generation. To perform at the highest level there are several key principles that all teams must have no matter what playing field they are on, including health care. Several resources were used to identify the challenges we face in health care with respect to the delivery of quality care, improving outcomes and decreasing complications. A search of the lay press and scientific literature was evaluated to identify those key elements that lead to improvements in team performance. In addition, personal observations were accumulated with time and examples of strategies used at home institutions were identified. The teams in our pediatric orthopaedic practices are many and include those in the clinic, the operating room, research, and our administrative office. The Institute of Medicine, in their influential article in 1999, defined the alarming rates of complications/harm occurring in the US health care system. In response, the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DOD) collaborated to create the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) in 2006. This was implemented in military facilities and later civilian hospital settings with varied success in civilian hospital settings. They defined key principles based around team structure, communication, leadership, situation monitoring, and mutual support. Other important foundational attributes of a successful team include identifying the vision of the team, hiring top-talent in the form of hard and soft skills, having open communication, being goal-focused, practicing accountability, and having an organized team. We can look to excellent examples in medicine, business, and sports to see where and how high-functioning teams have existed and to learn from them to implement similar successful teams. Team performance is a function of talented members who share a common vision, who have the opportunity to voice their thoughts/opinions, and have the ability to be accountable to each other. Surgeons need to lead by example, and provide each member of the team an opportunity to contribute in a meaningful way which ultimately will improve the lives of the patients we are honored to care for.

Driving high-functioning clinical teams: An advanced practice registered nurse and physician assistant optimization initiative.

Rapid changes in the health care marketplace are driving health care systems to modify operations by which the advanced practice registered nurse (APRN) and physician assistant (PA) clinicians serve patients. By identifying more effective and efficient utilization workflows, organizations can meet these demands resulting in high-functioning clinical teams. With the growing number of APRNs and PAs within a large academic medical center, there was a recognized need to establish effective and efficient utilization practices for these health care providers. Directors of the Advanced Practice Provider Best Practice Center developed an internal nurse practitioner (NP)/certified nurse midwife (CNM)/clinical nurse specialist (CNS)/PA assessment service in which evaluations were conducted to optimize APRN and PA practice at the clinical/department level. This assessment excluded certified registered nurse anesthetists. Thirty-two clinical areas were evaluated between September 2016 and May 2019. This included an NP/CNM/CNS/PA survey and over 200 individual NP/CNM/CNS and PA provider interviews. Assessments addressed utilization, billing practices, professional development, and communication among team members. Qualitative and quantitative reports were compiled. Many common themes were identified. These were broken down into three major categories: productivity, clinical operations, and professional development/support. Several recommendations were presented to department leaders regarding NP/CNM/CNS/PA practice. Those departments who implemented several of the recommendations showed positive outcomes. This was evidenced by increased financial gain (increased relative value units, increase in revenue generated), increased patient access (increased clinic densities), and overall NP/CNM/CNS/PA satisfaction.

Driving high-functioning clinical teams: An advanced practice registered nurse and PA optimization initiative.

Rapid changes in the healthcare marketplace are driving healthcare systems to modify operations by which advanced practice registered nurses (APRNs) and physician assistants (PAs) serve patients. By identifying more effective and efficient utilization workflows, organizations can meet these demands, resulting in high-functioning clinical teams. With the growing number of APRNs and PAs in a large academic medical center, there was a recognized need to establish effective and efficient utilization practices for these healthcare providers. Directors of the APP Best Practice Center developed an internal NP/certified nurse midwife (CNM)/clinical nurse specialist (CNS)/PA assessment service which conducted evaluations to optimize APRN and PA practice at the clinical/department level. This assessment excluded certified registered nurse anesthetists. Thirty-two clinical areas were evaluated between September 2016 and May 2019. This included an NP/CNM/CNS/PA survey and more than 200 individual NP/CNM/CNS/PA interviews. Assessments addressed utilization, billing practices, professional development, and communication among team members. Qualitative and quantitative reports were compiled. Many common themes were identified. These were broken down into three major categories: productivity, clinical operations, and professional development/support. Several recommendations were presented to department leaders about NP/CNM/CNS/PA practice. Departments that implemented several of the recommendations showed positive outcomes. This was evidenced by increased financial gain (increased relative value units, increase in revenue generated), increased patient access (increased clinic densities), and overall NP/CNM/CNS/PA satisfaction.

Spatial Influences on Team Awareness and Communication in Two Outpatient Clinics: a Multiple Methods Study.

Healthcare organizations are moving their primary care teams out of private offices into shared workspaces for many reasons, including teamwork improvement and cost reduction. Identify the specific aspects of layout and design that enable two fundamental processes of high-functioning teams: communication and situation awareness. This was a multi-method study employing qualitative interviews, floor plan analysis, observations, behavior mapping, and surveys. Two primary care clinics in a large, integrated healthcare system in the upper Midwest, with Clinic S in a suburban location and Clinic A in a rural setting. In the two clinics, a total of 36 staff members were interviewed, 57 (66% response rate) staff members were surveyed, and 2013 individual-points were recorded during 63 behavior mapping observations. Communication encounters, team members' perception of the environment and teamwork, visibility, distance, functional pathways, and self-reported mode and frequency of staff communication. Observations, interviews, and surveys identified environmental factors that predict staff awareness and communication patterns. Visibility impacts situation awareness. Frequency of face-to-face communication increases with visibility and proximity between workstations (e.g., Clinic A nurses' intra-role communication without workstation proximity vs inter-role communication with workstation proximity: 22.6% [11.4, 33.9] vs 77.4% [66.1, 88.6], p = 0.001) and with staff members' functional paths. Visual exposure to patients predicts staff's concerns about their communication (Clinic S: 2.29 ± 0.81 vs Clinic A: 3.20 ± 0.84, p < 0.001). Design and layout of team spaces have important influences on the way that team members work together. The organizational goals of the healthcare system, particularly which staff members need to work together most frequently, should drive the specific design solution.

Fortifying Our Teams to Best Serve Our Patients: A Report of the 2019 Summer Intersociety Meeting.

Continuing the thematic focus on fostering wellness and professional fulfillment in our workplace, the 2019 Radiology Intersociety Committee Conference focused on understanding and leading multigenerational workforces and developing high-functioning teams. To lead a multigenerational workforce and to understand and embrace traditional versus emerging cultures in our workplace, effective leaders should foster diversity of their teams. Sustaining such teams requires an understanding of different styles and preferences for bidirectional communication and clarity of information sharing and learning; active efforts may be needed to focus on practical approaches to succession planning, breaking down traditional hierarchies, clarifying role delineation, and managing authority gradients. An effective team requires attention to the well-being of team members and professional behavior in and out of the workplace. Conference participants unanimously endorsed multi-organizational support statements and activities assuring professional behavior of their members, along with the desire to explore codes of conduct and ethics.

Trust within your team during a pandemic.

The concept of trust is essential for high-functioning general practice teams during a pandemic.

Evidence-Based Review and Discussion Points.

Evidence-Based Review and Discussion Points.

Enhancing teamwork to create a high-performance team in the acute stroke unit at Worcestershire Royal Hospital – quality improvement project

The acute stroke unit (ASU) in Worcestershire Royal Hospital has a multidisciplinary team including consultants, junior doctors, nurses, physiotherapists, occupational therapists, and speech and language therapists focusing on delivering hyperacute stroke treatment and rehabilitation. However, it is felt there are difficulties in multiple levels such as staffing issues, disorganised ward rounds and teamwork, lack of communication between teams, lack of local induction, hindering our multidisciplinary team to become a high-functioning team. This quality improvement project (QIP) focused on identifying the areas of improvement and …

Practical Strategies for Building and Growing an Effective, High-Functioning Interdisciplinary Team (P12)

Practical Strategies for Building and Growing an Effective, High-Functioning Interdisciplinary Team (P12)

Peak Performance: A Communications-Based Leadership and Teamwork Simulation for Fourth-Year Medical Students.

Background:Medical education has traditionally been rooted in the teaching of health and disease processes, with little attention to the development of teamwork and leadership competencies.Objective:In an era of value-based health care provided by high-functioning teams, new approaches are needed to develop communication, leadership, and teamwork skills for medical students.Design:We designed and piloted a simulation-based educational activity called Peak Performance that linked a workbook, which focused on self-reflection on communication and leadership skills, with professional coaching. The simulation scenario placed students in the role of an upper-level resident on an inpatient service, followed by a small group debrief with students, a clinical faculty member, and a professional executive coach. After the debriefing session, students were invited to complete a self-reflection workbook within 1 week of the initial simulation. The final element of the curriculum was an individualized session with an executive coach. Peak Performance was offered to all fourth-year medical students enrolled in the Social and Health Systems Science required course at the University of North Carolina School of Medicine.Results:Pre-/post-self-assessments of leadership competencies were completed by students. Pre-simulation self-assessment scores ranged from 3.72 to 4.33 on a 5-point scale. The lowest scores were in “Managing Conflict” and “Managing Others.” The highest score was in “Self-Awareness.” The post-simulation scores decreased in every competency, with “Managing Others” dropping significantly from 3.72 pre-simulation to 3.36 post-simulation (0.31, P < .05). Satisfaction with the curriculum was high, as reflected by a Net Promoter Score of 91% (“excellent” > 50%).Conclusions:A novel simulation-based educational activity linked to professional coaching is a feasible and impactful strategy to develop leadership, communication, and teamwork skills in medical students. Student insight and self-awareness increased as evidenced by a decrease in competency self-assessment after guided reflection and individualized coaching.

Measuring attributes of team functioning in primary care settings: development of the TEAMS tool

ABSTRACTThis study examines attributes of a high-functioning primary care team by creating a survey measuring staff perceptions of team culture in primary care practices with innovative team-based workforce models. Survey data from a national study of 30 exemplar primary care practices with innovative team-based workforce models was used. Staff and clinicians (n = 943) at the 30 primary care sites completed a 31-item survey online. Survey items came from previous surveys of adaptive reserve and team culture. Factor analysis, reliability and validity were examined for the survey. Case summaries from site visits and survey comments were compared for high and low scoring sites to establish validity. Three core attributes of a high-functioning team were identified: joy in practice (4 items), personal growth (3 items), and leadership and learning (20 items). Four items did not measure any attribute. Using item correlations, the 20 items for leadership and learning were reduced to 7 items. All three attribute subscales had good reliability and validity. The final 14-item survey measuring joy in practice, personal growth and leadership and learning may be useful in clinical practice as a practical tool to gauge progress in developing a high-functioning team. Further research is needed to determine the sensitivity of this instrument to change over time with interventions designed to improve team functioning in primary care.

The impact of clinic design on teamwork development in primary care.

Traditional clinic design supports a high-volume, hierarchical practice model. New design models are evolving to foster a high-functioning team delivery model. The goal of this study was to determine whether new design models, specifically colocation, improve care team development. A quasi-experimental design was used in this study to obtain validated teamwork development scores and patient satisfaction data to compare clinic design models. We took advantage of a difference in designs of primary care clinics among several clinics within the same care system in the Upper Midwest region of the United States. The participants were staff members of the primary care delivery teams in the studied clinics. The intervention was a redesign of staff space in the clinic. Our measures included a validated measure of team development and a commonly used patient satisfaction tool that were both in use at our institution at the time of the study. Teamwork scores were significantly higher in clinics where the primary work space of the entire team was colocated than in clinics where providers were in spaces separate from other team members. The differences in scores held across team roles, including providers, registered nurses, and licensed practical nurses. Patient satisfaction was not different. Colocation in clinic design appears to have a significant impact on team development across primary care team member roles. Primary care practice leaders should consider colocated clinic designs if their goal is to optimize care team development in support of team-based care delivery models. A more precise understanding of colocation that includes aspects such as distance to and visibility to teammates might help improve design in the future.

Interprofessional Practice: Just a Trend or Worthy Investment?

This article discusses the vital leadership role of the chief nursing officer (CNO) in building a dynamic professional practice environment across a hospital or system that ensures excellence in nursing practice within the context of a high-functioning interprofessional team. The CNO's ability to articulate the value of such an investment and demonstrate the expertise required to lead the effort is essential to garnering organizational support for such a major practice and culture change. This article describes the use of Edgar Schein's organizational culture model as a framework for making this foundational practice and cultural transformation successful. This article discusses the vital leadership role of the chief nursing officer (CNO) in building a dynamic professional practice environment across a hospital or system that ensures excellence in nursing practice within the context of a high-functioning interprofessional team. The CNO's ability to articulate the value of such an investment and demonstrate the expertise required to lead the effort is essential to garnering organizational support for such a major practice and culture change. This article describes the use of Edgar Schein's organizational culture model as a framework for making this foundational practice and cultural transformation successful.

Achieving dialysis safety: The critical role of higher-functioning teams.

The potential for harm from errors and adverse events in dialysis is significant. Achieving a culture of safety in dialysis to reduce the potential harm to patients has been challenging. Recently, improving dialysis safety has been highlighted by Nephrologists Transforming Dialysis Safety (NTDS), a national initiative to eliminate dialysis infections. Other aspects of dialysis safety are important, though less measurable. Approaching dialysis safety from a systematic thinking view helps us to understand the need for leadership and high-functioning teams to deliver safe, reliable care in dialysis facilities. Resilience in healthcare is embodied by strong teamwork-interdependent professionals working together with clarity of goals and communication. This paper reframes the role of dialysis facility medical directors as leaders of these high-functioning teams. Alignment between nephrologists and dialysis management is necessary for these teams to function. This will require nephrologists to embrace their leadership roles as medical directors and for dialysis facility management to provide adequate operational support. The accountability for dialysis safety is shared between the nephrologists and dialysis organizations; coleadership is required for safety culture and high-functioning dialysis teams to develop.

3302 Student Leadership Training effects on team dynamics and collaborative work in high-pressure, interprofessional team environments

OBJECTIVES/SPECIFIC AIMS: We aimed to explore the impact of leadership training on student’s abilities to work in interprofessional research teams successfully. The Translational Research Design and Interprofessional Skills Development Course (shortened, Interprofessional Research Design) brings together students from different disciplines (science &amp; medicine) and education tracks (PhD, MD, MD/PhD training) in a seven-week course to learn interprofessional collaborative skills and leadership styles that support success in translational research environments, while undertaking a research grant writing project. Part of the course involves a two-day leadership training workshop (12 hours) with the goal of understanding leadership styles and how to develop productive working relationships with team members to help students work more effectively in high-performance, interprofessional team environments. The course incorporates personality testing to develop self-awareness, with various exercises meant to build empathy, as well as knowledge of project management and effective leadership. METHODS/STUDY POPULATION: Nine teams of 32 students (23 MD; 9 Ph.D.) who took part in the Interprofessional Research Design course in 2017 and 2018 were required to write a reflective essay at the end of the course. We used an inductive thematic analysis to evaluate the essays. Reflective essays were coded openly by one study member. Codes were rationalized; then codes were collaboratively developed into themes by the study authors. We identified issues of integration between student groups that functioned well together and those that did not. Reflective writing responses were grouped into overall positive experiences and negative experiences. RESULTS/ANTICIPATED RESULTS: Seven of the nine teams collectively described their experiences positively. Themes related to positive team experience were “empathizing with group members”, “sophisticated communication” and “collaborative workflow/styles.” We found that those who had a positive experience utilized knowledge and skills learned during leadership training to better understand and communicate with their teammates leading to a more collaborative and dynamic workflow. These groups had higher degrees of communication both between their task assignments and within task completion periods. They also showed more awareness of others’ needs in work and communication styles. For those that had a negative experience, themes were related to “basic communication”, “poor integration” and “theory-practice gap of leadership training.” Those who struggled showed much less in- and between-task communication and showed an inability to address the personal needs of other members in communication and workflow (while still often being able to identify them). DISCUSSION/SIGNIFICANCE OF IMPACT: These findings demonstrate the usefulness of leadership training that facilitates student self-awareness and empathy, as well as effective communication, leading to collaborative high-functioning interprofessional teams. Further work incorporating conflict management and exercises to overcome the theory/practice gap of leadership and teamwork training are recommended.

Abstract TP384: Effective Communication and Engagement Cultivates Teamwork Among Virtual Telestroke Providers

Background: In most hub-and-spoke telestroke systems, geographically co-located hub stroke specialists support regional spoke sites. In the VA’s National Telestroke Program (NTSP), a virtual hub of stroke specialists located around the country provides 24/7 consults nationwide. We examined how stroke specialists adapted to virtual teamwork, and identified factors important in developing and sustaining a high-functioning virtual team. Methods: Semi-structured, confidential interviews with hub stroke specialists were audiotaped and transcribed. Probes were used to explore the extent to which providers had developed a sense of a teamness or a community of practice, and what factors helped or hindered this development. Core elements of a high-functioning team were defined using Mitchell's taxonomy, developed as part of the IOM's Best Practices Innovation Collaborative. Each interview transcript was independently coded by two investigators using NVivo11. The constant comparative method and matrix displays were used to identify themes, with special attention to themes about team, communication, trust, and satisfaction. Results: Of 13 hub providers with &gt; 8 months NTSP participation, 12 were interviewed; 7 had prior telestroke experience. Participants reported high levels of trust and sense of teamwork with their virtual colleagues, sometimes even more than with local colleagues. Factors facilitating perceived teamness included communicating via a weekly case conference call, a sense of transparency in discussing challenges, engagement in NTSP development tasks, and leadership support. Lack of in-person contact decreased perceived teamness, but having an in-person NTSP meeting helped mitigate this issue. Despite technical challenges, providers reported high levels of satisfaction with the NTSP. Conclusions: Practicing as a virtual Telestroke hub provider can provide an equal or greater sense of trust and sense of teamwork with colleagues compared with traditional practice. Engaging in transparent discussion of challenging cases and contributing to program improvements may be key to promoting high-functioning virtual teams. Ongoing surveys will assess providers’ satisfaction with program outcomes over time.

The LOTUS: A Journey to Value-Based, Patient-Centered Care.

In response to the merger of our 248-bed community hospital with a new health system, a multidisciplinary team began a journey of holistic transformation via the evolution of a new rounding process called Leadership, Ownership, Transformation, Unity, and Sustainability (LOTUS) in the 20-bed ICU. Morphing from a hierarchical practice structure with limited engagement of multidisciplinary members, the LOTUS initiative (named for the blossom whose petals surround its core, the patient) afforded each discipline (petal) an equal voice and allowed a once-fragmented team to work cohesively, collaboratively, and at the highest level of the scope of practice for each discipline, thus affording expert guidance during care planning while providing a method to collect quality metrics. LOTUS allows us to view our patients in a new way as we refocused goal determination on patients and their families. The restructuring and evolution into a high-functioning team was targeted with the goal of enhancing quality critical care for patients, which, in the literature, has correlated with improved patient safety and decreased mortality and ICU length of stay.