Healthcare = Team Sport

The Hospitalist. 2010 March;2010(03):

March 1, 2010 | The Hospitalist

The good news is we aren’t alone in our efforts to change the culture, even the mission, of our hospitals. In a time of healthcarewide workforce shortages, there are increasing demands for direct inpatient care, coupled with the added time needed to document current performance and train and implement needed improvements. The only way to meet all of the volume and performance demands is with process change. We need a different way to deliver care to hospitalized patients.

All-Star Teams

High-performing organizations are composed of high-performance teams and a set of operating principles that create a widespread culture of motivated individuals who are focused on metrics, are execution-driven, and are committed to continual improvement and rapid adaptation.

The characteristics of high-performance teams are that they:

Self-correct and reallocate resources;
Have clear roles and responsibilities;
Have clear, valued, and shared visions;
Have strong team leadership;
Develop a strong sense of “collective” trust and confidence; and
Manage and optimize performance outcomes.

SHM has taken the lead at a national level in helping to organize the Hospital Care Collaborative (HCC), which is made up of CEOs and leaders in nursing, pharmacy, case management, social workers, and respiratory therapy. The HCC has published a set of “Common Principles” (see “Common Principles for the Hospital Care Collaborative”) and is planning to develop practical strategies for building high-performance teams at our nation’s hospitals.

SHM recently received support from Ortho-McNeil and has created a partnership with the American Hospital Association, American Organization of Nurse Executives, and American College of Physician Executives to develop principles and strategies to implement high-performance teams and to use this as a springboard to look at hospital care in the broadest sense (including transfers with medical home and accountable-care organizations). To start, SHM has convened a blue-ribbon group of hospital CMOs, CQOs, nursing executives, and other leaders in the hospital C-suite. Former SHM president Pat Cawley, MD, MBA, FHM, assistant professor and executive medical officer at the Medical University of South Carolina in Charleston, will chair this effort.

In these two initiatives, SHM and national hospital leaders are providing direction and innovation at two entry points—the C-suite and executive team—as well as on the front lines with the other healthcare professionals who care for our nation’s hospitalized patients.

More to Come

HM has had an interesting decade, growing to more than 30,000 hospitalists now practicing in 75% of our nation’s hospitals. We’ve taken on comanagement and are providing real success as change agents. But the decade to come will see the reinvention of our nation’s hospitals and distinct changes in workflow and responsibilities. We are moving from care based on the unit of the visit or the procedure to episodes of care. We are moving from a system that rewards just doing something to one that rewards doing the correct thing and doing it well. We are moving our hospitals from a swap meet where each physician has a booth and everyone supports those individual efforts to an institution with a culture that is patient-centered, based on quality measurement and performance, and provides care delivered by teams of health professionals working in concert.

This is a world that hospitalists can thrive in and, with your help and direction, SHM will provide the tools along the way. TH

Dr. Wellikson is CEO of SHM.

Common Principles for the Hospital Care Collaborative

The following HCC common principles were approved by SHM and five other medical professional associations in 2009:

The HCC believes healthcare is a “team sport” with respect and recognition for the knowledge, talent, and professionalism of all team members.
The HCC supports clear delineation of team roles and responsibilities with an emphasis on a collaborative and nonhierarchical model.
The HCC believes in patient-centered care, rather than provider-centered care, and that the healthcare team members should involve the patient/family/caregiver in developing care plans and goals of care.
The HCC believes collaboration of the healthcare team can lead to improved systems and processes that provide care more efficiently and result in better patient outcomes. Examples include strategies for implementation, improved workflow, and the utilization of evidence-based processes.
The HCC believes all members of the team within their licensure and scope of practice have a role to play in establishing organizational policy, and directing and evaluating clinical care.
The HCC believes in a system that involves many team members; all health professionals should work to create safe care transitions and handoffs within the hospitalization and post-hospitalization episodes of care.
The HCC believes all team members must be as proficient in communications skills as in clinical skills.
The HCC believes the appropriate capacity and staffing of the entire team is a requirement for providing the best care.
The HCC believes all team members are accountable for their individual performance as a healthcare provider, as well as the performance of the entire team. While this may be defined by statute or regulation, this also relies on the clinical judgment of each member of the team.
The HCC understands that in order to improve quality of care, standards and measurement of performance are important. The HCC believes that the measurement should be of the outcomes of the team rather than of any individual member of the team.
The HCC believes that in order to provide the best care possible, appropriate information must be readily available to all team members, at the right point of decision-making, and in a format that allows for ongoing updating and communication to the team.
The HCC believes the current undergraduate and postgraduate professional education of team members is inadequate to promote true team functions. The HCC calls on the training institutions for health professionals to adopt new curricula and experiential models that foster the competencies and the culture that support team-based care. The HCC also calls on professional associations to likewise function in a team-based manner and develop creative approaches to “teaching” the professionals they represent, as well as modeling for other healthcare professionals the skills to be a functioning member of a healthcare team. Professional associations should foster research that demonstrates the effectiveness of team-provided care.
The HCC recognizes that today’s hospital cultures do not foster true teams of healthcare professionals. The HCC calls on all stakeholders (e.g., payors, providers, administrators, patients) to work together to create a new hospital culture that nurtures and rewards high-performing teams.