IPE Core Competency Domain 4: Teams and Teamwork

IPE Core Competency Domain 4: Teams and Teamwork


♪ Welcome to Core Competency
Domain 4 – Teams and Teamwork. The purpose of inter-professional
education is to help students learn how to work as part of an effective
inter-professional collaborative healthcare team. In 2011 the Interprofessional Education
Collaborative, also known as IPEC, released four interrelated core competency
domains for interprofessional education. These interprofessional education
competencies were developed to better prepare health profession students
to deliberately work together to meet the common goal of delivering high quality,
safe, patient-centered health care. This video will be addressing the fourth
competency domain, which is to apply relationship building
values and the principles of team dynamics to perform effectively in different team
roles to plan and deliver patient population-centered care that is safe,
timely, efficient, effective and equitable At the end of this training video you’ll
be asked a short series of questions about this competency to help assess your
understanding of the competency presented. Let’s talk to our healthcare team from the
scenario in this video series to learn about how this competency domain
can be applied. Remember each health care team with be
unique with different professions based on the context and type of
care delivered. As with previous videos in the series
this scenario centers around Ella, a 78 year old woman who in collaboration
with her health care team had decided to stop curative directed
oncology treatments and transition solely to palliative medicine and symptom
management and control. Ella has been working with her
interprofessional collaborative team for two years. In addition to Ella, our patient
and her daughter Karen, there is Dr. Young, the oncologist
who specializes in breast cancer. Jose, the oncology clinical nurse
specialist, an advance practice nurse, who works with cancer patients to
manage symptoms, Andrea, the oncology social worker with
advanced training in palliative care, and psycho-social oncology, And Dr. Lee, the oncology pharmacist
with experience in palliative care. If you haven’t watched the previous
videos in this series, additional description of the different
health provider roles are discussed in greater detail
in video two. And the other inter-professional
collaborative practice competencies are addressed using this scenario. The healthcare team has a pharmacy student
who’s being precepted by Dr. Lee, and is joining the group today. The team is taking some time out of their
very busy schedule to explain to the student about how they function as a team
and how that has developed over time.>>This is my student intern for
the semester, Marie Lopez. I thought maybe we could talk to her about
inter-professional team work.>>I really appreciate the opportunity to
learn more about teamwork from you.>>I think we work well together. We’ve been together
at least two years now. There are many kind of teams
in health care. Some have a lot of team member transition or only come together
on a short term basis. This is one of the reasons why developing
your personal team work skills is so important. No matter where you work or
what kind of team you’re on, your personal team work skills
are an asset. Every team is going to have its own
set of communication styles, or even relationships. I’ve found that the team stepps training
serves as very good basis for team work.>>One of the most important things
in working as part of a team is to understand our common purpose. When everyone focuses on working together
to meet the needs we’ve talked about with our patients and their families
as we plan care and make decisions, we can discuss complex and even
conflicting ideas more effectively. And if we work hard to maintain open
communication, that is so essential to help us bring our diverse professional
ideas into planning and providing care. It helps when we disagree, rather than
competing with each other about who is right, we realize we each
have a piece of the bigger picture.>>Also when you have a team you don’t
have to do everything yourself. It helps you be more efficient to do
things that you are best at and then to know that other aspects
of care are being well taken care of by other team members. We work together to understand which
member of the team might be best-suited for which care task.
>>Yeah I agree with Dr. Young. Collaborative inter-professional practice
is different than just delegating various components of care to different members
of health professions or even talking amongst ourselves. With collaborative practice we share
accountability for the patients care. In a recent palliative care case we worked
together to help a patient achieve the goal she identified for symptom
management. We literally shared in the goals
and outcomes of care.>>So how did you all develop into
the team you are today?>>Well we had just started
working together. Andrea and I have been here a few years
and Dr. Young had just come on board and hired Jose as the clinical nurse
specialist, which is one of the advanced practice
nursing roles. We had a really complex patient where we
had to focus on working together to come up with a good plan of care. We had different perspectives on what
was needed but we felt that talking out loud about
our ideas helped us develop a stronger plan for the patient. You know it was a really satisfying
experience and we such great outcomes.>>And we decided that intentionally
working as a team can improve our care, not just for this one occasion
but for all of our patients.>>So we started with a one day retreat
where we focused on some team-building exercises and we scheduled a weekly team
meeting where we laid out some general rules.
>>Like what?>>Like sharing leadership during the
meetings, we rotate who runs the meetings but we also use a timed agenda because
we have so much to talk about in the limited time and we also had some important discussions
about what ethical principles we could use to guide our teamwork. In the beginning we agreed that we would
each take a turn at sharing our ideas about what thought was going on
and what was needed. We found that we had to overcome the
natural hierarchy of healthcare. And we had to be intentional about
sharing power and respecting each other. Now, each of us feels comfortable about
speaking up and we each have something to say. We also speak up anytime and not just
during meetings because we realize that we need to be looking out for
each other all the time.>>We spent a lot of time learning about
each other’s roles and learning to listen to each other. Also we routinely review our team
performance which includes how we perform together
as well as individually. It takes a lot of trust to do this and
we’ve built that with each other over time We’ve built our own what they call
‘psychologically safe space’ together and we use what we learn in our review
to help build our teamwork. Also, we do a quick debrief at the end of
each meeting to see if we accomplished what we needed to in the meeting or how to improve the meeting process
as well as our work together. But also we review our performance
at a quarterly review meeting where we pay close attention to
our outcomes.>>That’s right. We’re going to do a
retreat for the quarterly review meeting this year at my house, complete with
backyard barbecue and swimming. It helps to get to know each other in
a less pressured situation.>>Wow. I want to be on a team
like this when I graduate. You all seem to get along so well.>>Well we work at it
but it’s not always easy. Sometimes we disagree about a plan of
action and sometimes we have a bad day and we say things more harshly than
we intend to.>>But because we have a good
foundation for communication, we can talk about that too. One of our intentional team development
activities was to participate in team stepps training and practice using
some of the techniques like debriefing and huddles to
improve our communication.>>Even so, I think the trust that we’ve
built in each other and reaching our common goal has helped
get us through.>>Yeah so that and Andrea’s expertise
in conflict management and communication.>>And we really do try to keep the
patient and family at the center of everything that we do. You want to remember that the patient
and the family are part of the team.>>You see the whole point of our
inter-professional collaborative care is that our outcomes and our solutions
tend to be better since we all come from different
perspectives and strengths based on different professions
and experiences.>>This is inter-professional
competency four. Apply relationship-building values and the
principles of team dynamics to perform effectively in different team
roles to plan and deliver patient population-centered care that is safe,
timely, efficient, effective and equitable Let’s examine what sub-competencies
we saw illustrated in the conversation with the student intern about the team
work that the healthcare team has worked hard to establish
and maintain. When we look at the specific teams
and teamwork sub-competency, in sub-competency one –
describe the process of team development and the roles
and practices of effective teams. In this scenario the team has been working
together for two years. It had a very positive experience working
as a team and deliberately decided to further develop as a team,
starting out with a retreat that included team-building exercises
and developing guidelines that help improve becoming an
effective team. Part of the team development also
included learning about each others roles. The process of developing as a team
included the sub-competencies of teams and teamwork eight –
reflect on individual and team performance for individual as well as team
performance improvement. Sub-competency teams and teamwork
nine – use process improvement strategies to increase the effectiveness
of interprofessional teamwork and team-based care. And sub-competency teams and teamwork
10 – use available evidence to inform effective teamwork and team-based
practices. This team used process improvement
strategies like quick debriefs at the end of meetings, and quarterly
reviews to increase their effectiveness. Building in these systematic ways
reflect on individual and team performance provides for continuous quality
improvement and is supported by evidence. As additional research evidence about what
contributes to effective teams becomes available, these evidence based
strategies should be evaluated for potential use within teams. The next sub-competency is team
and teamwork two – develop consensus on the ethical
principles to guide all aspects of patient care and team work. Dr. Young indicated that the team
discussed what ethical principles would guide their teamwork,
demonstrating the development of a consensus on the ethical principles
used to guide the patient care and teamwork. Consensus can not be reached without
a dialogue on the topic with the entire team involved. Again, inter-professional ethics related
to healthcare teams is an emerging area as traditional ethical principles and
professional codes of ethics need to be reexamined to determine
application to inter-professional collaborative practice. For sub-competencies three and seven
address the nature of inter-professional collaborative practice, which includes
both patient-centered problem solving and shared accountability. Sub-competency three is engage other
health professions appropriate to the specific care situation in shared patient-
centered problem solving. Dr. Lee indicated that working together
and talking about their different perspectives on care helps develop
a stronger plan for the patient which demonstrates shared
patient-centered problem solving. Each specific care-situation will dictate
which health professionals should be engaged in sharing patient-centered
problem solving to maximize outcomes. Paired with shared patient-centered
problem solving, is shared accountability. Sub-competency team and teamwork seven –
the shared accountability with other professions, patients and communities
for outcomes relevant to prevention and healthcare. As Jose, the clinical nurse
specialist pointed out, true collaborative practice requires
shared accountability. In this team, the shared accountability
comes from the shared common goals and the patient-centered problem solving. In sub-competency teams and teamwork
five – apply leadership practices that support collaborative practice
and team effectiveness. This specific team has decided on a shared
leadership model for team meetings and rotates who runs the meetings. This type of leadership supports
collaborative practice which includes common goals and
shared accountability. Any one of the healthcare professionals
on this team has the skills to run a team meeting. By taking turns, the team acknowledges
that there’s a sharing of power and accountability. Which conveys respect for team members. Overcoming the traditional hierarchies
inherant in healthcare can augment teamwork but it may require deliberate strategies
in order to successfully shift to a more non-hierarchical structure. For sub-competency teams and teamwork
four – integrate the knowledge and experience of other professions
appropriate to the specific care situation to inform care decisions while respecting
patient and community values and priorities and preferences for care. Jose the clinical nurse specialist reminds
us at the end of the discussion that the patient and family are part of
the team and the center of the care. Their priorities and preferences will be an
integral part in the decision making. Andrea the social worker highlighted
the benefit of bringing the diverse perspectives from the different
professions to planning patient care. You can see the overlap with the
professional communication competency here You need good communication skills
so that everyone understands the different perspectives that inform
decision making and communicates these perspectives in a respectful way. For sub-competency teams and teamwork
six – engage self and others to constructively manage disagreements about
values roles, goals and actions that arise among health care professionals
and with patients and families. Dr. Young acknowledged that disagreements
inevitably arise about a course of action and that how things are sometimes said
can contribute to these disagreements. Constructive management of disagreements
in this team is handled by discussing the issues as they arise. At least one of the team members,
in this case Andrea, has formal training in conflict management
which further helps the team to manage disagreements. It is important to note that sometimes
disagreements can constructive by providing the [inaudible] for
developing new and sometimes better solutions that arise out of
the disagreement. For sub-competency teams and teamwork
eleven – perform effectively on teams and in different team roles
in a variety of settings. Jose the clinical nurse specialist
clarifies the importance of developing personal teamwork skills since teams
change based on context and setting. So some teams will develop over time
and other teams are thrown together for a short period of time
due to necessity. By being prepared to perform effectively
on a team and in different roles, you’ll be able to maximize the outcomes
for that team regardless of context or setting. Team stepps, which stands for team
strategies and tools to enhance performance and patient safety,
is a national evidence based teamwork system to improve communication
and teamwork skills among healthcare professionals. Team stepps training is one way to enhance
your teamwork skills. The IPE competencies can be accessed at
the website on your screen. For further information about team
stepps, that can be found at the website also on your screen.

Leave a Reply

Your email address will not be published. Required fields are marked *