Interprofessional Teams to Support Healthy Aging

Definitions of Teams  A team is a small number of consistent people committed to a relevant shared purpose, with common performance goals, complementary and overlapping skills, and a common approach to their work.  Team members hold themselves mutually accountable, team results are outcomes."

Types of Healthcare Teams  In the "multidisciplinary" team model, health care providers tend to treat patients independently and to share information with each other, while the patient may be a mere recipient of care.  An interdisciplinary team aspires to a more profound level of collaboration, in which constituents of different backgrounds combining their knowledge mutually complete different levels of planned care

Team Process and Structure  Understanding team ups and downs  Ingredients for success  Interdisciplinary team organization

Roller Coaster of Highs & Lows Scholtes, et al 1988

Roller Coaster of Highs & Lows Scholtes, et al 1988

10 Ingredients For a Successful Team  Clarity in team goals  An improvement plan  Clearly defined roles  Clear communication  Beneficial team behaviors  Well-defined decision procedures  Balanced participation  Established ground rules  Awareness of the group process  Use of the scientific approach Scholtes, et al 1988

Organization of Interdisciplinary Team Care Structure Meetings Held Regularly Information Shared Joint Collaboration on Treatment Plans Assessment Implementation Evaluation Successful Outcome Unsuccessful Outcome Interdisciplinary Discharge Planning Zeiss & Steffen, 1995

Life Cycle of a Team Issues are maintenance & preparing for change PERFORM- ING. Issues are awkwardness. Pressure to get going FORMING Issues is learning to live with disagreement STORM- ING Issue is creating functional norms & changing dysfunctional ones NORM- ING. Tuckman, 1965

Team Role Map Zeiss & Steffon (1995) Coordinate placement for DC planning Decide on equipment needs Monitor Medication Regimen Planning & Counseling during illness Physical assessment

An Interdisciplinary Team CORE TEAM Patients Clinical Services Other Hospital Teams Hospital Administration Accrediting Bodies Community Campbell & Cole, 1987

Interdisciplinary Questions

Team Roles

Functional Roles in Teams: Necessary Skills  Leader  Facilitator  Recorder  Timekeeper

Team Leader (Joiner, Team Memory Jogger, 1995)  Educates team members about team purpose, limits, etc.  Tracks team’s goals & achievements  Anticipates and responds to changes in timing, schedules, workloads & problems  Helps team members develop their skills (Cont.) Joiner, 1995

Team Leader (cont.)  Communicates with management about the team’s progress and needs  Communicates with the rest of the organization about team’s actions & achievements  Removes barriers to team progress  Helps resolve conflict  Takes care of logistics Joiner, 1995

Team Facilitator (Joiner, Team Memory Jogger, 1995)  Provides training as needed  Helps team deal with conflict  Coaches the team leader or team members on team skills  Helps the group use basic problem- solving principles and tools  Leads team meetings, especially when difficult or controversial subjects are being discussed Joiner, 1995

Team Leadership  Crucial to effective team functioning  Not vested in one person or position  Set of behaviors/skills that can be taught/learned  Shared responsibility of each team member

Situational or Shifting Leadership  Leadership is a process of interactions by team  Leadership is not a person a thing a position

Transformational or Shared Leadership  Self-leaders through development of individual talents  Leadership shared among team members as tasks change  Related to expertise to the task at hand

The Qualities of Followers Effective followers share a number of essential qualities  They manage themselves well  They are committed to the organization and to a purpose, principle, or person outside themselves  They build their competence and focus their efforts for maximum impact  They are courageous, honest, and credible Kelley, 1988

Don’t Forget the Family

Interacting Dimensions of Geriatric Assessment Functional Status Social Support Spirituality Affective Medical Cognitive Environmental Economic

Patient/Family On the Team  Pro Input required to establish goals Enhances commitment/compliance to program “Patients’ rights” issues

Patient/Family On the Team  Con Issues of patient competence, confusion, understanding Presence could interfere with open discussions Countertherapeutic effect of exposure to team dynamics

Outcome: Evaluation and Accountability Overview

Essential Components of Effective Team Functioning Guide to Interdisciplinary Practice in Rehabilitation Settings, 1992 Context Team as individuals Team as a unit Leadership Information sharing & Communication Problem solving and decision making Conflict resolution and feedback Evaluation and accountability Team maintenance and enhancement Processe s Outcomes Structure

Dimensions of Team Goals  Target client professional organizational  Time Frame Short-term Long term  Purpose task-oriented goal-oriented

Organization of Interdisciplinary Team Care Structure Meetings Held Regularly Information Shared Joint Collaboration on Treatment Plans Assessment Implementation Evaluation Successful Outcome Unsuccessful Outcome Interdisciplinary Discharge Planning Zeiss & Steffen, 1995

Were team goals achieved? How were they reached?

Team Efficiency and Effectiveness  Organizational context  Team membership  Team member roles  Problem solving and decision-making strategies  Outcomes

Evaluation and Accountability  Acceptability  Timeliness  Productivity  Problem solving processes

Team Membership Dimensions  Working out of conflict  Learning strategies for flexibility  Creativity and innovation

Team Role Dimensions  Participation  Effective working partnerships  Responsibility  Professional knowledge and skills

Performance Improvement

Success Equals:  Timeliness  Capacity for future interaction  Innovativeness  Clarity  Workability  Acceptability  Patient functional recovery

Success Equals: (cont.)  Agreement management  Conflict management  Meeting effectiveness  Participation in decision making

Success Equals: (cont.)  Accountability to patients, families, and colleagues  Planning for future teamwork  Training components  Increasing knowledge of team functions, strategies, and collegial interactivity

Success Equals: (cont.)  Patient Acceptability Accepts each team member Accepts limitations Engages as a team partner

Focusing On Team Basics Katzenbach & Smith, 1993 Commitment Performance Results Collective Work Products Personal Growth Specific Goals Common approach Meaningful purpose Technical/ function Mutual Small # of people Problem solving