The million-dollar question: Are you a team?

The new patient had a question and, according to Dr. James Salwitz, it was “a zinger”: “What is the culture of collaboration in your group?”

Very few patients ever think to ask this or perhaps even realize it’s important, Dr. Salwitz reflected recently on his blog, Sunrise Rounds. But maybe they should, because when medical groups function effectively as a team, they’re also better able to provide good care. Or, as Dr. Salwitz puts it, “As with lessons learned in kindergarten, if your doctor does not play well with others, your medical care may be in trouble.”

Why would collaboration matter, when the patient’s primary relationship is with his or her own physician? Dr. Salwitz lists some reasons:

- Doctors can’t be available 24/7 and there may come a time when the patient must be seen by someone else. Colleagues need to know the plan of care for the patient, and this takes skilled and consistent communication.

- Doctors need to be able to review cases with their colleagues and give and receive constructive criticism without becoming defensive or isolated.

- Working closely with colleagues is how doctors are able to evaluate each other’s skills and abilities. Doctors depend on this knowledge when referring patients to other physicians.

I’d take this one step further by including the rest of the doctor’s staff. Patients don’t generally get to choose the nurse, the person who answers the phone or the person at the front desk, but these individuals are part of the team too – and what they do, or don’t do, can either enhance the care of the patient or sow confusion, frustration and the potential for error.

The impact of teamwork on patient outcomes is difficult to measure. But as it turns out, there’s a whole chunk of research reinforcing that patient care tends to be better and safer in organizations that emphasize a culture of collaboration.

One classic study, published in 2009 in the American Journal of Surgery, found that poor teamwork was associated with more complications and more deaths among surgery patients. Among the behaviors that seemed to make a difference were the amount of information shared during the surgery and how well the team was briefed during handoffs.

Other studies have documented the problems created when health care professionals engage in disruptive behavior.

And a study of a group of emergency rooms found that when physicians, nurses and technicians received formal training in emergency team coordination, they performed better as a team and made fewer errors.

How can consumers assess the quality of teamwork at their clinic or hospital? There’s no set of standardized online ratings, at least yet, hence not much guidance for the public. But Dr. Salwitz offers a few thoughtful questions with which to start the conversation:

“Do you discuss cases with your partners?” “How do you cover each other on the weekends?” “How long have you been together?” “What do you, as a doctor, look for in other doctors?” “What is your culture of collaboration?” And finally, “Is there a unifying philosophy that the doctors in your practice share? What is it?”

More patients ought to be asking these questions. And maybe more clinicians ought to be thinking about what their response would be.

3 thoughts on “The million-dollar question: Are you a team?

  1. Teamwork is critical to medicine. That’s actually, and surprisingly, “news”. It wasn’t long ago that medicine was hierarchical and teamwork didn’t matter — following orders is really all that mattered. Thank goodness, times have changed! The old hierarchical system didn’t take full advantage of all the other professionals with independent observations, histories, and biases who could make real contributions to safety. And with safe care, comes efficient and cost-effective care. So everyone wins if all the insights are shared in a team. The Joint Commission, the accrediting body Rice Memorial uses, has lots of tools for teamwork that Rice already implements. This tradition of teamwork is a big advantage for the Willmar community.

  2. I don’t know how accurate this is, but my perception is that rural community hospitals like Rice tend to have a stronger tradition of being multidisciplinary, perhaps because they don’t have the same resources as an urban or teaching hospital and they’ve learned to call upon what they have. But maybe this is just a generalization. Certainly many large hospitals also do very well at teamwork.

    Regardless of hospital size or location, a lot of this seems to come down to organizational culture. Patients and families do notice whether the professional caregivers function well as a team. Asking “What is your culture of collaboration?” seems like an important question for everyone to think about.

  3. I agree that organizational culture is the critical factor, and that rural facilities like Rice Memorial have an advantage. The advantage is that essentially all the jobs of a major medical center still have to be done, but they’re done by a smaller number of people. So one person might be both the occupational health nurse as well as the safety officer, or another person might be the quality officer and the accreditation coordinator. These are examples, and may not be how Rice is organized, but it is typical for facilities like Rice to have key individuals wearing more than one hat.

    That gives these organizations an advantage in cooperation, teamwork, and agility. Instead of being entirely vertically organized, there is great horizontal spread of ideas and solutions. The net effect, though, is dependent on the organizational culture. I’ve seen small organizations with a culture of fear that took no advantage of these opportunities. Thankfully, Rice has a culture of collaboration that lets it take full advantage of its associates and colleagues.

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