the fundamentals of creating cohesive multidisciplinary teams in the medical home kenneth w. phelps,...
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The Fundamentals of Creating Cohesive
Multidisciplinary Teams in the Medical Home
Kenneth W. Phelps, Ph.D.Assistant Clinical Professor
Department of Neuropsychiatry and Behavioral ScienceUniversity of South Carolina School of Medicine
Keeley J. Pratt, Ph.D.Post‐doctoral Fellow in Personalized MedicineObesity Signature Program, RTI International
Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.
Session #B4BOctober 29, 201110:30AM
Faculty DisclosureWe have not had any relevant financial
relationships during the past 12 months.
Need/Practice Gap• More settings are adopting the use of integrated
teams; however, most training programs have not adjusted to educate providers on how to work in settings where intense collaboration exists.
• The resulting dilemma is that providers are often trained in silos, but have no real practice on how to effectively integrate their skill sets.
• The presenters hope to address how providers can create effective, cohesive teams, as well as problem-solve common issues.
Objectives1. Identify the necessity to use multidisciplinary
teams in the patient centered medical home (PCMH).
2. Examine challenges when practicing on multidisciplinary care teams that arise from dissimilar education / training experiences.
3. List strategies to troubleshoot barriers to effective multidisciplinary care.
4. Describe methods for evaluation of collaborative team-based care.
Experience with teams…
• All of us can relate to being on a “team”o Sports teams (football, soccer, volleyball)o Education teams (school projects, IEP, PTO, board)o Extracurricular teams (glee club, band, fraternity)o Business or executive teamso Family, marriage, or relational teamso Healthcare teams o Others
“For a group of individuals to be transformed into a team, they must have a purpose that is
distinctive, specific to the group and promotes member buy-in to a whole that becomes greater than
simply collecting individual contribution toward the same
objective.”
Kohn and O’Connell, 2007, p. 45-46
“6 Habits of Highly Effective Teams”
Kohn and O’Connell, 2007
Strengthening emotional capacity to
improve team relationships
Expanding team self-awareness
Practicing empathy and respectfulness
Establishing and regulating team
normsThinking laterally
Entrusting team members with
appropriate roles
Why use multi-disciplinary teams?
• Effectiveness of care• Efficiency of delivery• Targeting of BPS needs• Multiple expertise• Mutual learning• Limits oversight and mistakes• Increases professionalism
Effective Primary Care Teams
An effective team may have the…• “capacity to function at a level that enhances the
individual contributions of their members and team effectiveness.”
Themes of primary care team effectiveness:1. Understanding and respecting team members’ roles2. Recognizing that teams require work3. Understanding primary health care 4. Working together: practical know-how for sharing care5. Communication***
Sargeant et al., 2008
Key Elements of Team Building
• Defined Goalso Overall organizational mission statemento Specific, measurable, operational objectives
• Systems (Clinical, Administrative, Financial)• Division of Labor• Training and Cross-training• Communication Structure and Processes
Bodenheimer, 2007 for California Health Foundation
PCMH Team Soup: Most Important
Ingredient?CommunicationFlexibility
Collective MentalityFlat HierarchyShared Vision
Dependability of MembersAddressing Multiple Systems
Etcetera
Common Team Challenges in PCMH
• Languages of care• Unclear roles• Conflicting
personalities• Minimal cohesiveness• No common goals
• Alliances• Triangulation• Boundaries• Indistinct team
leader• Absent patient
and/or family
Narratives of Problematic Healthcare
Teams
Troubleshooting Strategies
1. Give & Take Education2. One Cohesive Treatment Plan3. Reflective Listening 4. Role Statements5. Outside Consultation6. Evaluation
Give & Take Education• Appreciate each person’s unique skill set
and overall contribution to the team• Prioritizing what information should be
included in discussion • Round robin effect vs. lead/follow• Speaker-listener review
*Consider use of personality inventories (True Colors, Myers Briggs, etc.) to highlight differences in approaches to the team and each person’s strengths.
One Cohesive Treatment Plan
• Mission Statement = primary objectives• Vision Statement = values
• Cohesive Treatment Planso Biopsychosocial frameworko System for designation and f/uo Location, location, location
Reflective Listening & Role Statements
• Refresher on I-statementso Replacing the “I” with your professional role
• Team-statements during meetings
• VCR Approacho Validateo Clarify/challengeo Request
Hardy and Laszloffy, 2005
Seeking Outside Consultation
• When is it necessary?• How to find someone?• What is the anticipated end product?
o Assess functional performance of teamo Provide environment where feedback is the normo Assist with problem solving, resolving conflict and
enhancing cohesiveness
Evaluation• Process Groups• Observational Data
o Live observation by 3rd partyo Video or audio record
• Formal Questionnaires o Providerso Patient or family
• Frequency of re-evaluation/appraisal
References• Bodenheimer, T. (2007) Building Teams in Primary Care:
Lessons Learned. California Healthcare Foundation. • Kohn, S. E., & O’Connell, V. D. (2007). 6 Habits of Highly
Effective Teams. Pompton Plains, NJ: The Career Press. • Sargeant, J., Loney, E., & Murphy, G. (2008). Effective
Interprofessional Teams: “Contact is Not Enough” to Build a Team. Journal of Continuing Education in the Health Professions, 28, 228-234.
• Hardy, K. & Laszloffy, T. (2005). Teens who hurt: Clinical interventions to break the cycle. Guilford Publshing.
Questions
Contact Information
• Kenny Phelps, Ph.D.Kenneth.phelps@uscmed.sc.edu (803) 434-4221
• Keeley Pratt, Ph.D.Keeley.pratt@gmail.com(317) 902-7233
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