Orlando, FL—The word “teamwork” may not immediately come to mind when thinking about the US healthcare system, but certain methods can contribute to the development of more efficient teams in the delivery of oncology care, said Doris Quinn, PhD, Consultant in Process Improvement, at ASCO’s first Oncology Practice Conference in March 2017.
“Working as a team in healthcare is extremely difficult. But it’s not that we don’t want to do it, it’s that we don’t know how to do it,” said Dr Quinn.
Working as a Team
A team represents a group of individuals who work together to achieve a common purpose for which they hold themselves mutually accountable. The members of a team have a shared work product, with interdependent tasks and shared responsibility for the output and the results. Team members also share a commitment to a common approach to working together, and collectively manage their relationships across organizational boundaries.
When the departments in a healthcare system only operate in silos, patients do not receive high-quality care. To understand whether a healthcare system works as a team, Dr Quinn proposed a series of questions for consideration
- “Do the physicians understand what the staff at the ‘front desk’ do?”
- “Do the nurses and other clinicians understand what the support staff do to troubleshoot?”
- “Does the team collect data on what is not working well in the clinical areas?”
- “Does the entire team (not just the administrator) brainstorm solutions for what is causing patient issues?”
Healthcare systems can learn from football teams, she said. A football team has a set role for each position, the coach has an evidence-based plan, and the aim is clear, but the strategies adapt depending on what happens in each game. The football players practice and learn from their mistakes, and they see immediate and visible results.
Managing Change
Change can happen on many levels, and can sometimes be uncomfortable, especially when the people affected by change are not aware of what to expect. However, a change that is transparent and has been agreed on before its implementation decreases anxieties and is better received. Incremental change is limited in scope and is often reversible, whereas deep change requires new ways of thinking and behaving. But organizational change begins with personal change, said Dr Quinn.
Incorporating process changes early on is crucial, she emphasized. For example, hospital readmissions often occur because patients were not properly prepared to leave the hospital, particularly in the case of major surgery.
“Start preparing patients for discharge early in their treatment, rather than at the end. They’re still trying to process everything that’s happened to them; it’s not a good time to just send them on their way,” Dr Quinn suggests.
In healthcare, providers are expected to adhere to a multitude of ever-changing payment structures, quality metrics, and management structures, and it is often difficult to be enthusiastic about these mandated changes, she noted. Change can also mean grieving the old way, because it is familiar; therefore, it is important to consider the effects that change, such as the introduction of an electronic medical record (EMR) system, can have on healthcare providers.
“Epic and other EMR programs are a big change,” said Dr Quinn. “Wouldn’t it have been nice if we’d given clinicians a flowchart and said, ‘This is how your life is going to be different’? Instead we gave them a bunch of rules,” she added.
Flowcharts and run charts can be invaluable tools for facilitating challenging transitions. A flowchart defines a process, the role each member plays, and the interdependency of the steps involved; and a run chart lays out data over time, and informs an institution on how that process is performing.
“Processes can be messy, but flowcharts shouldn’t be. If you don’t know the intricacies of what you’re trying to change, then change will be difficult,” said Dr Quinn. A pathway is a kind of clinical flowchart that is embedded within a clinical practice operation, and can be a helpful method for decreasing care variation.
“This can all look very complicated, but it gets at the heart of what you do, and why you do it,” she added.