EBM12: Teamwork plays a role in evidence-based medicine
CHICAGO--Teamwork is associated with lower costs and increased job satisfaction, says Beatrice J. Kalisch, PhD, RN, Titus Distinguished Professor Nursing and director of Education & Innovation at the University of Michigan School of Nursing in Ann Arbor, speaking Oct. 4 at the CMIO Leadership Forum: Transforming Healthcare through Evidence-Based Medicine.
Kalisch cited a litany of studies and reviews that show the profound effect teamwork has on healthcare, including the association between high teamwork and a culture of safety, decreased errors, increased patient satisfaction, patient perceived quality of care and provider-reported quality of care, decreased readmissions to the ICU and shorter length of stay.
A review of medical malpractice claims in the emergency department found that appropriate teamwork might have averted more than 60 percent of deaths and a lack of performance monitoring was a major cause of errors in 35 percent of cases.
Kalisch referred to Salas et al’s “big five” theory of teamwork in which the concept is comprised of five core elements: team leadership, backup behavior, mutual performance monitoring, adaptability and team orientation.
Team leadership refers to the structure, direction and support provided by both the formal leader and each member, who each take turns being in charge. Backup behavior requires a willingness to provide and seek assistance, Kalisch said, as well as a willingness to jump in and help and accept help without fear of being perceived as weak. It also refers to helping one another with tasks and responsibilities including feedback. “Giving feedback is the most undeveloped skill anywhere,” she said, because most people don’t know how to give feedback without offending.
Mutual performance monitoring refers to keeping track of fellow team members’ work while completing their own. Could be interpreted in negative terms but is accepted and maximizes the team’s overall performance.
Adaptability refers to the ability to adjust strategies and resource allocation on the basis of information gathered from the environment. Team orientation means that the team’s success takes precedence over individual desires and performance. None of the team members view themselves as isolated individuals, she said. And, “part of everyone’s job is to ensure that everyone on the team gets their work done in a quality manner. It’s a whole different way of thinking.”
To achieve teamwork, training is important, Kalisch said. However, the best team training will not yield the desired outcomes alone unless the organization is aligned to support teamwork. Training accounts for 20 percent of the team’s performance variance and the other 80 percent depends on other organizational systems. The learning alone is not sufficient, she said. The bulk of training expenditures don’t transfer to the job.
Some organizations’ culture fosters collaboration and some “stop it dead in its tracks,” Kalisch said. Some people think you need only purchase software but it fails because people don’t know how to collaborate effectively. Meanwhile, a positive transfer of training can be a challenge. There need to be things in place on the job that reinforce training, she said, because studies estimate that only 10 percent of training expenditures are actually transferred to the job. “It’s very expensive to train people. It’s scary to think that only 10 percent is transferred but people think training in and of itself is the answer,” she said. The biggest problem with change is maintaining it. She suggested providing opportunities to perform and realizing that the leader role is the largest contributor to successful transfer so he or she should set goals before starting so it’s clear why the staff is going through training.
Team size is a big issue. Kalisch said. The ideal size is five to nine people. The negative consequences of a large team include decreased motivation, poorer decision making, poorer coordination, higher levels of conformity and social loafing.
Team stability depends on such factors as a shared history and the length of time the team has worked together. Teamwork has been shown to result in lower turnover, less intent to leave the job and less absenteeism.
Teamwork is “worth it but we have to figure out how to make it happen,” Kalisch said. EHRs have the potential to enhance teamwork tremendously. “We need common ground where everybody on the team can see the plan of care and add to it for an interdisciplinary care plan. It’s very hard to make it happen.”
Kalisch cited a litany of studies and reviews that show the profound effect teamwork has on healthcare, including the association between high teamwork and a culture of safety, decreased errors, increased patient satisfaction, patient perceived quality of care and provider-reported quality of care, decreased readmissions to the ICU and shorter length of stay.
A review of medical malpractice claims in the emergency department found that appropriate teamwork might have averted more than 60 percent of deaths and a lack of performance monitoring was a major cause of errors in 35 percent of cases.
Kalisch referred to Salas et al’s “big five” theory of teamwork in which the concept is comprised of five core elements: team leadership, backup behavior, mutual performance monitoring, adaptability and team orientation.
Team leadership refers to the structure, direction and support provided by both the formal leader and each member, who each take turns being in charge. Backup behavior requires a willingness to provide and seek assistance, Kalisch said, as well as a willingness to jump in and help and accept help without fear of being perceived as weak. It also refers to helping one another with tasks and responsibilities including feedback. “Giving feedback is the most undeveloped skill anywhere,” she said, because most people don’t know how to give feedback without offending.
Mutual performance monitoring refers to keeping track of fellow team members’ work while completing their own. Could be interpreted in negative terms but is accepted and maximizes the team’s overall performance.
Adaptability refers to the ability to adjust strategies and resource allocation on the basis of information gathered from the environment. Team orientation means that the team’s success takes precedence over individual desires and performance. None of the team members view themselves as isolated individuals, she said. And, “part of everyone’s job is to ensure that everyone on the team gets their work done in a quality manner. It’s a whole different way of thinking.”
To achieve teamwork, training is important, Kalisch said. However, the best team training will not yield the desired outcomes alone unless the organization is aligned to support teamwork. Training accounts for 20 percent of the team’s performance variance and the other 80 percent depends on other organizational systems. The learning alone is not sufficient, she said. The bulk of training expenditures don’t transfer to the job.
Some organizations’ culture fosters collaboration and some “stop it dead in its tracks,” Kalisch said. Some people think you need only purchase software but it fails because people don’t know how to collaborate effectively. Meanwhile, a positive transfer of training can be a challenge. There need to be things in place on the job that reinforce training, she said, because studies estimate that only 10 percent of training expenditures are actually transferred to the job. “It’s very expensive to train people. It’s scary to think that only 10 percent is transferred but people think training in and of itself is the answer,” she said. The biggest problem with change is maintaining it. She suggested providing opportunities to perform and realizing that the leader role is the largest contributor to successful transfer so he or she should set goals before starting so it’s clear why the staff is going through training.
Team size is a big issue. Kalisch said. The ideal size is five to nine people. The negative consequences of a large team include decreased motivation, poorer decision making, poorer coordination, higher levels of conformity and social loafing.
Team stability depends on such factors as a shared history and the length of time the team has worked together. Teamwork has been shown to result in lower turnover, less intent to leave the job and less absenteeism.
Teamwork is “worth it but we have to figure out how to make it happen,” Kalisch said. EHRs have the potential to enhance teamwork tremendously. “We need common ground where everybody on the team can see the plan of care and add to it for an interdisciplinary care plan. It’s very hard to make it happen.”
Beth Walsh,
Editor
Editor Beth earned a bachelor’s degree in journalism and master’s in health communication. She has worked in hospital, academic and publishing settings over the past 20 years. Beth joined TriMed in 2005, as editor of CMIO and Clinical Innovation + Technology. When not covering all things related to health IT, she spends time with her husband and three children.