You’ll find the term “patient-centered care” floating around in the mission statements of many a hospital and clinic. The patient-centered care model focuses on the patient’s health and experience during every interaction with healthcare professionals. In this model of care, the patient is considered an integral part of their own treatment team. Therefore, treatment addresses the patient’s needs, “not only from a clinical perspective, but also from an emotional, mental, spiritual, social and financial perspective.” 1
The patient-centered care model requires multi-disciplinary “provider teams” who must successfully work together to meet the needs of the patient. These teams often include doctors, nurses, therapists, pharmacists, and even non-medical care providers such as billing professionals and receptionists – anyone who interacts with the patient and helps deliver on the patient’s needs and objectives.
“It has become necessary to develop medicine as a cooperative science; the clinician, the specialist, and the laboratory workers uniting for the good of the patient, each assisting in elucidation of the problem at hand, and each dependent upon the other for support.”
--William J. Mayo in his 1910 commencement address to Rush Medical College
The benefits of patient-centered care are many, including improved health outcomes for the patient, an enhanced reputation of providers, and even reduced hospital expenses. To achieve these benefits though, provider teams must demonstrate high quality communication in every interaction. In fact, the quality of communication within these teams directly impacts patient outcomes, either positively or negatively.
The Impact of Provider Team Communication on Patient Outcomes
In a study published in The Joint Commission Journal on Quality and Patient Safety, researchers observed surgical teams in the operating room and evaluated their success at communicating. as well as the results of communication failures. They found a 30% communication failure rate. Moreover, 36% of those communication failures had negative impacts, including procedural error, wasted resources, inefficiency, and increased tension.
An article in BMJ Quality & Safety reported that other “studies in surgery have shown increased odds of complications and death…when surgical teams exhibit less frequent teamwork behaviors (eg. less information sharing during intraoperative and handoff phases, and less briefing).”
Why do these communication breakdowns occur? It might be the result of teams consisting of people who have not worked together being expected to function as a team under stressful circumstances.
“As opposed to intact teams who have a history and future working together, some types of healthcare teams, particularly in acute care settings, may not have ever worked together before, form under stressful conditions (e.g., a code), and may not have great likelihood of working together closely in the future.”2
The Importance of Team Training in Healthcare
In 2013, researchers identified team training as a top patient safety strategy to be adopted in acute care settings. However, interpersonal communication and the ability to work in a team environment are two skills often overlooked in healthcare training programs.
“Despite the importance of teamwork for quality and safety of care, few health care professions’ curricula include teamwork training…”3
Providing teams with proper training improves both clinical processes and patient outcomes. In an evaluation of the VA MTT program, facilities that implemented team training demonstrated significantly greater reductions in both mortality and morbidity. Other benefits included:
- Decreased preoperative delays, from 16% to 7% of cases
- Increased antibiotic prophylaxis compliance, from 85% to 97%
- Decreased equipment issues and case delays, from 24% to 7% of cases
- Decreased handoff issues, from 5.4% to 0.3% of cases
In a recent study, researchers compared the patient outcomes after providing team training to three groups: a control group who received no training, a group that received only didactic training in the form of lectures, and a third group that participated in an in-situ simulation program. They found that the in-situ group experienced a 37% reduction in patient harm after participating in the training, while the didactic group posted only a 1% reduction. For the record, the control group showed a 43% increase in harm!
In short, patients are safer and receive higher quality care when providers work as a highly effective team. But teamwork doesn’t just happen. And all team training is not created equal.
What Does Team Training Look Like?
What should team training consist of, specifically in healthcare settings? First and foremost, a needs assessment must be conducted to customize training for each environment and audience. Without a needs assessment, companies run the risk of addressing the symptoms and not the cause of any areas of weakness.
Common team training competencies include leadership, communication, cultural competency & diversity, situational awareness, and role clarity. As stated in the BMJ Quality and Safety journal, in healthcare, team training should be a “systematic methodology for optimizing the communication, coordination and collaboration of healthcare teams that combines specific content with opportunities for practice, formative feedback and tools to support transfer of training to the daily care environment.”
According to these researchers, hospitals generally rely on the following types of training:
- Information-based methods (e.g., lecture)
- Demonstration-based methods (e.g., videos, behavioral modeling)
- Practice-based methods (e.g., simulation, role-playing)
On their own, each of these methods has strengths and weaknesses. Using just one is less effective than using a combination of varied training delivery types. “Current evidence supports the notion that the most effective team-training programs leverage a bundled intervention design that pairs learning activities and practice, with tools designed to support effective teamwork during daily clinical care (e.g., checklists, reminders, peer coaches).” 4
This “bundled intervention design” is otherwise known as a blended learning approach. Using different delivery styles activates different areas of the brain and allows the learner to make connections between conceptual content and practical skills.
The Joint Commission Journal outlined several critical factors for developing successful team training. In brief, they are:
- Align team training objectives and safety aims with organizational goals.
- Provide organizational support for the team training initiative.
- Get frontline care leaders on board.
- Prepare the environment and trainees for team training.
- Determine required resources and time commitment and ensure their availability.
- Facilitate application of trained teamwork skills on the job.
- Measure the effectiveness of the team training program.
A blended learning approach addresses each of these factors. Delivery methods in blended learning programs include video, which can be a tool used by executives to convey management support. eLearning reduces classroom time, which is beneficial in the dynamic and rapid-paced healthcare environments, and brings employees to a common baseline of understanding. Instructor-led training is an opportunity for practice and individual coaching. And performance support, such as the above-mentioned checklists, provides work instructions in the time of need.
In summary, effective teamwork is critical to successful patient care and safety. By assessing a healthcare organization’s needs to define training topics, applying a blended learning approach of conceptual training along with practical skills application, and ensuring the factors for success are in place, provider teams will be more successful. More importantly, patients will receive the proper care they need, actively partnering in attaining the best health possible.
Dashe & Thomson provides custom training and communication services for organizations who are serious about improving workplace performance. Services include Instructional Design & Curriculum Development, Video, eLearning & Blended Learning, Instructor-Led Learning, Learning Portals, Training Delivery, Change Management & Communication, and Documentation.
Clients include premier healthcare providers across the United States.
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Shekelle PG, Pronovost PJ, Wachter RM, McDonald KM, Schoelles K, Dy SM, et al. The Top Patient Safety Strategies That Can Be Encouraged for Adoption Now. Ann Intern Med. 2013; 158:365–368.
Salas E, Almeida SA, Salisbury M, King H, Lazzara EH, Lyons R, Wilson KA, Almeida PA, McQuillan R. What Are the Critical Success Factors for Team Training in Health Care? The Joint Commission Journal on Quality and Patient Safety. 2009; 35(8), 398-404.
Weaver SJ, Dy SM, Rosen MA. Team-training in healthcare: a narrative synthesis of the literature. BMJ Qual Saf 2014; 23: 359-372
What Is Patient-Centered Care? (2017, January 1). Retrieved from https://catalyst.nejm.org/what-is-patient-centered-care.