There are five principles of effective teamwork and collaboration in healthcare:8
- Shared goals
- Clear roles
- Mutual trust
- Effective communication
- Measurable processes and outcomes
These five principles are codependent and support each other; for example, effective communication helps build mutual trust.
A shared purpose is a critical step in working together as an effective team. Members of the team create a common purpose and goal/s that include their collective interests and demonstrate shared ownership. The shared team goals in many teams are not explicit, in particular for affiliated teams and extended teams. The implied goal is usually around the care of a specific patient and often to deliver person-centred care.
Practice tip: In communication with team members, it can be helpful for GPs to clarify the shared goal for the patient (eg use phrases such as ‘Let’s confirm the goals of care for this patient and how we can help to best achieve them’).
Every member of the team brings a unique perspective given their different backgrounds and specific skill sets respective to their disciplines. While there may be some overlaps in roles, for effective and efficient teamwork it is important to have clear expectations of functions and responsibilities. Given the patient and their family are key members of the team, it is important that their roles and responsibilities are also clear.
The role of each member of the multidisciplinary team needs to be outlined and properly communicated to the patient and their family and carers. Good teamwork within the multidisciplinary team also requires resolution of problems that may arise because of factors within the team. Factors may include:
- personality differences
- perceptions of one person’s role in the team being more important than others
- a lack of confidence in expressing one’s views
- ignoring the wishes or concerns of the patients and/or families.
External factors such as scarcity of resources or difficult organisational changes can also have an effect within the team.
Multidisciplinary team leader
The multidisciplinary team leader or coordinator has an important role in any multidisciplinary team care.9
For residents in an RACF, the role of the multidisciplinary team leader is usually carried out by the senior nursing staff; however, social workers or case managers have also taken on this role in the community setting. It is increasingly likely that GPs will be involved in leading aged care teams, as is the case in countries like the Netherlands.10
Whoever takes on the role as the multidisciplinary team leader needs to coach their staff and fellow team members in the principles of teamwork, and inspire them to perform their best in their role. They need to ensure the team is achieving its objectives, and adjudicate between team members when there are problems within the function of the team. At the heart of all this, the patient should be at the forefront of every decision made.
Practice tip: Reinforce the roles and responsibilities by being clear in your documentation who is responsible for action (eg record notes from a case conference or care plan contributions).
Mutual trust is a critical element for effective teamwork. Findings from a review on interprofessional collaborative teams identified that the effectiveness of shared care models was primarily limited as a result of role ambiguity and lack of trust between providers.11 Collaboration is a by-product of trust. Trust needs to be present at both an individual level and also at the organisational level. Trust needs to be established between patients and their care teams, as well as between the members of the care team/s and the organisations in which they work.
A core mechanism to establishing trust among team members is ensuring all voices on the team are heard equally. There are three elements within trust:12
- Relational trust – how one member of a team treats another member.
- Functional trust – trust built through achieving and getting things done together.
- Flow-of-value trust – this is complex, but involves a combination of reciprocity, competition and exploitation.
Practice tip: You can contribute to improving trust in your team by working on how you treat other team members and by ensuring you follow through on areas you have agreed to do (this could be as simple as ensuring you have the prescriptions done if you promised you would send them later).
Communication is a critical component of effective teamwork. Patient safety research demonstrates communication failures between team members contribute to adverse events. In medico-legal claims, communication failures were responsible for about 30% of the claims.13 An effective team prioritises communication, and continuously monitors and works to improve communication. High-quality communication should be a guiding principle for the team’s operation, rather than an attribute of individual team members.
Multidisciplinary team meetings and case conferencing should take place regularly, where a number of cases can be discussed at the same session. These can take place face to face or by teleconference or videoconference. Each member of the multidisciplinary team should have input during the team meetings and use their expertise to advocate for the benefit of their patient.
Each team member should be responsible for providing a snapshot of the patient’s health to the team, which may include:
- medical issues
- activities of daily living functions
- care issues (eg transfers, continence, pain control, wound care)
- speech and communication
- eating and swallowing
- social and family
- behaviour and mood.
The patient’s goals and management plan can then be formulated based on all the issues identified.
Individual case conferences or family meetings are held in a similar manner, where the patient and/or their family members also have a chance to express their views, needs and wishes.
Care records and management plans
All healthcare professionals are required to keep contemperous accurate records(refer to Part B. Medical records at residential aged care facilities); however, those records are often not shared or accessible by different care team members, especially across care boundaries. Documentation of each case discussed should be kept with the patient’s medical records in general practice, the RACF, and with any other agency involved (eg with case managers providing home-based care). Technology can also be a lever; My Health Record can be used to create shared summaries and event records, and remote access can be set up to the practice computer or via a cloud-based clinical system.
Once goals and management plans have been drafted for a patient, it is important to note that these are living documents that can be modified and adjusted after discussion with the rest of the multidisciplinary team (eg individually or in subsequent team meetings).
Management plans should generally cover all the patient’s relevant clinical, social and functional domains. The most relevant information to include in the management plans of older people include:
GPs can be remunerated under the Medicare Benefits Schedule (MBS) for participating in case conferences (refer to Part B. Medicare Benefits Schedule item numbers ); importantly, GPs can contribute detailed information concerning symptoms, medical issues and progression along the illness trajectory. The team’s goals and management plan can inform GP clinical care plans.
The patient and/or their family can be given a summary report of such meetings, especially after those designated as ‘family meetings’. Some organisations and aged care providers will routinely provide patients and/or their families and carers with copies of the team case meeting reports. This is especially important where family members are scattered and cannot always be present at meetings or spend time with senior staff during weekday.
The overarching outcome of this kind of teamwork should focus on ensuring the aged care patient’s needs, goals and wishes are dealt with to the satisfaction of all concerned (ie person-centered care).14
Standardised communication tool
Standardised communication tools can assist in facilitating information exchange in a more structured and systematic way to ensure the necessary information requirements are communicated. Standardised communication tools (eg SBAR; Figure 2) can be used for both verbal and written communication. The SBAR tool requires training to be used and is described with other similar tools in the Australian Commission for Safety and Quality in Health Care’s (ACSQHC’s) OSSIE guide to clinical handover improvement.15
The SBAR tool is a structured communication tool often used to escalate care, but may be used in a range of settings and may be very helpful for conveying information between team members.
Practice tip: Consider using a structured communication tool such as SBAR when you hand over to other members of the team.
Measurable processes and outcomes
Teamwork is a process. When teamwork is impactful and effective, it leads to improved outcomes of care. Measurement of the effectiveness of teamwork therefore requires a measurement of the outcomes of care and the process of teamwork and/or level of team functioning. The measurement of the process of teamwork and functioning is more specific to address the effectiveness of teamwork itself. Measuring processes and outcomes may be challenging and requires everyone to be on board.
Increasingly, patient-reported measures (PRMs), which can include patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs), are being used in healthcare. PRMs can inform teams on how patients experience the care they receive and if that care is having an effect on the outcome as it matters to the patient.
Practice tip: Sometimes focusing on things that have gone well can be supportive and encouraging. For example, if the care of a patient has gone well then acknowledge and thank the members of the team and perhaps ask what we can learn from this to see if we can make it happen more often.