Effective Collaboration to Meet the Patient ‘s Needs 7/7

Effective Collaboration to Meet the Patient ‘s Needs 7/7


>>Welcome to segment seven, Effective
Collaboration to Meet the Patient’s Needs. In the last segment, we had an opportunity
to listen in on the Ace team rounds and hear from the team about some of the
challenges they face in working together. In this segment,
we’re going to focus on the principles for effective team-based care and spend some
time speaking to the team members of the ACE Unit at San Francisco General
Hospital to illustrate these principles. There’s been a fair amount of
research on what makes for effective team-based healthcare. The Institute of Medicine convened
an expert panel that reviewed the body of evidence in an attempt to really
identify some of the core principles for effective teamwork. We’re going to discuss each
of these in more detail. They are shared goals, mutual trust,
clear roles amongst team members, and effective communication structure,
and measurable processes and outcomes. Teams have shared goals and the team must
work with the patient, family members, and caregivers to ensure that these
goals reflect their priorities. The goals have to be clearly articulated,
understood, and supported by all the members of the team
in order to meet the patient’s needs. Let’s hear from doctor Edgar Pierlouisi,
the medical director of the ace unit. How the ace team works with patients and
their families to establish shared goals.>>We do that by talking with patients and
families about what their aims are for the hospitalization and
what they hope to see happen afterwards. We try to achieve that again by
maintaining function as best we can. As many patients want to go back home and
have things be as they were before. And many times that’s possible,
and some times it isn’t. In both cases we work with the patients
and families to create a care plan that’s acceptable to them and
tries to achieve those aims.>>Clear expectations need to be set for each team members functions,
responsibilities and accountabilities. These have to take into account
the discipline specific expertise that each member has, what their skills are,
and their interests. Clear roles are critical in order to
optimize the team’s efficiency, and to enable them to divide tasks and accomplish more as a team than
they would as individual members. And while clear roles and
responsibilities are important, team members also have to be flexible and
adapting when the need arises. Such as if a team member is absent or
the team membership changes. Let’s hear from several members
on the ACE team about their role.>>I am a geriatric social worker for,
here at San Francisco General Hospital. And my role is to help with discharge
planning from the moment that the patient is admitted into the hospital,
onto our floor, till they go home. And so I have to work with a team and
figure out what they were doing before they came into the hospital,
what’s going on with them now, and what their needs are going to
be when they leave. And everything in-between.>>On the ACE team, I act as
the rehabilitation department liaison. And so I represent physical,
speech, and occupational therapy. And help assist in the nurses
determining what the precautions. Maybe that they are finding clavicle
fractures, sternal precautions, hip precautions those kinds of things and
helping explain those to the nurses. And then I also represent what
the therapist that are working with the Ace patients are finding
are finding and back to the team.>>My name is Nam,
I’m the pharmacist on the geriatric team, and my role is basically to make sure that
the meds don’t interact with each other. In the geriatric population I definitely
make sure that they’re geriatric friendly. So, safe to use in geriatric patients. The dosing in geriatric patients
are a little bit different, so I make sure that happens. And I pretty much bring up issues, for instance certain meds
should not be crushed. So I let the nurse know,
since she’s right there doing the rounds. So those are some of the things that I do.>>A core function of a high-performing
team is to insure that consistent, clear, professional communication
happens amongst team members. Effective communication includes
the capacity to listen actively and to be attentive and observant. The ability to understand both
the situation and the message. The confidence to be sure of your message,
and to be convincing in relaying
your message to others. And finally, the ability to ask or tell someone to do something without
evoking negative emotions on either side. We’re going to talk more about
communication strategies and tools in the upcoming module. We saw the San Francisco
General Hospital ACE team on their rounds during the last segment. Let’s hear more from the team about
their communication strategies and how they work together.>>We have a very collaborative
model that we use, so everyone, assesses the patient according to their
own background expertise and then we, come together as a team for Ace Rounds,
and we, give our recommendations based on our assessment, and And
what we talk to the nurse about. And they present during rounds.>>I think we do a really
good job of working together. We stay in communication. We round on the patients in the morning. We each take a our turn. We have our our time limit rounds,
which I guess you’ll see. But we each have our part and
we contribute and then we work together and
check in with each other and we try to communicate with the team and
it’s, it’s all about communication, really, and staying in
communication throughout the day.>>Team members must earn each others
trust in order to allow them to rely on each other both personally and
professionally. A critical element of trust is
being able to understand and respect the rules and culture of the team. One key factor in establishing trust
is insuring that all voices on the team are heard equally without
regard to position or seniority. So that any member feels safe
voicing concerns or ideas. In addition, there must be a process or mechanism in the team to address
breaches in trust when they do occur. Finally, teams must have
measurable processes and outcomes. The team should agree on a mechanism for
reliable and timely feedback, on both the successes and
the failures of the team. This should include examining both the
functioning or process of the team, and also the outcomes of the team, and
whether they’re achieving their goals. Feedback should be used
both immediately and in the long term,
to improve team performance. Let’s hear from one of the ACE team
members on the processes they have in place to review the outcomes of their
program and respond to feedback.>>And the steering committee
meeting we have once a month. And then we talk about,
how the program is going and if we have any ideas for, new, development,
program development for example. And re-evaluating how effective the team
is and how the program itself is working. And we have other specialties there that
are not always at the at the Ace Reynolds.>>In summary there are five key
principles to effective team based care. Shared goals. Mutual trust. Clear roles. Effective communication strategies. And Measurable processes and outcomes. We’ve talked a lot about the benefits of
team care for patients in early segments. Let’s hear from ACE team members
about how their team approach to care benefits benefits
the patients they care for.>>I think it’s really great because
we take into account all the aspects of the patients health. The physical, and mental,
emotional, spiritual, and everyone has you know
their area of expertise. So it becomes like a very well rounded,
sort of view of the patient, that incorporates all the different
aspects of their health status. And I think that is really
benefits the patient in the end. And also, I think for the bedside nurse,
I think she really gets a good view of what’s going on with the patient and
I think, in that way she actually can give much better care, and
it empowers the nurse with knowledge, and feels that she’s a part of the decision
making process a little bit more, I think. And the care, and
also the patient too of course. We do spend a lot of time talking
to the patient, which I think, when the teams round is very little
time to actually talk to the patient. But we have the extra time
to spend with a patient and get their opinion of what’s going on and
even telling them sometimes about the plan of care, cause sometimes they get
left outta the loop a little bit so, and they feel like they’re being heard cause
we’re actually sitting down and talking to them a little more, so that really,
I think it’s great for the patient.>>I think it’s the only way that
the patient gets the care they deserve I, I, I hope that one day that,
that communication is there and that the national patient safety goal
no longer needs to be one because it just happens of increasing
communication amongst caregivers. I feel like in every hospital and
with almost every patient, the person that finds out, sometimes the last about what’s
happening is the patient in the bed. And I feel like if we all work together,
we can provide one line of, of maybe a direction into how to get
from the hospital back to their home and back to the safest discharge plan
by all being on the same page, and working together for that common goal.>>What about the benefits of
working on a team for team members? Let’s hear from some of the ACE team
members about the benefits they perceive from working in a team.>>Well it’s extremely gratifying to me,
personally, to be a part of a team that creates
a well crafted care plan for patients. Again, providing the best care
is what we aim to do every day. And I think this team helps,
helps to do that. I think second the team
is a learning team, so I love learning together with our team. We have lots of questions that
come up during rounds and together we helped we, we learn. And the last thing is I think in
the moment having that team structure, I feel smarter. I feel like, frequently,
somebody will say something, and I’ll think of something that I wouldn’t have
thought of otherwise that is important and that helps to, helps to, help,
help that patient recover.>>I gain a lot of knowledge that I
wouldn’t normally have access to. I’ve learned a lot about
medications that I can question, with some degree, with the teams
that aren’t maybe on the ACE unit. Or, maybe not even in this hospital. But, it increases my own knowledge base.>>You know, from working on
the interprofessional team, I feel,
I learn a lot from the other professions. For instance. From the occupational therapist. I learned that for
certain hip fractures you can’t sit up at 90 degrees after the operation room. And so some of my medications,
after you swallow the medication, you need to be sitting upright for
30 minutes. And so I learned that.>>In this segment we learned
about the five core principles for effective team care,
shared goals, mutual trust, clear roles, effective communication,
and measurable processes and outcomes. We also had the opportunity to
hear from members of the Ace unit about the benefits of team care,
for both patients and providers. Now let’s check your understanding. Which of the following elements is not
key for effective team-based care? Shared goals. Clear roles. Mutual trust. Hierarchical structure. That’s right, D is the correct answer. A hierarchical structure is not
a key element of team-based care. Thanks for joining us for Module one. We hope that you’ve had an opportunity
to have an introduction to what interprofessional
collaboration means and the different forms that inner
professional collaboration can take. As well as some of the benefits of
inner professional collaboration for patients, families and
for the healthcare system. I want to acknowledge the contributors
to module one, seen in this slide. We had students, faculty, and healthcare professionals from UCSF,
who all contributed to this module. In the upcoming module, you’ll hear
about the roles, responsibilities, and abilities of different
healthcare professionals. From Doctor Susan Hide.

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