Every week, a lot of allied health professionals find themselves in meetings with their colleagues, possibly under the banner of a ‘Multidisciplinary team meeting’. The purpose of these meetings is to better coordinate patient care, and give each professional better input into care in a holistic manner.
As I sat through a few during my hospital placement, I wondered first what the cost of these meetings was. In my head I thought: ten people making (say) $40/hr on average will cost the hospital $200 for a half-hour meeting in wages alone. In other words, teamwork comes with a price-tag – time in meetings is time away from other duties. However, you would assume teamwork to increase productivity by making care more efficient and effective. Also, most would say that teamwork is not an optional-extra that is present ‘in addition’ to ‘normal duties’, but instead is a fundamental part of the role.
Unfortunately, teamwork is not something that people can be forced to do through policy or procedure. People need to ‘opt-in’ to teamwork. Over the past week I’ve been reading “Interprofessional Teamwork for Health and Social Care” (1- whose authors I’ll abbreviate to RLEZ), which has clearly broken down the elements of teamwork, its impact on practice, and the barriers to its implementation.
What is teamwork?
Teamwork is simply not working together. Just because the physio and the speech pathologist might work with one patient, and have similar goals regarding (say) rehab planning doesn’t mean they are part of a team. RLEZ note an early definition of teamwork:
Teams are co-operative groups in that they are called into being to perform a task, a task that cannot be performed by an individual.
This definition would now be viewed as simplistic. The goal of a team is not necessarily to perform a task or tasks: for example, in the emergency department it may be unclear what the tasks are. Also, the definition lacks some key characteristics that RLEZ consider to be essential for teams (p.10):
- Clear team goals [note the difference between goals, which can be broad, and tasks, which are specific]
- Shared team identity
- Shared team commitment
- Role clarity
- Integration between team members
In my thinking, the most important characteristics are interdependence and shared team commitment. The team must want to and need to work together in order to truly be a team.
Teamwork and Practice
RLEZ offer a ‘contingency model’ of teamwork (p.43), where they create a nestled hierarchy of forms of interprofessional practice.
- Teamwork – E.g. intensive care teams, emergency departments – where the goals are clear but the tasks are shared, “unpredictable, urgent and complex”.
- Collaboration – E.g. a general medical ward – where accountability is shared, but the team identity is less strong.
- Coordination – E.g. tasks are coordinated, but not necessarily shared; and team members only communicate to share facts rather than to make decisions
- Networking – E.g. Professional groups, journal clubs, etc.
In my mind, the MDTs that I have witnessed have mainly been ‘Collaboration’. There is little shared responsibility, as decisions are made outside the group, and the group discussions are primarily to action referrals or inform people about patients’ progress in various disciplines.
Unsurprisingly, the most obvious barrier that came from reading the book is what I would characterise as institutional or historical. Most healthcare practice is informed more by past practice than by best practice. It is noted for instance, that doctors enjoy a great deal of power in ‘teams’ as they were the first healthcare profession to institutionalise, and seize the important powers of diagnosis and prescription; which in turn led to higher salaries and respect.
In addition, professions tend to reflect their institutional histories. Speech pathologists may make decisions or act in a certain way, because that’s how they feel speech pathologists should act; rather than having a logical reason for the action. Professions also develop bias against other professions, and fight for ‘space’ in the delivery of patient care. Examples that come to mind are the difficulties SPs had in delivering FEES without the oversight of an ENT; and the fact that only ENT’s can bill Medicare for that procedure.
I’m excited by the new developments in teamwork research, because I believe there is a lot of scope for improving such practices across healthcare, at least in the settings I’ve seen. I also think being made aware of biases and barriers in our own profession can go some way to removing them.
1. Reeves, S., Lewin, S., Epsin, S., Zwarenstein, M. (2010). Interprofessional teamwork for Health and Social Care. Chichester: Wiley-Blackwell.