Academic journal article Generations

Effective Interdisciplinary Teams: Do We Really Know How to Build Them?

Academic journal article Generations

Effective Interdisciplinary Teams: Do We Really Know How to Build Them?

Article excerpt

Substantial progress has been made in geriatric interdisciplinary team training, but we need more data on these teams' impacts on patient outcomes.

There have been more than four decades of published work related to the importance of interdisciplinary clinical care teams, the mandate for such teams, literature describing interdisciplinary teams, and the suggestion that team care improves the quality of care for older adults. Yet despite all that has been done to advance our understanding of interdisciplinary team training and team care, we have little evidence to quantify and demonstrate effective teamwork.

In the 1970s, the Department of Veterans Affairs did much to advance our understanding of teams with their program called "Interdisciplinary Team Training Program (ITTP)" (Heinemann, 2002; Heinemann et al., 1999; Stahelski and Tsukuda, 1990; Tsukuda, 1990; Heinemann and Zeiss, 2002). Their commitment to a team approach was impressive, and the emphasis of this work was on training individuals to work in teams. Veterans Administration hospitals were early pioneers in developing these programs and, subsequently, many other organizations have worked to advance our knowledge of teams, appropriate team members, and the "dose" of teams required for any given geriatric syndrome or disorder (Famadas et al., 2008).

Many have documented the need for team care (Clark, Leinhaas, and Filinson, 2002; Fulmer, Flaherty, and Hyer, 2003; Heinemann, 2002; Siegler, 1998). The Centers for Medicare & Medicaid Services has called for interdisciplinary care planning as a priority, in particular for those who are dually eligible for Medicare and Medicaid. The American Geriatrics Society put forth a strong position statement, clearly laying out the mandate for interdisciplinary teams for quality care of older adults (Montagnini et al., 2014).

But how do we encourage interdisciplinary team practice for those who have, until now, practiced independently? Solid evidence is potent stimulus for changing practice, however, there still are those who provide care as solo practitioners and those who resist the additional perceived burden of real teaming, which requires extra communication and time.

Over time, we have been able to describe and quantify advances in team training and team care in select settings such as intensive care units (Baggs and Schmitt, 1988, 1997, 2000; Schmitt et al., 2013). The capacity to measure activity and demonstrate patient care outcomes has been more successful in critical care than in other settings. This setting seems more conducive to measurement than general medical units or communitybased organizational teamwork. One early study examined collaboration and satisfaction with team care in a critical care setting using a longitudinal, descriptive correlational approach. Collaboration was found to be very important for nurse satisfaction and retention, and somewhat less so for physicians (Baggs et al., 1999).

This is not surprising considering physicians traditionally have been educated to believe that they are "captain of the ship"-ultimately responsible for all patient care outcomes. What is surprising is how long it has taken to adapt to this belief system and engender team approaches, not only with other healthcare professionals, but also with paraprofessionals, family members, and, of course, the care recipient (Goren and Ottaway, 1985).

Need for High-Functioning Interdisciplinary Geriatric Care Teams

Teaming can be hard. Organizational behavior literature has for decades documented the challenges and described contemporary issues related to power, geographically dispersed teams, limitations of virtual teams, and the overall inertia that exists in some settings (Cummings and Haas, 2012; Robey, Khoo, and Powers, 2000). As we consider the state of team analytics in evidence today, still we are asking about which healthcare team members are required for which geriatric syndromes. …

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