BUILDING A STRONG HEALTH TEAM FOR EFFECTIVE SERVICE DELIVERY BY DAYOM, D. WETKOS (PhD) A KEYNOTE ADDRESS AT THE NATIONAL DELEGATE CONFERENCE OF NIGERIAN UNION OF ALLIED HEALTH PROFESSIONALS (NUAHP) YAMUSA 2019
Hospitals are complex organisations humming with activities of heterogeneous groups of people such as, Pharmacists, doctors, nurses, Laboratory Scientists, radiographers, other paramedicals and administrative staff, all working with a common goal of providing health care to service users.
But all is not well with the public hospitals in particular and the health sector in general in Nigeria. The industry has been entwined in a web of dispute, discord, protests and wrangling and other expressions of disharmony. Further aggravating the cause and consequence of discontent is the fragmented and disproportionate salary structures coined along professional lines. There is poor prioritization of resource distribution in the health sector, poor management of human and material resources. This is largely the problem of leadership and leadership questions in the health sector. This leadership problem along with the increasing challenge of microbial resistance to conventional therapies, emerging new diseases and poor nutritional status of impoverished population has continued to increase the disease burden and sustained the poor health indices in Nigeria.
The consequence is that patients are getting used to seeking their healthcare outside public hospitals in the same way that we got used to making phone calls through private means when NITEL failed and also how we are now used to sending our children to private than public schools. These are clear indices of systems collapse we are living with.
These challenges has increased and expanded the roles of the various health professionals in training and in practice to mitigate these challenges.
The concept of Teamwork
Medicine is a collaborative effort among patients, service providers, care providers and family members but physicians have historically acted as the focal point around which all caregiving institutions focus. This scenario is changing as a limited physician talent pool opens the door for various haelthcare practitioners to fill service delivery gaps. The medical community has come to understand that collaboration is required among these professionals to improve patient outcomes, especially in the contemporary healthcare setting where service demand is on a steep rise.
The importance of effective teams in health care is increasing due to factors such as: (i) he increasing complexity and specialization of care; (ii) increasing co-morbidities; (iii) increasing chronic disease. The evolution in health care and a global demand for quality patient care necessitate a parallel health care professional development with a great focus on patient centred teamwork approach. An effective teamwork is now globally recognized as an essential tool for constructing a more effective and patient-centred health care delivery system.
A team can be defined as a distinguishable set of two or more people or groups who interact dynamically,
interdependently and adaptively towards a common and valued goal/objective/mission, who have been
assigned specific roles or functions to perform. The incorporation of sharing responsibilities with accountability between team members in health care systems offers great benefit.
An effective team is a one where the team members, including the patients, communicate with each other,
as well as merging their observations, expertise and decision-making responsibilities to optimize patients’
care (WHO, 2014)
Patients are undoubtedly interested in their own care and must be part of the communication process
too; their early and throughout involvement has been shown to minimize errors and potential adverse
events (WHO, 2014).
Now, more than ever, there is an obligation to strive for perfection in the science and practice of inter-professional team-based health care. Each clinician relies upon information and action from other team members.
Inter-professional collaboration, the pillar of teamwork is where health care is headed right now. Each of the health professions must shift its focus toward collaboration, partnerships, and sharing, rather than operate in silos. The triple aim of improving patient experience and satisfaction, improving the health of the population, and reducing costs of care is not attainable without IPC. Collaboration in health care can be described as the capability of every health care professional, to effectively embrace complementary roles within a team, work cooperatively, share the responsibilities for problem-solving, and make the decisions needed to formulate and carry out plans for patient care.
Teamwork requires that multiple health workers from different professional backgrounds work together with patients, families, caregivers and communities to deliver the highest quality of patient-centered care.
Patient-centered care which is the paradigm shift in modern healthcare is “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. Patient diagnosis, treatment planning and continuity of care are no longer dominated by clinician focused approaches to service delivery. The paradigm shift requires that all health professionals collaborate in managing a patients’ journey upon admission through interventions, discharge and follow up.
It is reported in recent times that the annual number of deaths from medical errors in the United States may approach 200,000. Many of these errors occur among the most complex and high-risk inpatients. It is noteworthy that a study evaluating the effect of adding a pharmacist during rounds in the intensive care unit demonstrated a two-thirds reduction in the number of potential adverse drug events. This fit was recorded when an estimated 99% of the pharmacists’ suggestions were accepted by the physicians.
In addition, a systematic review of 36 randomized controlled trials involving coordination of care demonstrated that coordination with IPC reduced the risk for hospital readmission by 19%.
In another study, adding psychologists to primary care clinics resulted in improved ratings of mental health symptoms and quality of life among patients.
Effective healthcare teams have been linked to an increase in job satisfaction, more productive staff, fewer clinical errors, greater staff retention, and improved patient care and outcomes. The importance of IPC and teamwork therefore cannot be overemphasized.
Barriers to Inter-professional collaboration
The move to create successful team-based care is not new. But despite growing recognition and acceptance of the importance of building successful teams in recent years, team building initiatives often fail to transit into practice
Several barriers exist to establishing and maintaining effective teamwork in health care: some of these include:
Reimbursement, no reimbursement for value added services
The culture of health care; the traditional culture of healthcare training and practice has been to train and work in silos with little or no exposure to each other’s role and perspective. This fosters miscommunication, mistrust, conflict, and a lack of coordinated care.
What works in one healthcare setting does not necessarily work in another
Resistance to change among healthcare practitioners
Rivalry and conflict of interest: organizational hierarchy, specialization, and multiplicity of skills have created rivalry and power struggle among various groups of health professionals over the control and leadership of the work process. To worsen the situation, different health-professional associations act as interest groups to influence government policy in favor of their members, not minding the implication to other professional groups and the health sector in general.
Several studies have shown that conflict or rivalry in the health sector disrupts intra- and inter-
professional collaboration and in addition, reduces the commitment of workers to the health
service and encourages selfish behaviors.
Individualistic nature of health care: Many health-care professions, such as nursing, dentistry and medicine, are based on the autonomous one-to-one relationship between the health care provider and patient. While this relationship remains a core value, it is challenged by many concepts of teamwork and shared care.
Resolving disagreement and conflict: The ability to resolve conflict or disagreement in the team is crucial to successful teamwork. This can be especially challenging for junior members of the team or in teams that are highly hierarchical in nature.
Building a strong team for effective healthcare
A team is made up of the coach, players and fans. Among the players is the captain. The coach who leads the team must not be a player to lead a successful team.
It becomes retrogressive for the team when captainship is skewed to a particular position on the field (goalkeeper, defender, or striker etc) or coachship must be retire or active player. When this is done, then competency is no longer a requirement. This kills team spirit and results in discontent, disharmony and collapse of the team. This is the problem militating the progress of the health sector in Nigeria.
The health care team is composed of a number of professionals of different backgrounds, education, training, experiences and theoretical viewpoints. They differ not only in the resources they bring to the team, but also in role expectations, status, and the extent of their legal responsibility for the service users.
The healthcare team is made up of the health professionals (players), the leadership (coach) and the patients (fans). All three play complementary roles in healthcare delivery.
Building a strong team for effective healthcare delivery will therefore require that all stakeholders understand and play their roles with utmost integrity in a mutually dependent manner.
The principles that characterize a successful team based health care include:
Shared goals: The team, including the patient and, where appropriate, family members or other support persons, generate a common and clearly defined purpose that includes collective interests and demonstrates shared ownership.
Clear roles: There are clear expectations for each team member’s functions, responsibilities, and accountabilities, which optimize the team’s efficiency and often make it possible for the team
to take advantage of division of labour, thereby accomplishing more than the sum of its parts.
The following are five cardinal approaches to building an effective healthcare team.
1. Value re-orientation: This is required to instill in team members a culture of:–
Honesty: A high value is put on effective communication within the team, including transparency and honesty. These are critical to continuous development and for maintaining the mutual trust required to drive teamwork.
Discipline: Team members carry out their roles and responsibilities with discipline, even when it seems
Creativity: Team members are excited and motivated to tackle emerging problems creatively. They even see errors and some unanticipated bad outcomes as potential opportunities for improvement.
Humility: Team members recognize differences in training. They also recognize that they are human and will make mistakes. Hence, a key value of working in a team is that fellow team members can rely on each other to help recognize and avert failures, regardless of where they are in the hierarchy.
2. Training of healthcare professionals: Team spirit and collaborative –oriented training of health professionals must inform the basis for eventual appreciation of the role of other healthcare professionals in practice. Historically, healthcare professionals were educated in isolation without knowledge of educational requirement and scopes of training and practice of other disciplines. All health professionals should be trained to identify opportunities to build trust and respect for each other. There are always over-lapping interfaces in the training of health professionals, these interfaces should provide opportunities to discuss and understand the scope, expertise, competencies and complementary roles of other disciplines in the healthcare delivery system.
In 2010, the World Health Organization issued a statement of support for interprofessional education—emphasizing that, to strengthen global healthcare, students must learn with, from, and about members of other health professions and proposed that Interprofessional education be included in the curricula for healthcare professionals. Students preparing for each discipline should not be educated in isolation from students of other disciplines, this will expose them to the educational requirements or scopes of practice of other health professions. This will make them more likely to embrace the core values of teamwork and appreciate the complementary roles of other professionals in practice.
3. Professional associations: This is the pillar that should anchor a successful collaborative practice. When each health professional group advocates for collaborative practice, respect and accepts the fact that effective healthcare delivery is a shared responsibility then a strong team will be built. Working together while respecting the expertise of other disciplines is essential. Collaboration requires members to work together with open minds and to value what each member brings to the team.
Intra- and interprofessional advocacy for collaborative practice and team building will engender a peaceful, harmonious and smooth healthcare delivery service.
4. Leadership: Healthcare leadership is the ability to effectively and ethically influence others for the benefit of individual patients and populations. Effective healthcare leaders influence the performance of diverse clinical teams, and also improves provider well-being by promoting workplace engagement and reducing conflict.
An effective healthcare leadership must stem from the core principle of Patient Centeredness and core competencies of Emotional Intelligence, Integrity, Selfless Service, Critical Thinking, and Teamwork.
Overseeing the operations of a hospital involves creating goals, developing plans and monitoring all arrears of the hospital operations. This requires someone with credibility, creativity and motivation to preside over a complex and dynamic healthcare environment. These qualities do not reside only in one professional group.
A change in leadership and leadership style that is open to fair competition should be adopted as part of the 21st century healthcare system reforms and healthcare system strengthening. Healthcare leaders must recognize the complementary roles of all team players and create a level playing field for each profession to bring their competency and expertise to bear on patient care.
5. Barriers to IPC: All habits and practices that constitute the barriers to IPC must be dealt with by the leadership and the service providers. There must be trust, respect and acceptance of every team player by the other.
The ambition to deliver quality patient care is subject to high performance through patient focused teams. We need to close the gap between traditional practices and the new attitudes required from an effective team to achieve such ambition. Health professionals must embrace the values and ethics of inter-professional practice, work together while respecting the expertise of those in other disciplines. When healthcare professionals are aware of the professional roles and responsibilities of each other; communicate effectively with patients, families, and other healthcare professionals; and build relationships to plan, implement, and evaluate safe care, the health industry will move to the next level.