Multidisciplinary care refers to the active collaboration between various members in the health care system to deliver optimal care for every hospitalized patient. Successful teamwork is a core competency that can be taught and incorporated into patient care processes. The Association of American Medical Colleges (AAMC), the Accreditation Council for Graduate Medical Education (ACGME), and the Society of Hospital Medicine (SHM) require specific teamwork-related competencies for medical students, residents, and hospitalists. Hospitalists can improve multidisciplinary care of hospitalized patients by demonstrating group dynamic skills, conducting effective multidisciplinary team rounds, evaluating performance, providing feedback, teaching about error and how teamwork and communication can reduce error, and by leading quality improvement initiatives.
The US health care system is a highly organized and complex system. Over the last three decades of the public safety movement there have been landmark studies and published reports about individual and systemic failures that have not only cost lives but wasted billions of US dollars while delivering unsafe care. Although different solutions may be debated, it is clear that the US health care system will need to be redesigned to deliver the highest quality of care possible while being ever mindful of ways to improve efficiencies and reducing the cost of care delivery. Sweeping change requires effective teamwork on every level: hospital networks, hospital, hospitalist service, skilled nursing, and home care—a more comprehensive approach to multidisciplinary patient care.
In general, most physicians have little formal training relating to complex hospital systems or human error and lack insight into their own limitations during conditions of stress, lack of sleep, or conflicting demands. Strong hierarchy, power differentials, lack of clarity requiring specific tasks and roles, and lack of coordination are common teamwork and communication failures in health care. Lessons learned from the aviation industry can be applied to the delivery of hospital care, and hospitalists can take steps to reduce the likelihood of (1) individual error resulting from physiological and psychological limitations of human beings and (2) team errors resulting from failure to act or deviation from established standards. Although it is not possible to eliminate individual error, systems can be designed that reduce the likelihood of error and make hospitals a safer environment for patients. Working in teams and serving as the hub of communication network in the hospital, hospitalists are ideally poised to change the culture of “how we do things around here” by serving as clinical role models and as leaders of patient safety on the multidisciplinary care team and truly coordinating care throughout the acute episode of care. Without effective teamwork and medical leadership, however, these complex systems have been shown to be less effective in producing quality outcomes.
THE MULTIDISCIPLINARY HEALTH CARE TEAM
The hospitalist team is a unit of professionals that directly provides care and so most directly impacts the patient experience and the quality of care. Composition of the team varies, but ...