For the past several years, Claire Peace, MD, an ophthalmologist, has performed eye surgery at 2 different hospitals in the Washington, DC, area—one in Washington (Capitol Eye Hospital) and one in Arlington, VA (Baroness Eye Center). In addition to the difference in physical facilities, Dr. Peace has noticed clear differences in the way that the operating room teams function at the 2 hospitals, both daily and over the years that she has worked at both hospitals. At the Capitol Eye Hospital, operating room staff turnover is high, and team members frequently need time to learn each other's roles and styles. Nurses rarely speak to Dr. Peace, interacting primarily with the other nurses. The anesthesiologist at Capitol Eye, Dr. Curmodian, sometimes seems distant and preoccupied.
In contrast, the Baroness Eye Center operating room staff seems fully invested in the surgical process, bantering with each other but focused on the patient. Very few of the staff members leave for better jobs. Dr. Peace also has heard other surgeons at Baroness speak enthusiastically about their own operating room experiences. On her drive from her office to the Baroness Eye Center, Dr. Peace was feeling upbeat. She wondered to herself if Baroness was just luckier to recruit the staff members they have, or if maybe hospital administration had something to do with how the teams functioned at Baroness.
Experienced clinicians like Dr. Peace learn through experience that some healthcare teams function better than others, and indeed, studies show wide variation in teamwork among different healthcare organizations (Schwendimann et al, 2012; Sexton et al, 2006). In the vignette, Dr. Peace wonders if administrators, while not present in her operating room during surgery, may be a "root cause" of such differences. The answer, of course, is "yes." Administrators play a critical role in team-based care delivery. Administrators bring knowledge and skills in leading and working in teams, managing people, project management, workflow design, and a host of other areas relevant to the work of clinical and management teams. In the vignette, the operating room teams at the Arlington Baroness Eye Center appeared to benefit from strong organization-wide promotion of teamwork resources and competencies by hospital administration.
In this chapter, we argue that administrators should play a more prominent role in clinical healthcare delivery teams. By the same token, however, clinicians should play a more prominent role in many healthcare administration teams. Such developments will help surmount a historical barrier between the administrative and clinical functions of healthcare delivery organizations, for the benefit of patients.
Virtually all team-based health care is conducted by teams that operate within a larger organization. Often, those organizations are hospitals, outpatient clinics, or physicians' offices. Those settings can range in scale from a single-clinician practice to a 1000-bed hospital or a much larger system of multiple hospitals and clinics. The management and leadership of those organizations require strategic ...