In Chapters 8, 9, 10, and 11, we explain the leadership of teams. Chapter 8 describes the choice, role, and competencies of team leaders. Chapters 9, 10, and 11 deal more fully with topics that have special importance for team leaders although they are also important for other team members. This chapter examines decision making in teams. Chapter 10 deals with fostering creativity. And Chapter 11 covers managing conflict.
The next 3 vignettes illustrate various decisions that are made within healthcare teams.
Robert Jarna, MD, was an internist in a suburban practice of 8 physicians and 3 nurse practitioners (NPs). He had seen Michael Penine for general medical care for 11 years. Over the past 18 months, Mr. Penine's blood pressure had become consistently elevated, with 3 high readings in the past 4 months. Prior to starting treatment, Dr. Jarna took a history and carried out a physical examination. Mr. Penine reported that he occasionally had episodes of rapid heart beating without any apparent cause. There were no other symptoms accompanying the rapid heart beating. Dr. Jarna ordered various tests to detect kidney dysfunction and other possible underlying causes of high blood pressure (hypertension). Because of the episodes of rapid heart beating, he decided to include a 24-hour urine collection to check for the presence of a pheochromocytoma, a rare hormone-secreting tumor that causes high blood pressure in 0.1% of people with high blood pressure.
Mary Thiessen, age 74, was a patient in the transitional care unit of a healthcare center that provided a wide range of services to elderly people and to some younger, disabled people. The services included long-term residential care, day care, and many others. Mrs. Thiessen had been admitted to the transitional unit after a hospitalization for a stroke. The purpose of her stay in the transitional unit was to determine her needs for nursing and other care for the longer term. The professional staff of the transitional unit consisted of several registered nurses, 2 social workers, 1 clinical pharmacist, and 1 internist-geriatrician. Over the 10 days Mrs. Thiessen was in the unit, her needs were evaluated by a nurse, a social worker, the pharmacist, and the physician. Options for her longer-term care were discussed extensively with Mrs. Thiessen and her family. Her stay culminated in a care conference attended by all of the professionals who had assessed her needs. Mrs. Thiessen was invited to join the discussion but deferred to her daughter. The meeting was chaired by the head nurse of the unit. All of the professionals had input to the discussion as did Mrs. Thiessen's daughter and the physical therapist who was asked to participate in the planning. In the end, the team reached a consensus that Mrs. Thiessen would be served best by moving into her daughter's home, where ...