Chapter 18 describes actions that senior leaders of organizations can take to invigorate teamwork in their organizations, focusing on the culture of healthcare delivery organizations. In terms of promoting teamwork in health care, direct delivery organizations are only one piece of a larger puzzle. The conviction that better teamwork can improve health care also needs to be embedded in the context that supports and surrounds healthcare delivery organizations in the United States and globally. Health insurance companies, professional associations, educators, researchers, government, the public, and media all can play important parts in accelerating the improvement of healthcare delivery through enhanced teamwork. In this chapter, we review ways that those constituencies can encourage teamwork more proactively.
As stated in Chapter 1, most patients today receive their health care from several individuals practicing different professions. This is particularly true for the growing chronic care component of healthcare delivery. These clinical professionals are supported by an array of other specialists who provide administrative or logistical support or consultation, often regularly and frequently. At the center of the clinical activity is the patient and the patient's family. It is unlikely that any one professional, without support, can provide quality healthcare services except for the simplest and most routine items of clinical care. Even those professionals who provide primary services in nursing, medicine, social work, and pharmacy rely on teams that include support workers from their own profession or other occupations and professions. As knowledge and specialization continue to increase, the pressures for team-based care only will expand. Clinical healthcare delivery is and will continue to be a team activity.
Management work in healthcare delivery, too, is increasingly team-based. Most management decisions impact clinical care delivery, from the choice of strategic plans for organizations to the redesign of organizational processes, for example, the processes that determine patient flow through the organization. Consensus management decision making requires representation from patients and from multiple clinical professions, because management work cannot be separated from clinical care. Managers need to collaborate with clinical professionals and patients to produce safe, effective, patient-centered, efficient, timely, and equitable care—the 6 quality aims of the Institute of Medicine (IOM), discussed in Chapter 6. For managers to make decisions independently of their clinical professionals and patients invites alienation of their core workers—clinical professionals—and their customers—patients—as well as poor quality and poor cost outcomes for the organization. Management of healthcare delivery is and will continue to be a team activity.
The growth of team-based care and the desire for more of it are evident in recent healthcare reform efforts in the United States. Examples include federal support for patient-centered medical homes, accountable care organizations (ACOs), and healthcare information technology development. The Patient Protection and Affordable Care Act (PPACA) of 2010 encourages development and testing of patient-centered medical homes and interprofessional community health teams to support them. As discussed in Chapter 4, medical homes (or health homes) provide patients with a ...